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TypeInnovation and Research
'Innovating today to change the future'
Clinical Trials Performance - future reporting
Please note the way we report our delivering and initiating clinical research reports has changed. You will be able to find our reports for 2020/21 and onwards uploaded to the National Institute for Health Research web platform here.
You can find all of our previous performance reports in the document folder here.
What is Innovation?
Innovation is the process of turning creative ideas into something that generates value. An innovation in the NHS might be a process, a service, a product or technology that results in better health, less harm and better patient experience with the same or with less use of resources. An innovation will be the outcome of a creative process of ideas generation, challenge, testing and evaluation that when put in place represents a step change on what has gone before. In NHFT we are keen to in develop ideas that improve your working life or makes us more efficient.
Check out this video introduction to innovation in the NHS:
NHFT recognises research as key to the delivery of evidence based care. We also recognise that the quality of patient care is higher when there is participation in research.
Building a research and development culture is crucial to improving the quality of care. At the core of our vision is to build a culture where research is embedded in routine clinical practice. It’s also our vision that research findings are habitually used, leading to sustained improvement in the care that is delivered to service users in the Trust.
Clinical research is the way in which we gather evidence to improve treatments for patients. Many people think it is just about drug trials, however it can include a variety of research. Promoting, conducting and using clinical research to improve healthcare is one of the key principles of the NHS. In fact, the Constitution for NHS England (2013) contains a pledge to inform patients of research studies in which they may be eligible to participate. The National Institute of Health Research wants patients and carers to feel empowered to ask about research, and to keep research at the top of the NHS England agenda. As a result, research is now core NHS business.
Check out the NHS Research video below:
AddressInnovation and Research Unit, Berrywood Hosppital, Northamptonshire, NN5 6UD
This is the website for a research project entitled: ‘Older adult forensic mental health patients: defining barriers, facilitators and ‘what works’ to enable better quality of life, health and wellbeing, reduced risk, and lower levels of security’. The project will be known as ENHANCE.
ENHANCE is being carried out by Dr Chris Griffiths, Dr Kate Walker, Dr Jen Yates, Professor Tom Denning, Professor Birgit Völlm, Dr Jack Tomlin, and Andrew Lowe, between September 2019 and May 2021. It is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1217-20028).
Why are we doing this research?
Forensic psychiatric services work with people with mental illness and who pose a risk to themselves or others deemed sufficiently high to require confinement to secure facilities, or risk assessment and management in the community. Specialist forensic inpatient services are also required specifically for older adults experiencing mental disorder who pose a risk to themselves or others and their needs and requirements are likely to have changes as they have aged. Older forensic psychiatric patients (defined as aged 55 or over) typically have complex histories having experienced many different types of trauma such as childhood neglect/abuse, substance abuse, poor health self-management, psychiatric admission, homelessness and violence. It has also been found that due to common histories that include poor health management and substance abuse, people with long term mental health disorders experience the challenges associated with old age earlier, and have significantly reduced life expectancy. It is important that psychiatric services offer suitable and appropriate treatment to all patients to enable recovery and better levels of health, wellbeing and quality of life and lower levels of risk to themselves and others. However, it is not known if this is being achieved with older forensic mental health patients, or what the barriers and facilitators to progress are for this group. We know that there is an increasing proportion of older people in secure settings now, but we are unclear how well and effective treatments are with this group of people. The aim of this project is therefore to discover this by undertaking research with service users and service providers, in order to get an in-depth understanding of their needs, requirements, and an insight in to what works for these patients to enhance their quality of life and reduce risk to themselves and others. The research will be used to make recommendations and to inform service provision and policy.
Who we are?
Dr Chris Griffiths:
Dr Chris Griffiths has co-ordinated NIHR, charity and industry funded mental health and forensic research and experienced as a principle investigator. He leads the project, ensuring delivery in line with protocol, on time, within budget and to a high standard. He leads collaboration with co-applicants, collaborators, recruitment sites and PPI lead (ensuring the project’s PPI requirements are fulfilled). He will lead full team meetings and be involved in interpretation of data and will lead synthesis study module, reporting, development of recommendations and dissemination.
Dr Kate Walker:
Dr Walker is a Research Associate, and an experienced qualitative researcher in the fields of intimate partner violence and sexual offending. She will be responsible for the day-to-day running aspects of the research for the duration of the project. She plays a key role in connecting with service users, inviting them to participate in the research and gathering the data over time. She will also analyse the data and write up the final findings and reports in collaboration with the other investigators on the project and the Lived Experience Advisory Panel.
