Improving health and reducing health inequalities for people with severe mental illness: the 'Closing the Gap' Network+

People with severe mental illness (SMI) such as schizophrenia and bipolar illness die on average 20-25 years earlier than those without such disorders. The causes of reduced life expectancy are things such as heart disease or diabetes (and its complications) or cancers associated with lifestyle factors. Rates of smoking and obesity are much higher in this population, and people with SMI often lead sedentary lives. Housing is often poor, and people do not benefit from the opportunities offered by exercise and interaction with the natural environment.

The need to improve physical health is recognised in a document known as the Five Year Forward View (FYFV) for Mental Health, where it is described as 'one of the greatest health inequalities in England'. Any solutions to these complex problems requires collaboration between researchers from different backgrounds and with different skills. For research to have impact, it is important that people with experience of SMI (and those who care for them) are involved from the outset. The University of York has a set of researchers with complementary perspectives who have not historically worked together. We will produce research that addresses and reduces this mortality gap. Our plan is to grow our Network with the help of the funds offered, and we will deliver a programme of research and collaboration. Our activities will be overseen by a steering committee with local, national and international expertise.

The initial activities of our network will involve four areas of work. The first is led by international experts in how people interact with and benefit from natural environments ('green- and blue-space'). The second area of work will seek to harness the potential of the large amounts of information that are recorded on how people with SMI use health services and the natural environment ('big data'). We will make links between data that have not been connected before. The third area of work will explore the potential of digital technologies (such as smartphones and 'apps') to improve the physical health of people with SMI. The fourth area of work will explore the potential of the arts and creativity to understand and improve the physical health and wellbeing of people with SMI.

Collaboration is at the centre of this Network, and we have put in place a plan to ensure that researchers work together to find creative solutions to the problem of the mortality gap. We have also identified issues which cut across the four research areas that we have prioritised. One factor which links each of the themes is the inequality that people with SMI experience when compared to the rest of the population. We have enlisted a research team with a very strong track record in this area.
Our Network will run over four years. During this time we will hold events which will encourage collaboration and where new members are added to the Network. Investments will stimulate new initiatives and collaborations. Research in this area is challenging and takes time. Our task will be made easier because we bring to this collaboration a number of resources including a group of people with SMI who have already agreed to be invited to take part in research.

In preparing this bid we have assembled partners from the NHS, social care services, environment organisations, local government, business and the voluntary sector. We have formed a collaboration with an important national charity who represent the interests of people with mental ill health (the Mental Health Foundation). From the beginning we will think about how the results of our research can have impact in society. We see the CTG-Network+ as a spring board for a much larger and long-lasting programme of work to address health inequality for people with SMI. Whist the work of the Network+ will start in the University of York, we will ensure that we form strategic alliances with people working in other universities in the UK (& internationally).

The CTG Network+ team is committed to the authentic co-production of knowledge with research users. This commitment is exemplified by the legacy of partnerships and projects (led by Gilbody and the Network+ team) that the CTG Network+ builds upon. The CTG Network+ team actively use co-production and co-design with those with lived experience in project design, delivery and translation of findings and have worked with partners to develop innovative pathways to impact such as web resources (AH/M009181/1 - http://www.listeningtovoices.org.uk/) and youtube animations (e.g. DIAMONDS NIHR ref. RP-PG-1016-10004; CASPER NIHR ref. 08/19/04; CHEMIST - NIHR ref. 14/186/11). The CTG Network+ funding will allow the team to extend those partnerships and deliver a broader range of interdisciplinary co-produced research outputs and impacts to a wider pool of potential beneficiaries (detailed in the Pathways to Impact section). Many of the partnerships outlined in the CTG Network+ have evolved over a number of years (e.g. Cochrane, NHS Trusts, the Equality Trust, Yorkshire and Humberside CLAHRC) and some are new and emerging (e.g. Mental Health Foundation, Wildlife Trusts). All the partnerships have been carefully considered to allow the CTG Network+ to build links and contacts with a broad and diverse range of potential beneficiaries and users (outlined below). It is through the exciting new combinations of partnerships that the CTG Network+ intends to realise a step-change in our ability to close the mortality gap for those with lived experience. For example, teaming up the technical and creative expertise of our ESPRC funded digital creativity labs extensive range of SME partners with our CLAHRC and NHS delivery colleagues and HWB SMI cohort members in Research Focus 4.

Who will benefit and how will they benefit from this research?

Service users, families and carers: The CTG Network+ outputs will contribute to new ways to reduce the mortality gap. This will have a profound impact on the lives of those with SMI their family and carers.

The public: Mental Health problems are systemic in our modern society and many of the interventions and outputs of the network will be ultimately applicable to more common mental disorders. The benefits of the research will extend beyond the SMI community. The Network+ research outputs will also contribute to improved mental health literacy and support a reduction in the stigma associated with mental health more broadly and the misrepresentation of SMI. The public will also benefit from cost savings in the NHS and broader benefits system which could result in the redirection of government funding.

NHS and social care organisations: Equipping health care professionals with a range of alternative tools (available both inside and outside traditional NHS structures) to support the prevention of chronic, preventable and modifiable physical health problems will have numerous benefits both to direct patient care but more broadly in terms of cost- saving efficiencies. Improved access to training materials and improved guidance (e.g. NICE) to support staff to better integrate the treatment of mental and physical health.

LAs/Public Health/CCGs/LGA: Improved access to training material and datasets to enable local decision makers to make decisions to reduce health inequalities and improve population health.

Governments: New evidence to support policy change to drive a reduction in inequalities and reduced health and social care costs.

SMEs: New solutions that involve working with new and diverse partners will provide opportunities for business and SMEs to innovate.

Mental Health NGOs: New evidence to help support NGOs to empower their community of supports and to lobby for change in the quality of health support provided for people with SMI.

Research Funders: Identification of key new research priorities.