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CLAHRC Oxford and its partners demonstrate the vital role, for both patients and the NHS, of early intervention in psychosis services.

Boy at sunrise for adolescent mental health blog post
  • Impact of increasing the proportion of healthier foods available on energy purchased in worksite cafeterias: A stepped wedge randomized controlled pilot trial.

    29 November 2018

    Increasing the proportion of healthier foods available could encourage healthier consumption, but evidence to date is limited in scope and quality. The current study aimed to: (a) examine the feasibility and acceptability of intervening to change product availability in worksite cafeterias; and (b) estimate the impact on energy purchased of increasing the proportion of healthier (i.e. lower energy) cooked meals, snacks, cold drinks and sandwiches. Six English worksite cafeterias increased the proportion of healthier foods available, aiming to keep the total number of options constant, in a stepped wedge randomized controlled pilot trial conducted between January and May 2017. The intervention was generally successfully implemented and acceptable to clientele. Generalized linear mixed models showed a reduction of 6.9% (95%CI: -11.7%, -1.7%, p = 0.044) in energy (kcal) purchased from targeted food categories across all sites. However, impact varied across sites, with energy purchased from targeted categories significantly reduced in two sites (-10.7% (95%CI: -18.1% to -2.6%, p = 0.046); -18.4% (95%CI: -26.9% to -8.8%, p = 0.013)), while no significant differences were seen in the other four sites. Overall, increasing the proportion of healthier options available in worksite cafeterias seems a promising intervention to reduce energy purchased but contextual effects merit further study.

  • Acceptability of screening for mental health difficulties in primary schools: a survey of UK parents.

    10 January 2019

    BACKGROUND: Many children and young people experiencing mental health difficulties (MHD) do not access care, often due to inadequate identification. Schools have a unique potential to improve early identification; however, evidence is limited regarding the acceptability of school-based identification programmes. This study aimed to examine parents' beliefs about the acceptability of school-wide MHD screening in primary schools. METHODS: We collaborated with experts in school-based mental health to develop a questionnaire to measure parental attitudes toward school-wide MHD screening. The questionnaire contained 13 items relating to acceptability; three open-text boxes for comments on harms, benefits, and screening in general; and four questions that captured demographic information. Parents of children attending four primary schools in Cambridgeshire and Norfolk completed the questionnaire. We calculated counts, percentages, and means for each statement, and analysed responses to open-ended questions using content analysis. RESULTS: Two hundred ninety parents returned the questionnaire across the four schools (61% response rate). In the 260 questionnaires analysed, a total of 254 parents (98%) believed that it is important to identify MHD early in life, and 251 (97%) believed that schools have an important role in promoting pupils' emotional health. The majority of parents (N = 213; 82%) thought that screening would be helpful, although 34 parents (13%) thought that screening would be harmful. Perceived harms of screening included inaccurate identification, stigmatisation, and low availability of follow-up care. There was no clear consensus regarding how to obtain consent or provide feedback of screening results. There were no significant differences in responses according to ethnicity, gender, age, or school. CONCLUSIONS: Results suggest that most parents within the socio-demographic context of our study will accept MHD screening within primary schools, and that school-based screening is viable from the perspective of parents. The comments provided about potential harms as well as suggestions for programme delivery are relevant to inform the development and evaluation of acceptable and sustainable school-based identification models. Implementation and scale-up of such programmes will require further understanding of the perspectives of mental health professionals, school staff, and the general public as well as further evaluation against the established standards for identification programmes.

  • Non-vitamin k antagonist oral anticoagulants in a European primary care physician survey.

    10 January 2019

    Background: Familiarity and competency in the options for stroke prevention in atrial fibrillation (AF) and the role of non-vitamin K antagonist oral anticoagulants (NOACs) may vary among primary care physicians (PCPs) from different European countries. Aims: To investigate PCP views on prescribing and managing NOACs across Europe and identify perceived unmet needs. Design & setting: Web-based survey including PCPs with particular interest in cardiovascular medicine. Method: A questionnaire was drawn up, containing 10 questions on initiation and ongoing management of NOACs; use of AF stroke guidelines on NOACs and anticoagulant switching; and perceived information needs. Results: The overall response rate was 42%. The majority of PCPs declared they are responsible for and confident in both initiating and managing NOAC therapy. In some countries, PCPs are not able to initiate NOAC therapy due to administrative barriers (namely, Italy and Slovakia). No single set of guidelines is referred to across all countries and over a fifth of responders indicate they do not follow specific guidelines. The main learning needs reported were more related to initiation than to ongoing management of anticoagulant therapy. Conclusion: According to this self-assessment survey, the experience of most PCPs in management of different aspects of AF appears good and only some felt the need for further training. However, in the light of the importance of this topic as public health issue, intensified efforts aiming at better equipping PCPs to meet their key roles in an integrated service across Europe are overdue.

The CLAHRC and its project partners, Jannsen Healthcare Innovation and Oxford AHSN’s Early Intervention in Psychosis Network[1], initiated a project to look at health service use by psychosis patients in the Thames Valley, over a three-year period.

The project used Jannsen Healthcare Innovation’s unique ‘case identification and data linkage’ methodology with data from routine mental health system and secondary care physical health system databases – the Mental Health Minimum Data Set (MHMDS) and Hospital Episodes Statistics (HES) databases, respectively.

This data then served as the basis for an economic evaluation of the services.

More than 4,640 patients were identified for the study and 20 per cent were found to have been treated under an EIP service. Rates of admission to mental health hospitals, length of stay, employment outcomes and A&E attendances were compared between those who were treated in an EIP service, and those who were not.


The study revealed that savings of using EIP services could equate to £5,200 per patient in EIP per year, and include significantly fewer mental health bed days and reduced attendances at A&E.

If all people with a first-episode psychosis across England were to be treated by EIP services, the savings in societal costs would be an estimated £63.3 million per year, of which £33.5 million would be savings to the NHS.

This evidence was accepted by the BMJ Open for publication[1] and resulted in an invitation by NHS England to organise a national expert reference group to draft the first mental health Referral to Treatment Time for EIP, submitted to the Health and Social Care Information Centre in December 2014 and published by NICE/NHS England in 2016[2].

On a local basis, by providing unambiguous evidence of service improvement and the resulting patient benefit, CLAHRC Oxford paved the way for Oxford AHSN to widely implement and facilitate adoption of this innovative approach to mental health care for young people with psychosis.

The project was showcased in the ‘saving lives, saving money’ chapter of the NIHR Annual report 2014/15[3].