Professor John Geddes, Director of the NIHR Oxford Health Research Centre (BRC), discusses the growth of the BRC, the objectives of the Mental Health Mission and the challenges of translating mental health research into practice.
“The past couple of years have completely transformed the amount of investment into mental health research infrastructure nationally. Oxford, under the strategic leadership of the Oxford Academic Health Partners, has played a massive role in bringing this to fruition.”
Oxford Health BRC is entering its second year of operation since it was refunded. Looking back, what have been your highlights?
It’s been an incredibly busy year because we now have a much bigger mental and brain health Biomedical Research Centre than we did previously! In setting this up, our vision was to develop a national network of centres of excellence for brain health based around Oxford’s expertise, bringing in key partners who are doing high-quality translational research across England. So, as well as tripling our budget, we were successful in including 10 additional partner universities and NHS Trusts across England. On top of that, we are now hosting the NIHR Mental Health Translational Research Collaboration, and we were also successful in our proposal for hosting part of the Mental Health Mission.
The past couple of years have completely transformed the amount of investment into mental health research infrastructure nationally. Oxford, under the strategic leadership of the Oxford Academic Health Partners, has played a massive role in bringing this to fruition.
What gap is the Mental Health Mission filling?
Nationally, we have seen a lack of investment in the mental health research infrastructure needed in the NHS and universities to enable mental health research can be done effectively. The infrastructure has probably declined in recent years, which creates a huge capacity problem. One of the goals of the Mental Health Mission is to reverse this.
Part of our focus is to build new research capacity and infrastructure at sites where there is a critical patient need for mental health research, like Birmingham and Liverpool. We are also focusing our efforts on areas where new innovations are emerging to encourage translation into practice, like mood disorders and psychosis. We are also prioritising investment in children and young people’s mental health.
Alongside this, we are working to boost funding and the national infrastructure for big data informatics, so researchers can make the most of routinely collected clinical data in mental health.
Another key objective of the Mental Health Mission is to ensure that UK mental health researchers are well-positioned to engage with industry. This means that when companies have new innovations that are ready to develop and translate into practice in collaboration with NHS and academic partners, then our clinical research infrastructure is appropriately resourced to support this.
Why is Oxford a good fit to contribute to the leadership of the mission?
Until 2011, Oxford didn’t have much in the way of research infrastructure for mental health. We had strong university departments in neuroscience, and an NHS Trust that was interested and supportive, but that was it. Since then, we have built an extensive BRC focused on mental health that brings together the university and the NHS, supported by the leadership of the Oxford Academic Health Partners who saw mental health as a priority. In doing so, we have boosted research infrastructure for mental health dramatically in Oxford, proving that it can be done. We’re well-positioned, and very keen, to share that experience and leadership with the rest of the country.
What’s the biggest challenge in translating mental health research into practice?
There remains a big problem from the point of view of really basic biological interventions in mental health. So, while we are starting to see one or two novel drugs reaching the market, our understanding of the basic mechanisms that underpin how drugs can treat mental health conditions remains quite limited. Part of our rationale for developing the mental heath BRC has been that this basic understanding is now starting to improve, which has led to quite a bit of investment in research. But despite optimism that we are reaching an inflection point, it takes quite a lot more for industry to invest and take forward some of these research assets – it’s this large-scale industry investment that’s now lacking.
In other areas, such as digital health interventions, psychosocial interventions, and psychological therapies for child and adolescent mental health, things are coming along quickly. There has been a big increase in how digital technology is being harnessed, including some innovative therapies using virtual reality, like the gameChange VR project led here in Oxford, for example. The challenge is to ensure that these digital health developments are properly validated and evidence-based. There’s quite a rush of companies coming out with apps for mental health without the evidence that they’re effective.
When we do start bringing these sorts of treatments into NHS clinical practice, the next hurdle is to get staff trained to deliver them, to identify the right groups of patients who can benefit from them, to make them accessible to everyone who needs them, and to get them funded. One of the things that the Mental Health Mission is seeking to do is to reengineer some of the mental health care pathways and clinical services so they are more focused on specific groups of patients and disorders.
What can be done to help make mental health research studies more inclusive?
We have been working on a new approach to recruitment called “Count Me In”, which is interesting because rather than asking patients to opt-in to research, it assumes that everyone wants to hear about research opportunities, unless they opted out. It’s been hugely important in terms of getting more patients to participate in research, and it’s actually quite simple. In the first three months of the project we saw a 400% increase in the number of patents who we could contact for research, and the project didn’t see high numbers of opt-outs.
We also need to make sure we have interfaces for research in places where there are lots of people who want to participate in research. This neatly relates back to the work the Mental Health Mission is doing to boost clinical research infrastructure in sites that have a huge need.
Generally, we find that if you ask anyone if they’re interested in research, then the majority will say yes. This is because people generally see that research brings benefits, like access to innovative treatments that they wouldn’t be offered otherwise. Also, the quality of care that people receive when they’re involved in research projects tends to be higher than in standard service, because they have both the researchers and clinical teams looking after them. Critically, people need to know about research and have the opportunity to take part.
Lastly, patients and populations need to be involved really early on in the design of research studies so it’s easy for people to take part. Getting this sort of patient engagement early on is a big focus for both the Oxford Health BRC and the Mental Health Mission.
For me, the pandemic reinforced that if you design a research project without talking to the people you want to include, then you just make really simple mistakes, but it’s very easy to have those conversations early on.