Professor Birgit Völlm:
Prof Völlm is a Professor in Forensic Psychiatry and Director of the Forensic-Psychiatric Hospital and Outpatient service in Rostock, Germany. Previously, she was Professor of Forensic Psychiatry at the University of Nottingham and a Consultant Forensic Psychiatrist in the Personality Disorder service at Rampton high secure hospital. Prof Völlm has extensive experience in conducting research in forensic settings in senior roles, including the management of large, multisite projects, both nationally (including NIHR) and internationally. She will attend full team meetings and will be involved in interpretation of data and contribute to the project’s synthesis module, final report, development of recommendations and dissemination. She will also provide mentorship to the chief investigator.
Dr Jack Tomlin:
Research Fellow, Klinik und Poliklinik für Forensische Psychiatrie, Universitätsmedizin Rostock.
Dr Tomlin is a Research Fellow who conducts and publishes research on forensic mental health. He will lead the project’s quantitative module and will direct the analysis and interpretation of the obtained psychometric data. He will attend full team meetings. He will contribute to the project’s data synthesis module, final report, development of recommendations and dissemination.
Professor Tom Dening:
Professor Dening, an academic old age psychiatrist with over 25 years consultant experience, leads the Centre for Dementia, Institute of Mental Health, Nottingham, and is the Dementia clinical lead, NIHR CRN East Midlands. Research interests include dementia and technology; the arts and dementia; and services for people living with dementia, including clinical trials, psychosocial interventions, care homes and forensic settings. He will attend full team meetings and contribute to all stages of the research.
Dr Jen Yates:
Dr Yates is an assistant professor of mental health and an experienced qualitative researcher in the fields of older people, dementia, and health services delivery. She brings experience in collecting, managing, and analysing qualitative data from both staff and service user perspectives. She will provide qualitative methodology research expertise and will lead the qualitative module. Jen will attend full team meetings and contribute to project’s data synthesis module, final report, development of recommendations and dissemination.
Andrew is a Lived Experience Advisory Panel member and Co-Applicant for the ENHANCE project. He has previous experience working on several other research projects, such as a Nottinghamshire Healthcare NHS Trust project, examining the effectiveness of individual placement and support in improving employment rates and associated psychosocial outcomes in forensic psychiatric populations. He will be involved with the research throughout the project. His role will include: advising on what is important to patients; practical aspects of recruitment; ethical and patient acceptability factors; input into project patient facing materials; interpreting both the staff and patient data; assisting with plain language summaries; and promoting the study in recruitment and dissemination events.
Expert Advisory panel:
Dr. Aamir Ehjaz
Dr Aamir Ehjaz is a Consultant Forensic Psychiatrist employed by Northamptonshire Healthcare NHS Foundation Trust (NHFT), where he was also the Clinical Director for Forensic Mental Health Services between 2011 and 2014. His qualifications are MBBS (London, 2002), LLM in Medical Law (University of Northumbria, 2005), MRCPsych (Royal College of Psychiatrists, 2007), and MSc in Forensic Mental Health (St George’s Medical School, London, 2012). Since 2010 he has also been the visiting psychiatrist at HMP Rye Hill. In 2019 he has been elected as a Fellow of the Royal College of Psychiatrist (FRCPsych). He will provide expert advice regarding forensic mental health psychiatry.
Dr. Vivek Furtado
Dr Vivek Furtado is an Associate Clinical Professor in Forensic Psychiatry at the University of Warwick and Honorary Consultant Forensic Psychiatrist to an enhanced rehabilitation medium secure service in the West Midlands. He studied Medicine at the Christian Medical College and Hospital in Vellore and completed his basic and specialist training in Old Age Psychiatry in Leeds. He was awarded an NIHR Academic Clinical Fellowship to research long term care in forensic psychiatric settings and completed further specialist training in Forensic Psychiatry. His research interest spans forensic psychiatry, terrorism, extremism and radicalisation, old age psychiatry, prison psychiatry and old age forensic psychiatry. He will provide expert advice regarding old age forensic mental health psychiatry and contribute towards recruitment strategies, development of recommendations and dissemination.
Dr Jonathan Waite
Dr Waite was a Consultant in the Psychiatry of Old Age in Nottingham. Before he retired in 2018 he was a clinician for forty six years working as a community and liaison psychiatrist. He was Clinical Lead for Dementia for NHS East Midlands, and Lord Chancellor’s Medical Visitor for East Midlands and East Anglia. He is author of Dementia Care (OUP 2009) and co-editor of The ECT Handbook (CUP 2019). He will provide expert advice regarding old age forensic mental health psychiatry, dementia and contribute towards data collection strategies, development of recommendations and dissemination.
Tracy Oliver is a Community Forensic Psychiatric Nurse and Queen’s Nurse, working as a care-co-ordinator and social supervisor in Northamptonshire Community Forensic Team. Prior to this she worked as an Inpatient Nurse in medium secure environments. Tracy will offer expertise on the project in relation to community mental health services and provision, psychiatry and contribute towards recruitment strategies, development of recommendations and dissemination.
