Professor Andrew Gumley Dr Suzy Clark Dr Heather Laithwaite Translating Practice to Research and Research to Practice in Psychological Therapies NES Psychological Interventions: Hitting the Targets 17th March 2010 Heriot Watt Conference Centre Edinburgh Professor Andrew Gumley Dr Suzy Clark Dr Heather Laithwaite

Overview of Workshop Research evidence derived from randomised controlled trials of psychological therapies has been central to underpinning the Widening Access to Psychological Therapies agenda in Scotland. There remain real challenges in developing close partnership between research and practice in mental health services. The workshop will provide an opportunity to explore tensions between scientific, health service and political drivers on research in the NHS in Scotland.

Intended Learning Outcomes Specifically the workshop will address the following Intended Learning Outcomes:

1.      Develop an overview of current initiatives to increase capacity for mental health research in the NHS in Scotland and the UK.
2.      To identify barriers to research in relation to psychological
therapies
3.      Identify priorities for research in in psychological therapies.

It is hoped that the workshop will facilitate an orientation to exploring increasing partnerships between clinicians, services and researchers to address priorities for the further development and availability of evidence based psychological therapies.

Workshop Presenters Professor Andrew Gumley, Chair of Psychological Therapy, Consultant Clinical Psychologist, West of Scotland Clinical Lead for Scottish Mental Health Research Network and BPS representative on Psychological Therapies NOS National Reference Group. Dr Suzy Clark, Consultant Clinical Psychologist and lead for psychological therapies in ESTEEM North Glasgow Early Psychosis Service. Dr Heather Laithwaite, Consultant Clinical Psychologist in Rowanbank Forensic Mental Health Services.

Competence Framework for Psychological Therapies Driven initially by IAPT and SfH NOS the framework determined the core competences required to deliver CBT by: Identifying those therapeutic approaches with the strongest claims for evidence of efficacy, based on the outcome of therapies in clinical controlled trials. Competences derived from the manuals by which therapists were evaluated for fidelity and competence. Basis for model of Systemic, Humanistic and Psychodynamic / Psychoanalytical psychotherapy competences.

Hierarchical organisation of competences Competences organised to reflect complex, dynamic non-linear nature of competences required in psychological therapies. Reducing psychological therapies to a series of rote operations makes little sense since competent practitioners need to be able to make higher order links between theory and practice. Note the key terms here: Randomised Clinical Trials Fidelity Competence Theory Practice Reflect the close relationship between theory, research and practice in meeting strategic NHS priorities!

Commitment 4 in ‘Delivering for Mental Health’ (DfMH) (Scottish Executive 2006) stated that:-  ‘We will increase the availability of evidence-based psychological therapies (PTs) for all age groups in a range of settings and through a range of providers." Summarising the most up-to-date advice on evidence-based interventions; Providing information and advice on strategic planning issues in the delivery of efficient and effective Psychological Therapies services; Explaining the levels of training and supervision necessary for staff to deliver Psychological Therapies safely and effectively. Mental Health in Scotland A Guide to delivering evidence-based Psychological Therapies in Scotland “The Matrix”

Delivering Evidence Based Psychological therapies: Research to practice and practice into research. The concept of delivering ‘evidence-based ‘interventions have a number of implications for any service. The evidence base is derived from the results of key therapeutic research trials, and to deliver an ‘evidence-based’ therapy we must be able to demonstrate that we are replicating the conditions operating within those trials as closely as possible. In practice this means having therapists: trained to recognise standards, and having the competences necessary to deliver psychological interventions effectively to the tier of service within which they work; delivering well-articulated therapy, and adhering to the appropriate model; and operating within a well-governed system which offers regular high quality, model-specific clinical supervision, support and relevant CPD.

