ADCARE

Acute Day Units as Crisis Alternatives to Residential Care

This study is evaluating the impact of Acute Day Units as crisis alternatives to residential care for individuals with acute mental health needs. Please find more information on the study here.

HE: Jason Madan, Alastair Canaway

DAPA

Dementia And Physical Activity

DAPA is a randomised controlled trial funded by the National Institute for Health Research Health Technology Assessment programme to estimate the effect of a 4-month, moderate- to hard-intensity exercise training programme and subsequent advice to remain active, on cognition (primary outcome) at 12 months in people with mild to moderate dementia. Community-dwelling participants (with their carers where possible), who are able to walk 3 metres without human assistance, able to undertake an exercise programme and do not have any unstable or terminal illness are recruited. Participants are then randomised by an independent statistician using a computerised random number generator to usual care or exercise at a 2:1 ratio in favour of exercise. The exercise intervention comprises 29, 1-hour-long exercise classes, run twice weekly at suitable venues such as leisure centres, which include aerobic exercise (on static bikes) and resistance exercise (using weights). Goals for independent exercise are set while the classes are still running, and supported thereafter with phone calls.

Please visit the study website here.

HE: Stavros Petrou, Iftekhar Khan

ENCORE

Evaluating the Effects of Community Treatment Orders (CTOs) in England Using the Mental Health Minimum Dataset

Community Treatment Orders (CTOs) were introduced in England 2008. CTOs allow patients detained in hospital for treatment under the Mental Health Act (2007) (MHA) to be discharged under specific conditions. The extent of their use was unexpected: around 20,000 patients have been placed on CTOs to date. Large variation in their use has been noted, and monitoring by the Care Quality Commission (CQC) suggests that patients of black and minority (BME) ethnicity are over-represented among those on CTOs. Evidence of effectiveness is sparse, and the only (three) clinical trials worldwide all failed to show any effects on clinical outcomes. Reviews of observational studies broadly confirm this, although results are more mixed.There have been no population-based studies of the use or effects of CTOs in England.

The study will: 1. explore spatial and secular variation in the use of CTOs in England over a four-year period (from 2011/12, including variation between people (and especially different ethnic groups), places and services and over time; 2. describe and model associations between CTO use and outcomes, namely re-admission, time spent in hospital, time spent in intensive psychiatric care or forensic units, episodes of seclusion and restraint, community mental health service contacts, criminal justice system contacts, Accident & Emergency Department attendances and deaths, after adjusting for patient characteristics;3. test the hypotheses that outcomes associated with CTOs vary between people and places; and 4. model the health care costs associated with CTOs (including administrative and regulatory costs) and the impacts of increasing or decreasing their use using a range of projections. Please find out more about the study here or on the pages of the University of Portsmouth here.

HE: Jason Madan, Alastair Canaway

EURIPIDES

Evaluating the Use of Patient Experience Data to Improve the Quality of Inpatient Mental Health Care study

EURIPIDES aims to understand which of the many different approaches to collecting and using patient experience data are the most useful for supporting improvements in inpatient mental health care. To find out more about the study, please visit this website.

HE: Jason Madan, Alastair Canaway PI: Scott Weich Funder: NIHR HS&DR

MILESTONE

Managing the Link and Strengthening Transition from Child (CAMHS) to Adult Mental Health Care Services (AMHS)

There is international concern about young people who get ‘lost’ during their move from CAMHS to AMHS. Disruption of care during transition may adversely affect the health, wellbeing and potential of this vulnerable group. The main aim of the MILESTONE project is to understand and improve transition of care from CAMHS to AMHS across different healthcare systems in Europe.

Findings from the study will help transform mental health care in the EU for young people, enhance patient outcomes, quality of life, and service satisfaction, and improve mental health status at individual and population levels.

Please find out more about the study here.

HE: Jason Madan, Alastair Canaway PI: Swaran Singh Funder: EU FP7

WPIS

Warwick Pain and Insomnia Study

Chronic pain patients often also have severe problems sleeping, which can amplify their pain and increase their distress and disability. These patients do request treatment for their insomnia, but such treatment is never a main focus in pain management programmes. In primary care drugs remain first-line treatments for pain-related insomnia despite limited evidence of their long-term effectiveness and safety. Hybrid cognitive-behavioural therapy (Hybrid CBT) is a new approach to tackling pain-related insomnia. It addresses pain and sleep simultaneously, exploiting factors underpinning the persistence of both problems. Delivered as a brief but intensive treatment in secondary care, Hybrid CBT was effective in not only improving sleep and reducing pain interference, but also counteracting fatigue and depression. The improvements were also clinically meaningful, however, it is not yet known if the patient benefits could be translated to primary care. This study therefore aims to test the feasibility of delivering this promising intervention in a primary-care setting. The results of the study will inform the planning and implementation of a definitive randomised controlled trial (RCT) evaluating the clinical- and cost-effectiveness of the Hybrid CBT in primary care. To find out more about the study, please visit this website.

HE: Jason Madan, Benjamin Parker Funder: NIHR RfPB