Patient and Public Involvement
The project has a Lived experience Advisory Panel (LEAP) which comprises current and ex-service users who have been invited to help shape the project from inception to delivery and beyond. All literature and research methods have been devised with the LEAP group, and they have helped develop the questionnaires for participants. They will also be responsible for assisting and guiding with data collection, analysis and interpretation of findings. Finally they will be involved with dissemination by helping with the design and development of key messages and through attending and presenting at conferences and roadshows.
This independent research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1217-20028). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
What are our research questions?
R1. What are the levels of wellbeing, recovery related quality of life, cognitive functioning, and health related quality of life in older (aged 55 and over) secure inpatients and those based in the community and how can this inform development of adequate service to address their needs?
R2. From a staff and patient perspective, what are the barriers and facilitators to progress in terms of quality of life, health, wellbeing, risk and lower levels of security? How can these barriers be addressed to facilitate progress?
R3. From a staff and patient perspective, what interventions do and do not work, how, when, why and for who to enhance progress in terms of quality of life, health, wellbeing, risk and lower levels of security?
How will we do it?
Over 20 months, we will work with advisory teams, service users, service providers, and with members of the public, in order to better understand the needs and requirements of older forensic mental health patients. We will do this in four main ways:
Firstly, we will look at existing research and bring it all together to see what it says about service provision and interventions for older forensic mental health patients. This will help guide our research focus and the questions we ask. We will also undertake a policy review to understand what is already in place for older forensic mental health patients.
With their consent we will interview 36 service users, from high, medium and low risk units as well as those in the community. We will:
- Ask about their wellbeing, recovery related quality of life, cognitive functioning, and health related quality of life;
- Question them on their experiences of service provision and interventions, what they feel works and what does not work, and their views and perceptions on what helps and hinders their progress;
- Examine their case files for background information; and
- Ask them to fill in some questionnaires about quality of life, health and wellbeing in order to understand the characteristics and contextual factors associated with this population.
Alongside this we will also interview 35 people who provide service and/or care for older forensic mental health patients, e.g., psychiatrists, psychologists, nursing staff, social workers, and occupational therapists. We will ask them from their perspective what are the barriers and facilitators to progress in terms of quality of life, health, wellbeing, risk and lower levels of security, and their views about service provision and interventions. This will give us multiple perspectives across different settings.
We will analyse all the data that we have collected from service users and service providers. We will work with our advisory panels to analyse, interpret and write up the findings from the research.
The final phase of our project will bring the various threads together and identify key ‘messages’ from the findings. We will share these with those who: commission services for older forensic mental health patients; deliver day-to-day services; work with this population; and who could benefit from understanding the needs and requirements of this population. We will deliver this in various ways such as through journal articles and reports, conferences and workshops, and roadshows and exhibitions.
There is very limited research around the experience and the added challenges of ageing in secure forensic psychiatric settings. This is the first UK-based study to examine in detail the barriers and facilitators to progress for older forensic mental health patients, and understand well being recovery and quality of life. The increasing prevalence rates, the longer stay in secure care and the preliminary evidence around the unique barriers to recovery experienced by older patients require that this research is conducted. The proposed research is timely to inform service guidance and standards and decisions on future service design and funding.
What our project is creating?
Depression, physical health, wellbeing, sleep and physical activity are all interlinked, each affecting the other. Healthy levels of physical activity and effective night-time sleep can reduce depressive symptoms, improve well-being and physical health.
Fitbits (wearable activity trackers) can increase physical activity, self-awareness, motivation, and lead to healthier lifestyle and more effective sleep.
Twenty four patients diagnosed with treatment resistant depression (TRD) undergoing transcranial magnetic (TMS) treatment for depression were given wearable Fitbits.
We found a Fitbit is useful to enhance physical activity, self-awareness, motivation, healthier lifestyle and effective sleep. Facilitators for healthy sleep and physical activity included knowledge of benefits, support from family and friends, and applying sleep hygiene.
There is a need to provide interventions employing wearable activity trackers that build on the links between increased physical activity, improved sleep and lower depressive symptoms.
Dr Chris Griffiths
Dr Kate Walker
Dr Ksenija Maravic da Silva
Professor Alex O'Neill-Kerr
Acknowledgements: Neuromodulation centre staff and patients
ASCalmeD: Alpha-Stim for anxiety
Alpha-Stim cranial electrotherapy stimulation (CES) uses very low voltage current to induce changes to electrical activity of the brain, from stressful rhythms to relaxing rhythms. Similar effects to skilled practice of meditation/mindfulness.
