Professor Morriss, who is also Research Director of the Collaboration for Applied Leadership in Health and Social Care Research East Midlands (CLAHRC EM), said: “Friday October 10 will mark World Mental Health Day, which encourages global mental health education, awareness and advocacy.
“This emphasis on awareness is especially important for BPD which to some extent could be considered to be a hidden illness. In between episodes of illness, patients can appear entirely unaffected — they are often able to work, bring up families and lead a relatively normal life. However, this does not reveal the true extent of BPD. While it may not always be obvious, the illness often goes hand in hand with other debilitating problems which can include increased anxiety and substance abuse.”
Successful management
BPD is a mental illness in which patients experience extreme mood swings which can often last for weeks or months at a time — from periods of overactive, excited behaviour known as ‘mania’ to episodes of deep depression.
Nottingham experts are leading on two out of the five research themes in the Psychoeducation, Anxiety, Relapse, Advance Directive and Suicidality (PARADES) Programme.
The first is examining a new method of self-directed management called psychoeducation in which patients attend group therapy sessions led by a psychiatrist or psychiatric nurse. Crucially, the group also features guidance from a service user facilitator or ‘expert patient’ who is there to share their own experiences of BPD. The groups enable BPD patients to explore the many treatment options and, with the help of the ‘expert patient’ identify which treatment or treatments are likely to be most successful in helping them to manage their condition in the long term.
This approach has been used for some time in parts of Europe and has been successful in reducing patient relapses and saving money by reducing the burden on the health service from hospital admissions and the use of psychiatric services. Their use is a key recommendation in the new NICE guideline for bipolar disorder.
Promising results
The PARADES Programme has trialled the use of psychoeducation at a number of locations across the UK — including Nottinghamshire in collaboration with Nottinghamshire Health Care NHS Trust — compared with a control group of standard group therapy sessions, and the results have proved so promising that the approach has already been introduced for patients in some parts of the country including Nottingham, Mansfield and North Nottinghamshire, Birmingham, Leicestershire and Newcastle.
Peter Bartlett, Nottinghamshire Healthcare NHS Trust Professor of Mental Health Law at The University of Nottingham’s School of Law has led an investigation into the effectiveness of the Mental Capacity Act for people with BPD.
The Act was introduced in 2005 and allows people with BPD to ensure that their wishes on issues such as preferred treatments and provision for the care of dependants and pets are respected during periods of extreme illness when they lose their mental capacity and ability for decision making.
The researchers carried out a national survey of patients, psychiatrists, lawyers, nurses and other professionals whose job it was to implement the act. The results showed that out of 550 people, only 10 per cent had used it. More worryingly, the vast majority of people who took part had never heard of the act. Of the 10 per cent who had used it, many had used it in a way that was inefficient and provided little or no benefit to the patient.
Professor Morriss said: “This act is unique in the world and should be a real feather in our cap but instead it has been to a large extent forgotten and neglected.
“During the creation of the infrastructure to support this new law, something was lost in translation of the Act to the extent that the House of Lords set up a committee to review the implementation of the Act and Nottingham experts have given evidence to that committee.”
Bench to bedside
As a result of the research, the academics have put together a new booklet for BPD patients and their families which outlines the Mental Capacity Act, why it is so important and advance planning options that are available including Lasting Power of Attorney in which patients can nominate a person to take charge of their affairs when they lose the capability to manage this themselves.
The booklet has been produced and will be distributed by the East Midlands Academic Health Science Network (EMAHSN) and the NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). EMAHSN is an organisation which brings together the NHS, universities, industry and social care to take research from ‘bench to bedside’ and use innovation transform the health of the East Midlands’ 4.5 million residents. CLAHRC EM conducts world-class research into a range of conditions, including mental health, with particular emphasis on getting research into practice quicker. Mental health is a top priority for both organisations.
The booklet will be officially launched at a PARADES event being held at the Nottingham Forest City Ground on Thursday December 4, which will feature a series of practical workshops and presentations on the final results of all five of the Parades research themes.
This will include the results of work looking into the risk of suicide and self-harm in people with BPD by academics and the associated problems of alcohol and drug use and anxiety issues by researchers at the University of Manchester and the lead institution Lancaster University’s Spectrum Centre for Mental Health Research.
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PARADES is a Programme Grant for Applied Research (Ref: RP-PG-0407-10389) funded by the National Institute for Health Research (NIHR).
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).
Collaboration for Leadership in Applied Health Research and Care East Midlands
The NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM) is a partnership between the universities of Nottingham and Leicester, Nottinghamshire Healthcare and NHS, academic, industry, local authority and public partners across the region. CLAHRC EM will improve patient outcomes by conducting research of local relevance and international quality into chronic disease, older people and stroke survivors, mental health and implementing evidence and improvement. Over the next five years CLAHRC EM will aim to deliver health service improvement, better patient outcomes and improved public health by ensuring that lessons learned are put into practice quickly with a focus on delivering safe, high quality, patient centred care.
For more information visit www.clahrc-em.nihr.ac.uk or @CLAHRC_EM
East Midlands Academic Health Science Network
EMAHSN is one of 15 Academic Health Science Networks in England. It brings together the NHS, universities, industry and social care to transform the health of the region’s 4.5 million residents and stimulate wealth. Current priorities focus on identifying and spreading innovations that address health challenges including obesity, diabetes, mental health, respiratory disease, cancer, stroke and support for frail older people.
For more information visit www.emahsn.org.uk or @EM_AHSN