Mental health research priorities for Europe
by Vanessa Pinfold
There seems to be a lot of conversations at the moment about priorities for mental health research. What should funders fund to improve the lives of individuals and communities with regard to mental health? Where are the promising breakthroughs? How can we gain parity for mental health research funding alongside other health areas? How can we ensure generated knowledge and evidence translates quickly into changes in frontline practice?
There are two important questions. How much money should be invested in mental health research? And what should it be spent on?
How much money should be invested in mental health research?
MQ landscape analysis published April 2015, built on previous work by the Medical Research Council (MRC) Review of Mental Health Research 2010 to highlight how much is spent on mental health research and what areas are targeted. The UK health research analysis 2014 from UK Clinical Research Collaboration (UKCRC) has also just been published, providing 10 years of data revealing percentage spend on mental health increasing from 4.3% in 2004/2005, 5.5% in 2009/2010 to 5.77% in 2014 but this lags behind figures documenting the scale of the health problem. The gap in 2014 was 13.66%. MQ landscape analysis shows how the UK invests about £115 million per year in mental health research but that works out as £9.75 per affected person whilst in cancer the equivalent figure is £1571 per person. In terms of public giving, for every £1 spent by government, the public gives 0.3p to mental health and £2.75 to cancer research. All these analyses are imperfect and you can identify issues with how things are categorised or organisations that have been left out, but the picture is pretty clear. Mental health research is underfunded. We have less than we need and funding comes mainly from the government and a few large trusts.
What should be the funding target? Well if we align to Disability Adjusted Life Years (DALYs) as shown in the UKCRC 2014 report, 13.66% of research spend would need a £258.99 million investment compared to the current £109.4 million – so quite a lot more.
What should we be spending research funding on?
This is a very important question and a difficult one to answer. Who should decide? Currently, the most democratic approaches are based on consensus methods – asking stakeholders to work together to decide; service users, families, clinicians, researchers, and policy makers. Great in theory, but institutions with budgets to allocate research funding make the final decisions. These exercises are only really feeding information in. And all organisations and people within them are bias, with strong preferences for areas of research or types of research. The challenge remains ensuring investment is spread across the prevention – service delivery – treatment – cause pathway.
Currently there is much activity around priority setting.
Firstly, there are two priority setting exercises focused on bipolar and depression, run by the James Lind Alliance: we will soon learn what 10 priorities are identified for each.
Secondly, the NHS England Mental Health Taskforce – the five year forward view will report autumn 2015 with a vision for mental health to 2020, linked to the Comprehensive Spending Review from the HM Treasury; it is working on research recommendations jointly with the Department of Health.
Thirdly, ROAMER which stands for Roadmap for Mental Health Research in Europe, and was funded by the European Union has published its findings and is promoting them.
It was with great interest that we read a viewpoint paper in the Lancet Psychiatry by the ROAMER team led by Professor Til Wykes. What were Europe’s mental health research priorities building on three years of consultation? Would current European pressures that can impact on mental health including economic crises and migration with thousands fleeing war and trauma seeking sanctuary be relevant within these recommendations? Published last week, this open access paper (meaning anyone can read it, you just need to register with the journal) outlines the recommendations made by a European team of researchers who have been mapping current mental health research across Europe, identifying gaps and then seeking consensus on priority areas. They came up with a list of 20 priorities, generated by 486 scientific experts and 245 stakeholder organisations across Europe. You might well ask how they decided on these priorities.
- Did each country have to agree?
- Did they have to build on established research that showed “progress”?
- Did they consider timely impact on frontline practice and individual quality of life for mental health service users?
- Did they have to be relevant for every mental health problem to go onto the list?
These were questions we thought of, but many would have their own check list of how to decide if something was ‘priority’ enough. The ROAMER team did too. ROAMER participants rated 151 priority areas on a ten-point scale for:
- Relevance (likelihood that advance will result in effective intervention to improve mental health)
- Feasibility (likelihood that the advance can be achieved)
The exercise was the most inclusive and comprehensive priority setting process ever delivered in mental health research. Building on European Science it has developed six priority areas that are very broad but actionable, and supported by high level service user input into their development.
The first one is around the theme of early intervention – Preventing mental disorders, promoting mental health and focusing on young people
The second is on understanding the development of mental health problems and causal mechanisms, including comorbidity [having more than one health problem].
The third area is about research infrastructure – building collaborative networks, sharing databases, running multidisciplinary training programmes. [Research is a complicated endeavour and it often requires a myriad of ‘support’ from different organisations such as the Clinical Research Network for it to succeed. The support necessary to make sure that research happens is called ‘infrastructure’]
Fourth, is to develop and implement better interventions using new scientific and technological advances for mental health and well-being.
Fifth, reduce stigma and empower service users and carers in decisions about mental health research.
Lastly, establish research into health and social care systems that can address quality of care taking into account local approaches.
Will anything change? The authors acknowledge that their priorities are similar to those of the past 10 years. But drivers for change include the increase in cost of mental health problems and better infrastructure to progress with genome-wide studies and next generation sequencing, alongside a policy agenda for personalised care. The paper talks about European researchers being resourced to address some of the biggest social challenges that mental health problems present, and achieving this within 5-10 years. The McPin Foundation would be keen to ensure that a multi-disciplinary emphasis extends beyond psychiatry and psychology, ensuring that other areas of mental health contribute to research agendas. The McPin Foundation would be keen to see the development of nursing research, social work research, mental health systems research, as well as cultural studies, mad studies, survivor research, health geography and public health. This means not just which topics to fund, but also invest in how we carry out research, extend and improve our methodological approaches. We champion experts by experience in order to #transformMHresearch and will continue to ask how user led priorities can best be set and implemented to influence funding bodies, governments, charities and the public.
The ROAMER team are keen for everyone to join in the debate about mental health research priorities. @TilWykes @ROAMERproject #ROAMERpaper #MentalHealth
Vanessa Pinfold, Research Director, The McPin Foundation.