How working together can help overcome the complexity of mental health research

By Professor Hamish McAllister-Williams, Professor of Affective Disorders and lead at the Northern Centre for Mood Disorders (NCMD) which is a collaboration between Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) and Newcastle University.

Mental health is, by its very nature, inherently complex.  This inevitably makes mental health research complicated and diverse – with many mental health researchers being distributed across multiple organisations as well as spread across departments, schools or institutes.  The mental health research landscape is therefore often difficult to navigate.

This is why collaboration is vital to making mental health research effective. We need to coordinate and strengthen the focus on areas where research is having the most impact – which is why working across a partnership like Newcastle Health Innovation Partners is invaluable.  NHIP provides a space to bring some of these researchers together – to provide truly interdisciplinary, person-centred professional support for people.

The diversity of mental health research arises in many ways.  These include:

  • The “issue” under investigation. Often “mental health problems” is used as a way to describe the entire spectrum of conditions under investigation.  However, in reality, this can span from a lack of wellbeing (for example mental distress) through to severe mental illness.
  • Disorders. Many research funding opportunities differentiate between dementias and mental illness.  However, the same professional groups and services tend to look after both.
  • The underlying aetiology. This traditionally is considered on a bio-psycho-social spectrum, with researchers often being polarised either at the biological or psycho-social ends.  In reality the aetiology underpinning conditions is a combination of biopsychosocial factors, with biology affects psychology and hence social situations, and vice versa.
  • Comorbidity. Mental illnesses, substance misuse and dementia collectively are some of the most comorbid conditions that we are aware of.  It is the norm for people with mental illnesses to have some degree of comorbidity – be that another mental illness, a physical illness or substance misuse.  In the opposite direction, there is a high proportion of people with multiple long-term conditions (MLTCs) who have a mental illness as one of those conditions.
  • Care setting. At one end of a spectrum this is in the community, which may include schools, workplaces and voluntary sector organisations.  At the other end there are primary (GPs etc), secondary (mental health Trusts) and tertiary (highly specialised regional or national) NHS services.
  • Professionals. There is a vast array of different professional groups that work with people with mental health problems or mental illnesses.  These include, but are not limited to: Psychiatrists, Psychologists, GPs, Mental Health Nurses, Social Workers, Occupational Therapists etc.  There are also a range of different sub-specialties in many of these professional groups.  Psychiatrists are qualified as either General Adult, Old Age, Child and Adolescent, Addictions, Eating Disorders, Forensic, Intellectual Disability, Liaison, Neuropsychiatry, Perinatal, Medical Psychotherapy, Rehabilitation and Social Psychiatrists.  Any of these may also be classed as “Academic Psychiatrists” with a major focus in research.  Psychologists similar are divided into subgroups, with one being Clinical Psychology.  Research is done both by Clinical Psychologists and other Psychologists without this specific qualification.  Their orientation can be very varied, for example cognitive or social psychology.
  • Interventions. Research can focus on primary prevention (e.g. in the community), through to treatments and secondary prevention.  Treatments themselves are very varied, including self-help, social prescribing, support groups, psychotherapy, medication and neurostimulation.
  • Therapists. Therapists come from many different professional, or lay, backgrounds.  Their focus can vary between many different schools of psychotherapy (e.g. psychoanalytical psychotherapy and cognitive behavioural psychotherapy (CBT)) to art or music therapy, to non-directional counselling.
  • Research areas and techniques. There is almost a limitless number of research areas and techniques employed to study mental health and illness.  They can be thought of as falling on the translational pathway from basic discovery, through preclinical development, early phase trials, late phase trials to implementation and health care delivery research.  In addition to all of the standard biomedical areas of research (e.g. genetics, omics, neuroimaging etc), there are also strands along the translational pathway related to psychological and social interventions.  Of perhaps greater prominence compared to some other areas of health, is qualitative, alongside quantitative, research.

It is evident from all of the above that mental health research can be extremely fragmented.  For instance, a public health specialist undertaking research into the primary prevention of mental health problems in school children is very different to a psychiatrist undertaking genotyping of people with psychosis being managed in secondary care.

However, differences and separations from one another occur even within professions (a cognitive psychologists does very different types of research from a social psychologist) or between those working on the same disorder (e.g. psychiatrists undertaking epidemiological versus neuroimaging research in people with bipolar disorder).

At NHIP, we work to try and overcome some of these barriers by bringing partners together. One way we are doing this at the moment is creating a community of practice (via teams) NHIP Mental Health Community of Practice | General | Microsoft Teams – to facilitate identification of, and collaboration with, other relevant researchers.  It is also a place to find out what else is needed within the ecosystem to allow us to work together more easily.

Additionally, we are currently creating an online roadmap of mental health research across the NHIP partnership, which will be going live very soon.

If you would like to find out more about mental health research and the work being carried out across the NHIP partnership, you can also sign up to our Lightning Talk here.

It is only by working together, that we can overcome some of these complex barriers – for the benefit of research in this field, and ultimately the patients who need it most.

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