PARTNERS2

Shaping mental health care through collaboration
PARTNERS2

This NIHR funded Programme aims to help primary care and community based mental health services work more closely together by developing a system of collaborative care based in GP surgeries for people with schizophrenia and bipolar disorder. 

The research team in Devon is led by Professor Richard Byng (Plymouth University) and Professor Nicky Britten (University of Exeter) and supported by a number of additional researchers (study team). The project is being undertaken in collaboration with Devon Partnership NHS Trust. 

This multi-site study has the potential to impact significantly on the future care of people with schizophrenia and bipolar disorder. ​

An important feature of the programme is its commitment to Patient and Public Involvement (PPi) and the importance of service user perspectives. These important contributions will weave through the whole programme, and feed directly into each work package through a combination of service user researchers’, lived experience research panels and PPi co-ordinators working across the three sites. ​

This project is supported by the NIHR Collaboration for Applied Health Research and Care South West Peninsula (PenCLAHRC).

About PARTNERS2

Overview

PARTNERS2 is a five year National Institute for Health Research (NIHR) funded research programme. The multi-site project is being conducted by a national team of experts lead by Professor Max Birchwood and hosted by Birmingham University and Solihull Mental Health NHS Foundation Trust. There are work streams in Birmingham, Manchester and Devon.

The focus of the research is to enable primary care (GP) and secondary care (community based mental health services) to work more closely together and to develop an evidenced based model of collaborative care to support individuals with schizophrenia and bipolar disorder. 

70 per cent of adult service users who have a diagnosis of schizophrenia or bipolar are seen in primary care alone. PARTNERS2 aims to develop a model of collaborative care for primary care with secondary care support. 

A research intervention will be undertaken to test the model of care and at the end of the five year programme the study team will have identified whether collaborative care for people with schizophrenia and bipolar disorder is likely to work. 

Research findings will be drawn from the views of people (including service users) involved in setting up and using the intervention, how well those who receive it are feeling, the quality of the theirs lives and recovery and the costs involved in running the intervention.

Background to study 

People with schizophrenia and bipolar disorder often live very different lives from the general population. Around 66 per cent live in poverty and isolation, most rate their quality of life as poor, and only 12 per cent are employed. These disparities are related to poor mental health, the side effects of medicines on both physical and mental functioning and ongoing prejudices towards mental illness. 

Previous research suggests that many individuals with lower levels of need have minimal and poorly co-ordinated primary (GP) and secondary (specialist community mental health service) care. Service users and professionals often feel that too much focus is placed on medication rather than wider aspects of health and societal life. Once stabilised on medication, services don’t always then focus on supporting these individuals to take the next steps in their recovery and fulfil their potential. PARTNERS2 aims to help primary care and community based mental health services work more closely together and focus on such aims. 

Aims 

The PARTNERS2 team are developing a system of collaborative care based in GP surgeries. The focus is for service users to be seen regularly by an experienced mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist. This person would see the service user regularly, help them help themselves and facilitate recovery in the broadest sense and, where required, call on the talents of other parts of the health service, particularly secondary mental health care and voluntary organisations. This simple idea needs to be carefully developed and tested and then set up as a pilot trial to see if it makes a difference to the care provided. This will be achieved through a series of work streams that will draw on a variety of research methodologies and outcome measures. 

Study team

Devon research team 

Professor Richard Byng, Plymouth University
Site Principal Investigator 
Plymouth University Peninsula School of Medicine and Dentistry 

Professor Nicky Britten, University of Exeter
Principal Investigator
University of Exeter Medical School

Dr Helen Lloyd, Plymouth University
PenCLAHRC Senior Research Fellow (Qualitative)
Plymouth University Peninsula School of Medicine and Dentistry

Dr Ruth Gwernan-Jones, University of Exeter
Qualitative Research Fellow 
University of Exeter Medical School

Ms Charley Hobson-Merrett
Research Assistant
Plymouth University Peninsula School of Medicine and Dentistry​

 

Birmingham research team 

Professor Max Birchwood
Chief Investigator 
Research Director, YouthSpace & Professor of Youth Mental Health, University of Warwick
Mental Health and Wellbeing
University of Warwick
Email: m.j.birchwood@warwick.ac.uk 

Dr Humera Khan (Meena)
Programme Manager, PARTNERS2 Programme, University of Birmingham
Primary Care Clinical Sciences
University of Birmingham
Email: h.s.khan@bham.ac.uk 
Tel: +44 121 414 6947

Details of the wider multi-site study team along with special advisors can be found at the central study website.

Study design and work streams

Design 

The study is being undertaken as a two-stage programme across six work streams with research undertaken in Birmingham, Lancashire and Devon. 

The first stage involves developing a model of collaborative care using evidence from service users, carers, GPs, Trust clinicians and commissioners. Evidence will also be gathered from secondary community mental health teams and their linked primary care (GP) practices to understand the nature of current care. The second phase will involve a randomized controlled trial to examine the effectiveness and acceptability of the new model. The research is divided into six work streams.

1. Work stream one: assessment of local care pathways and current services (0-12 months) 

Purpose: to describe the process of current care, help better target those who would most benefit from collaborative care and assess potential risk and safety issues. 

Methodology: observational retrospective cohort study (notes review), development of an economic decision analytic model and focus groups with service users and carers. 

2. Work stream two: development of a core outcome set (0-15 months and stated preference survey 15-30 months)

Purpose: to develop a core outcome set and measures for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting. 

Methodology: currently there is no gold standard for the development of core outcome sets. Our approach is therefore based on current practice and includes focus groups with key stakeholders, a Delphi process, systematic review and stated preference survey. 

3. Work stream three: development of the system of collaborative care (0-30 months) 

Purpose: to define and develop the key components of collaborative care for people with schizophrenia or bipolar disorder in an English context. 

Methodology: iterative development of the model building on the team’s recent Cochrane review using a range of qualitative and quantitative data. 

Further details of work streams one - three can be found on the wider study site. 

4. Work stream four: feasibility (0-24 months)

Purpose: to test the feasibility of patient and practice recruitment and commissioning. 

Methodology: qualitative work involving semi structured interviews, and patient and practice structured surveys. 

5. Work stream five: refine pilot trial design (25-30 months) 

Purpose: to draw the findings of the previous four work streams into a pilot trial protocol and process evaluation. 

Methodology: data synthesis and economic analysis. 

Phase two (31-60 months) 

6. Work stream six: cluster randomized pilot trial and analysis (31-60 months) 

Purpose: to establish the proof of concept of the intervention, estimate effects within a pilot trial and inform the design a definitive trial of collaborative care. 

Methodology: pilot cluster randomised controlled trial and process evaluation.

Patient and Public Involvement (PPI)

Role of PPi 

PPi is integral to this research study. PPi co-ordinators and service user researchers are also employed to work across each site. These important contributions will weave through the whole programme, and feed directly into each work package through a combination of service user researchers’, lived experience research panels and PPi co-ordinators working across the three sites. 

Service user research associates will be employed to work in each site 

Study advisory groups and focus groups (made up from people with lived experience) are being set up in Birmingham, Lancashire and Devon. 

For further details of how to get involved in Devon please contact the study team: partners2@plymouth.ac.uk or contact@mcpin.org.

 

McPin

The study team are working in collaboration with the McPin Foundation.

McPin are developing and delivering a public and patient involvement (PPI) programme for the study in collaboration with the research team. This will involve working alongside people with lived experience.

Ruth Sayers is the Public Involvement in Research coordinator for the study at McPin via contact@mcpin.org.