The call for ‘parity of esteem’ implies that mental health and physical health should be valued equally – both as outcomes in the commissioning of health services and also by investors in health research. Worryingly then, in spite of an increase in NHS mental health funding last year, the gap between funding for NHS acute trusts dealing primarily with physical health needs and funding for mental health providers continues to grow.
Funding for mental health services is around 11% of overall spend, yet it is widely accepted that approximately 23% of NHS activity is directly related to mental health care. This disparity is acknowledged by many but has yet to be tackled effectively. The funding gap is also present in research about mental health – with approximately 7% of total research funding allocated to mental health studies.
This gap in funding affecting mental health services and research has had an important influence on people’s ability to access excellent, evidence-based psychiatric services. It also means that increasingly stretched clinical teams are limited in their capacity to support research in clinical practice. This limits the availability and ease of access to important mental health studies for people who need them most, or may wish to take part.
People in mental health services are already far less likely to be involved in research than patients in other health specialities. Moreover, the incentives for health professionals to get involved in research are few and we risk losing valuable expertise and experience which allow clinical teams to promote and support research actively in their practice.
Addressing the shortfall
The need to increase spend on mental health services and research is put into context by an independent review commissioned by the Government in 2017. This reported that around 300,000 people leave their jobs each year because of mental illness – costing employers and the UK economy an estimated £42bn annually.
Delivering high-quality, well-resourced clinical research is key if we are to improve care and outcomes for people. Improving mental health for individuals conveys far wider benefits on society and the economy. We must do more both to facilitate existing studies and ‘grow’ new ones to help the many people whose lives are affected by poor mental health.
The need for high-quality evidence has also never been greater: mental health services across the country are undergoing significant change during austerity and important clinical evidence gleaned through research studies can optimise the chances that such changes are positive.
Key publications such as NHS England’s Five Year Forward View (FYFV) and Department of Health and Social Care’s Framework for Mental Health Research recognise these concerns. Both highlight the importance of more high-quality research and, crucially, the need for more strategic planning and co-ordination of studies to meet the gaps in our knowledge.
Achieving these goals from the current situation will be a challenge. Clinical and academic workforces are critically depleted. Both are over-stretched and the pipeline for clinical academics in psychiatry is low in numbers and some areas of the field are unrepresented. This means there is a lack of researchers available to undertake work in priority areas for the mental health workforce and for the population – such as addictions, or children and young people’s services. Other major shortfalls include the medical focus of much psychiatric research and the small service user research community.
The value of mental health research
The majority of mental health care is evidence-based and increasingly so. However, stigma pervades mental health research as well as practice. Within medical disciplines, there is an enduring and common perception that psychiatry is a lesser discipline and represents an ‘art’ rather than a ‘science’.
There are also perceptions that mental health research is not as ‘good’ as research into, say, cancer or heart disease. This persists in spite of the fact that mental health research funding confers 37p benefit for every £1 spent, exactly the same as the ‘big two’.
However, there are reasons for optimism. The UK produced nearly 8% of the global mental health research output in 2015 according to Mapping UK Mental Health Research Funding and its Contribution to Global Funding – so we ‘punch well above our weight’.
We also know that people with mental ill health overwhelmingly support research and would take part in studies if offered, with figures from an international study indicating this could be as high as 98%. Staff in services need to be discouraged from ‘gatekeeping’ clients in psychiatric services from taking part in research. This is a challenge the NIHR Clinical Research Network (CRN) is particularly well-placed to address. We need to work with clinical staff to reassure them that research improves lives and improves patient outcomes.
Conversely, we need to work with research teams to understand competing perspectives and pressures that mean research is not seen as a priority. Embedding research staff from the CRN within clinical services is one approach and offers additional staff time for the day-to-day clinical work with patients, while facilitating participation for clients who want to get involved in research.
Digital platforms such as Join Dementia Research, MQ’s patient portal, and NHS Research Scotland’s ‘SHARE’ initiative increasingly allow people to find out about research opportunities and take part directly. However, we must remain aware that clients with mental illness may (or may not) need additional support to access such portals.
The greater prominence of research and increasing awareness of its value by policymakers, inspectorates, and funders is very welcome. Combined with more patient choice, it provides a valuable opportunity to usher in a new era of discovery with the possibility for improved outcomes and healthier, happier lives. Our challenge is to rise to this.
Andrew Molodynski, Consultant Psychiatrist at Oxford Health NHS Foundation Trust and NIHR CRN Deputy National Speciality Lead for Mental Health Twitter: @Andrewmolodyns1 Professor Kathryn Abel, NIHR CRN National Specialty Lead for Mental Health. Email: firstname.lastname@example.org Twitter: @NIHRCRN
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