These are slides used in a presentation delivered in the School of Healthcare Sciences at Cardiff University on January 13th 2016.

1. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Ben Hannigan
Reader in Mental Health Nursing
Web: http://www.cardiff.ac.uk/people/view/39197-
hannigan-ben
Blog: benhannigan.com
Twitter: @benhannigan
Some cumulative insights from the
study of mental health systems

2. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Why study mental health?
• Mental ill-health is very common: an estimated one in four is
affected at least once during their lifetime
• In the EU, there are over 50,000 deaths by suicide each year
http://www.mentalhealthandwellbeing.eu/the-joint-action
• Mental illness shortens lifespans (Thornicroft 2013)
• In England, the total cost of mental health problems in
2009/10 (including the costs of care, lost economic output,
and the human cost of diminished quality of life) was
estimated at £105.2 billion (Centre for Mental Health 2010)
• In Wales, the total cost in 2007/08 was estimated at £7.2
billion (Friedli and Parsonage 2009)

3. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Funding mental health research
• Large gaps in what is known about
mental health and illness
• 85% of funding for UK mental health
research is from just three funders: the
Wellcome Trust; the NIHR; and the MRC
• Annually, approximately £9.75 is spent
on research per person affected by
mental illness…
• …over 100 times less than cancer
investments
(MQ: Transforming Mental Health 2015)

4. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Mental health research priorities
• Preventing mental disorders, promoting mental health and
focusing on young people
• Focusing on causal mechanisms of mental disorders
• Setting up international collaborations and networks for mental
health research
• Developing and implementing new and better interventions for
mental health and well-being
• Reducing stigma and empowering service users and carers
• Research into health and social systems
(Wykes et al. 2015)

5. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Mental health research priorities
• What are the psychosocial and community-based
interventions which help people live well with dementia?
• A programme centred on the therapeutic impact and
contribution of mental health nursing: helpful and effective
interventions, safe staffing, maximising nursing time through
service organisation and the development of roles, the work
of nurses assisting others in delivering support/interventions.
• A programme of public mental health research: what
promotes mental health, prevents mental illness, and helps
people living with mental illness to live better and longer?
(Mental Health Nurse Academics UK 2015)

6. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Developing a programme*
• Past studies on the (a) workforce, (b) work, organisation and
user experiences in community mental health care, and (c)
the establishment, work and impact of crisis services
• Current NIHR studies on care planning and coordination in
community and hospital mental health settings (COCAPP and
COCAPP-A)
• Recent NIHR evidence synthesis on risk in CAMHS (RiSC)
• Current NISCHR (as was) study on social networks and shared
decision-making (Plan4Recovery)
*with apologies to esteemed colleagues in HCARE pursuing
parallel programmes relevant to the wider mental health field!

7. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Making connections: theory, design
and methods
• A systems approach: which emphasises the interconnections
between policy, services and their organisation, work and user
experiences…
• …or the connections between macro, meso and micro
• The value of studying cases, at different levels: countries,
organisations, teams, people…
• …and of studying cases within cases
• Investigating in depth: qualitative and mixed methods
• Co-production: working with service users

8. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
So what have we found?
• The mental health system is organisationally complex, and is
dynamic
• Ideas and practices are open to contest, and evidence is
sparse. For example:
– for crisis services, and
– in the management of the less obvious risks for young
people in mental health hospital
• Work in community care is sensitive to organisational context,
divisions of labour are larger than people may sometimes
think, and work and roles are in flux

9. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
So what have we found?
• The system’s problems are ‘wicked’, and are hard to define (let
alone solve)
• In community-based crisis services, work is patterned by
system features
• Complex relationships exist between national policy, local
policy, and face-to-face practice and user experiences. For
example:
– in the production of care plans: see forthcoming COCAPP
final report

10. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
Want to read the detail?
• Check out my blog [http://benhannigan.com], where there
are plenty of posts and green open access versions of
published papers

11. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
What’s next?
• Follow-on studies from ongoing and recent projects…
• …and new lines of enquiry building on existing and new
collaborations

12. School of Healthcare Sciences
Ysgol Gwyddorau Gofal Iechyd
References
Centre for Mental Health (2010) The economic and social costs of mental health problems in 2009/10,
London, Centre for Mental Health.
Friedli, L. and Parsonage, M. (2009) Promoting mental health and preventing mental illness: the
economic case for investment in Wales, Cardiff, All Wales Mental Health Promotion Network.
Mental Health Nurse Academics UK (2015) Research priorities, https://www.jiscmail.ac.uk/cgi-
bin/webadmin?A2=ind1510&L=MHNAUK&F=&S=&X=70FEC66284D807F1B9&Y=HANNIGANB%40CAR
DIFF.AC.UK&P=40746.
MQ: Transforming Mental Health (2015) UK mental health research funding, London, MQ:
Transforming Mental Health.
Thornicroft, G. (2013) ‘Premature death among people with mental illness’, BMJ, 346:f2969
Wykes, T., Haro, J.M., Belli, S.R., Obradors-Tarragó, C., Arango, C., Ayuso-Mateos, J.L., Bitter, I., Brunn,
M., Chevreul, K., Demotes-Mainard, J., Elfeddali, I., Evans-Lacko, S., Fiorillo, A., Forsman, A.K., Hazo, J.-
B., Kuepper, R., Knappe, S., Leboyer, M., Lewis, S.W., Linszen, D., Luciano, M., Maj, M., McDaid, D.,
Miret, M., Papp, S., Park, A.-L., Schumann, G., Thornicroft, G., van der Feltz-Cornelis, C., van Os, J.,
Wahlbeck, K., Walker-Tilley, T., Wittchen, H.-U. on behalf of the ROAMER consortium (2015) 'Mental
health research priorities for Europe', Lancet Psychiatry, 2, 11, 1036-1042.