HISTORY: Why have a Mental Health Research Network? The importance of Mental Health as a public health issue Relatively under-developed research Relatively under-funded

HISTORY: Imbalance of resources Recent figures show that mental health research received 6.5% of the total research funding compared with 25% for research for cancer and 15% for neurological diseases. (Fair deal for mental health campaign, Royal College of Psychiatrists)

(people, studies, regions) Aims of the SMHRN Key challenge : To facilitate the development and successful completion of large, well-funded research studies across Scotland. Key strategy : Be more INCLUSIVE (people, studies, regions)

SMHRN objectives: Primary goals: To increase the amount of mental health research To increase the number of people participating in mental health research studies Broadening the scope: Trials at various stages of development Epidemiological, genetic and imaging studies A broad view of health services research

The SMHRN team Chief Scientist Office Management Group: Andrew Gumley, Jonathan Cavanagh, Alan Carson, Keith Matthews & Ross Hamilton Network Director: Stephen Lawrie Advisory Board Associate Directors: Gordon Murray, Andrew McIntosh & Jeremy Hall Manager Research Assistants: Emma Witt, Anna Peel, Sarah Browne & Lisa Blacklaw Research Nurses: Lewis Harpin & Jacqueline McTaggart Study Co-ordinator: Laura Hodges Administrator: Amy Lambert

SMHRN Services Adoptions Service Protocol Development Service Protocol Development Groups

Why should you contact the Network: (1) Adoptions Service Aim of the Adoptions Service is to support Study Set up and Completion Recruitment Data collection Regulation Site files / Master files Study documentation Statistical advice User Involvement SMHRN Adoptions Service help with

Adoptions Service: Application process Eligibility: Relevant to the understanding, prevention or treatment of mental illness Human participants Type of study Led from or include a site in Scotland Funded or application with funder Assessment: Study quality, feasibility, added value & Network capacity

Adoption Service: Current Portfolio Trials Genetic / Imaging Observational ProCEED COBALT CEQUEL SMaRT 2 & SMaRT 3 EDIE-2 Multiple Symptoms Study iMANTRA GCIT ACTp DOWNSLIT MD-CAD 2 commercial studies CBASP* KANECT* Bipolar Family Study Scottish Family Genetic Collaboration fNEMO Generation Scotland: Scottish Family Health Study TMRI GC Imaging Study SPECT PODS 1 commercial study

Mental Health Research Register Led by Andrew McIntosh Scotland-wide Aim to establish a register for people who might be interested in taking part in mental health research

Why should you contact the Network: (2) Protocol Development Service Aim of the PDS is to encourage a pipeline of research Focussing and refining the study question Development of the protocol Planning practical aspects of study execution Addressing regulatory requirements Making a power calculation and analysis strategy Identifying funding sources SMHRN Protocol Development Service help with

Why should you contact the Network: (3) Protocol Development Groups Aim of PDGs is to bring together researchers with a shared interest in specific research questions Funding to support PDG activity Methodological support Focus on producing high quality fundable research proposals Call for Applications for Protocol Development Groups Peer Review

Current PDGs Lead Research Area Kate Davidson Borderline Personality Disorder Jane Morris Anorexia Nervosa Alan Carson Functional Neurological Symptoms Andrew Gumley Recovery after Psychosis

Call for new PDGs 2010 – 2011 Actively encourage the development of PDGs in key areas such as - depression (primary / secondary care) - substance misuse - developmental disorders - …..?

Group Discussion Point Barriers to research can include individual, organisational, practical. Need for whole team approach and collaboration between services, clinicians, service users and clinical academics. What are your priorities research in psychological therapies? Recovery focus Competences for therapy and supervision Outcomes of psychological User Involvement Widening access ALSO CONSIDER ACTION POINTS BEFORE END OF DISCUSSION

Future directions for the Network Consult with: Clinicians and researchers Psychologists, psychiatrists, nurses, counsellors, physiotherapists… Patients, carers and the public Industry on how the Network can best engage and support them in research.

a.gumley@clinmed.gla.ac.uk