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

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.

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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

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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) 1. Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research. 2. At least six new UK multicentre studies within 3 years. 3. At least three new multi-centre studies led from Scotland within 3 years. 4. The number of patients participating in multi-centre studies increased by at least 20% of baseline every year. 5. Active grant funding for multicentre MH trials in Scotland increased by at least 20% of baseline every year.

13 The SMHRN achievements (2009) 1. Establishment of a baseline of multicentre clinical research activity in and funding for Scottish MH research. 2. At least six new UK multicentre studies within 3 years. 3. At least three new multi-centre studies led from Scotland within 3 years. 4. The number of patients participating in multi-centre studies increased by at least 20% of baseline every year. 5. 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

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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