This is delivered by a mobile phone sized device and connected via soft pad clips to the earlobes, for an hour a day. It is user friendly and CE marked for intended purpose. Alpha-Stim is safe and has research evidence that it reduces anxiety in adults (Barclay & Barclay 2014; Shekelle et al. 2018).
In an NHS IAPT based study 44.7% achieved GAD-7 remission at 12 weeks and 47.8% at 24 week follow-up (Morriss et al 2019). NHFT services are offering to patients experiencing anxiety, and in doing so giving patients access to technology that may give them control over reducing anxiety symptoms. We are evaluating to see if there is a reduction in levels of anxiety and an increased in health related quality of life.
Dr Chris Griffiths
Be Mindful Project
A new innovative programme has been implemented to provide patients and service users who have existing mental health conditions with free assess access to a supportive guided online mindfulness programme: ‘Be Mindful’.
The ‘Mindfulness for You’ project was launched in June 2020 following funding which NHFT received from Northamptonshire Healthcare Charity, enabling NHFT to provide this digital course to patients and service users during these extraordinary times.
If you see patients with experience of mental illness you can offer them free access (normal cost £40) to Be Mindful online mindfulness training.
NHFT is delighted to announce that the ‘Well-Track’ project has received funding from the second allocation of UK Research and Innovation (UKRI) Network+ funds ‘Closing the Gap’.
The aim of the second round of funding (awarded December 2020) was to stimulate and support innovative research and to build a cross-disciplinary research capacity into the inequalities that people with severe mental ill health (SMI) experience.
Dr Chris Griffiths, Research Fellow at NHFT, is leading ‘Well-Track’ project which focuses on improving poor sleep hygiene and low levels of physical activity linked to poor mental and physical health and higher mortality rates in psychosis.
Fitbit activity trackers, sleep advice and physical exercise guidance will be employed in N-Step early psychosis service to seek to improve sleep, physical health, mental health and wellbeing.
The impact on sleep, exercise, wellbeing and physical health will be evaluated. In-depth interviews will explore participant experience and gain understanding of how participants can best incorporate technology, sleep hygiene and physical exercise into their lives. The project will explore best-practice integration in mental health services and how to maximise benefits.
The project team includes:
- Dr Chris Griffiths, NHFT
- Dr Marlene Kelbrick, NHFT
- Dr Ksenija Maravic da Silva, Coventry University
- Dr Kate Walker, NHFT
- Sue Jugon, NHFT
- Farah Hina, NHFT
As part of the 'Research Sofa' series, Dr Chris Griffiths spoke about the Well-Track project, you can view the inteview here:
Ketamine and me
Qualitative methods were used to conduct in-depth interviews with 13 patients (6 male; 7 female) diagnosed with treatment resistant depression (TRD) with experience of receiving ketamine treatment for depression.
For the majority of participants ketamine infusion causes a reported initial ‘high’, enhanced perception, and dissociative experience; followed by a lifting of mood and a reduction in or removal of suicidal ideation and depression symptoms lasting around 3–6 days. This leads to a reported increase in motivation, socialisation, and activity. All participants valued the therapeutic alliance with clinicians which enhanced the treatment experience and all advocated treatment access for those with depression who have not responded to other treatments.
Ketamine for depression can have many beneficial effects, and it is potentially life-transforming for some. Ketamine may be a source of hope for patients for whom other treatments have not been effective. For some, ketamine is not tolerated or does not have anti-depressive effects.
Dr Chris Griffiths
Dr Kate Walker
Dr Ksenija Maravic da Silva
Professor Alex O'Neill-Kerr
Acknowledgements: Neuromodulation centre staff and patients
Insomnia is very common in residents in secured services. This project reviewed research evidence on interventions with sleep as an outcome (2000 to 2020) and rates of insomnia prevalence and associated factors in prisons (2015 to 2020).
Seven intervention and eight sleep prevalence or sleep associated factor papers were identified. Intervention research was very limited and the quality of the research design was overall very poor.
Interventions such as cognitive behavioural therapy for insomnia (CBT-I), yoga and mindfulness can be a benefit in a prison setting. This review found high prevalence of insomnia in prisons.
Factors linked with insomnia include anxiety, depression, post-traumatic stress disorder (PTSD), personality disorder, and pain.
The mental health of prisoners is often linked to insomnia; this is why it needs to be improved through more effective screening, assessment, treatment and management of sleep problems.
There is a need for randomised control trials (RCTs) of cognitive behavioural therapy for insomnia (CBT-I) in prisons and a need to introduce objective measures of sleep quality.
Once relaxation in COVID-19 restrictions allow, NHFT plan to engage in innovation to seek to address prisoner sleep problems in a prison it provides mental health care to.
Dr Chris Griffiths, NHFT
Farah Hina, NHFT
Financial support was received from National Institute for Health Research’s (NIHR) Clinical Research Network (CRN) East Midlands