From Where to Here…?

1. From Where to Here…? Michael Sharpe, Professor of Psychological Medicine, University of Edinburgh

2. Mental illness • One in six of the population suffers from anxiety or depression • At least 1 in 4 GP consultations for mental ill health • Annual direct care costs £12.5 billion • Annual cost to UK society more than £77 billion • We need better ways of helping mentally ill people • We need research to help us do this

3. What research do we need? • Research that is relevant • No only to cause but also to treatment • Relevant to different mental illnesses • Cover all aspects of treatment • Research that gives us high quality evidence • Good ideas • Well done studies • Large and representative samples • Research that is feasible • Results can be delivered

4. What research do we have? • Research that is relevant? • Less than 5% of the trials on the Cochrane database are indexed under mental disorder • Research that gives us high quality evidence? • Studies are generally far too small • The outcomes are too short term • They are too often based on hospital samples • Almost all are of drug treatment • Research that is feasible? • The majority of studies are not completed as planned

5. How can we get better research? • Clearly, researchers simply need to work harder and faster to deliver more and better research ! • But researchers also need to be able to deliver good research • What obstacles do they see ? • Surveys by Dr Craig on CSO 2004 and by us in 2005.

7. Obstacles to better research?What might a Network provide? • Feeling it can’t be done • Galvanize energy and vision and make it feel possible • Lack of expertise staff and infrastructure • Provide design statistical and other practical expertise • Overwhelmed by paperwork • Offer guidance and help to address regulatory requirements • Isolated with limited capacity • Forge links between clinicians and researchers, centres and networks • Can’t get big grants • Offer advice expertise and support to make strong applications • Can’t recruit sufficient patients to studies • Provide manpower to assist

9. Medical school CRFs Trials Unit

10. A Proposal for a Scottish Mental Health Research Network • The challenges • Diffuse concept of ‘mental health’ • Small clinical research community • Limited research culture in clinical services • The opportunities • Our population and organized services • Our potential for collaboration • Existing infrastructure • The ‘X’ factor • Determination to make it work

11. The original bid for SMHRN • To Link • 4 clinical medical schools • NHS and academic researchers • Other networks • To Provide • Methodological and practical support • Guidance on regulation • Assistance with recruiting • To Supplement • CRFs • R & D departments • Research grants

12. The SMHRN 3 year targets (2006) • Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research. • At least six new UK multicentre studies within 3 years. • At least three new multi-centre studies led from Scotland within 3 years. • The number of patients participating in multi-centre studies increased by at least 20% of baseline every year. • Active grant funding for multicentre MH trials in Scotland increased by at least 20% of baseline every year.

13. The SMHRN achievements (2009) • Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research. • At least six new UK multicentre studies within 3 years. • At least three new multi-centre studies led from Scotland within 3 years. • The number of patients participating in multi-centre studies increased by at least 20% of baseline every year. • Active grant funding for multicentre MH trials in Scotland increased by at least 20% of baseline every year.

14. What we have learned • It remains a challenge • To achieve focus in ‘mental health’ • To keep political, CSO, University, NHS and Industry support • To recruit and keep good staff (let studies recruit their own) • It is a long term job • 10 years plus • It need a substantial commitment of senior time • We need to support success but also to grow new Scottish studies • Back winners • Promote PDGs and pilots

16. Thanks to the original team Edinburgh: Professor Michael Sharpe (Academic), Dr Alan Carson (NHS) Glasgow: Dr Andrew Gumley (Academic), Professor Bob Hunter (NHS). Aberdeen: Professor Ian Reid (Academic), Dr Ross Hamilton (NHS). Dundee: Dr Alex Baldacchino(NHS), Dr Rob Durham (Academic) Primary Care: Professor Jill Morrison (Academic Glasgow), Public Health: Dr Cameron Stark (NHS Highlands Health Board) Clinical Research Facilities: Mr Gordon Hill (Wellcome Trust CRF) Statistics and methodology: Professor Gordon Murray Manager: Dr Lucy McCloughan

17. Also to those who joined later Board members: Professor Keith Matthews (Dundee); Dr. Jonathan Cavanagh (Glasgow); Professor Stephen Lawrie (Edinburgh – biological psychiatry); Network Staff: Nadine Dougall; Mark Hazelwood; Gillian McHugh; Ann Doust

18. And also to CSO: Peter Craig,Roma Armstrong; Beatrice Cant; Hilary Lapsley CRFs: Anne Gordon; Fiona McArdle NIHR MHRN: Til Wykes and colleagues University of Edinburgh: Professor Stuart Ralston and Professor Eve Johnstone and colleagues in my research group (PMR) Scottish Government: Denise Coia