Wellcome Trust funding for UCL Division of Psychiatry Qualitative Researchers Working Group seminars and symposium

By Jake Fairnie, on 23 December 2017

On behalf of the UCL Qualitative Health Research Network, we are delighted to announce that the Wellcome Trust is funding our next 18-month programme of seminars and our 4th biennial symposium.  This programme, entitled “Crafting qualitative health research for the future,” is on the broad theme of “change” and will interrogate the conceptual and methodological problems it poses to qualitative approaches in health research.  We are especially interested in exploring the roles that qualitative researchers can take in supporting healthcare communities to anticipate and negotiate the social consequences of changing populations, global austerity, rapid technological advances, personalised medicine, and on-going demands for more patient involvement as well as the related tensions between in-depth qualitative work and timely dissemination of findings.  We look forward to engaging in this exciting programme of work.  For updates please see our Qualitative Researchers Working Group page and visit QHRN.

Community Navigator study: latest developments

By Dora Stefanidou, on 13 November 2017

We may not have blogged for a while, but we’ve been making a lot of progress on the Community Navigator study! Here are some of the highlights:

  1. We started recruiting people to take part in the study in April 2017 and hit our target of recruiting forty people in August 2017. The 30 participants who were assigned to receive the programme of support have begun to meet with their Community Navigators for 1:1 sessions and at the optional group meet-ups.
  2. We’ve begun running the meet-up groups. The idea behind the meet-ups is to provide opportunities for our participants to meet each other, discuss the programme’s aims and their own progress, and share information about local groups, activities and services that they have a positive experience of. The first group for our Camden & Islington (C&I) participants took place at the beginning of August and the one for our Barnet participants took place at mid-September.
  3. We’ve published the study protocol in the journal BMC Trials and you can take a look here: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2226-7
  4. Members of the study team attended the European Network of Mental Health Service Evaluation (ENMESH Conference) in the Netherlands. At the conference we presented our work on coproducing a Theory of Change for the project and it won a Best Poster Award!
  5. Follow-up Interviews and Qualitative data collection have begun and will continue until early next year.

If you want to know more, then keep reading below!

Outline of Meet-up Groups

War barnetBoth of our meet-ups followed a flexible agenda, which was co-produced by the Community Navigators and the study’s working group that is made up of researchers, experts by experience and clinicians. The meet-ups started with introductions and an icebreaker activity, in which people looked at photographs of places around their borough and tried to guess where they were. This activity was particularly successful in initiating discussion and giving people a chance to get to know one another. The icebreaker was followed by a short break for refreshments and a chance to mingle.

What was next? The Groups 4 Health quiz! Clients and Community Navigators completed a Groups 4 Health exercise that G4H-Logo-Purple-Largeinvolves ranking factors according to how important they are for our health. Once people ranked the factors, the Community Navigators showed them a graph of the general public’s rankings when asked the same question, and then showed participants another graph, which shows the real importance of each of these factors, based on the latest research. Contrary to what most people assume, social support and social integration are actually the most important factors for health in this list. People were really interested to hear each other’s ratings and a vigorous discussion followed about which factors are important and why. Each of the meet-ups came to an end after about two hours.

Reflections on Meet-up Groups

Attendees from both groups provided very positive feedback, and found the groups helpful and enjoyable. A second group has been planned in C&I for November 2017, and in Barnet for January 2018. We were very pleased that, following the group meetings, some of the participants have made connections and arranged to meet up together, or arranged a future Community Navigator session together with another participant.

Poster Prize

posterA poster designed by Vanessa Pinfold (Study co-applicant, McPin Foundation) about the theory of change behind the Community Navigator programme won the best poster award at the ENMESH conference in the Netherlands. The topic of the conference was “Conceptualising, measuring and influencing context in mental health care: from the individual to the society”, and took place on October 5, 6 & 7, 2017.  We won the poster prize for Theme 3: Approaches – using the patient’s own context, which was 250 euros. Our poster showed our current version theory of change (Version 18!), and celebrated that we had involved researchers, service users, and clinicians in the process.


Trial protocol paper

The final phase of the Community Navigator study is a feasibility trial. We will use this to further test and refine the Community Navigator programme of support, and check that recruiting and retaining people to take part in a randomised trial of the intervention can be achieved. The trial protocol, which sets out how we will run the trial, was registered in advance, and has now been published in BMC Trials. It is available here: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2226-7


You can share your thoughts with us on Twitter or get in touch with Dora by emailing theodora.stefanidou.15@ucl.ac.uk. You can also find out more about the study on our main webpage, https://www.ucl.ac.uk/psychiatry/research/epidemiology/community-navigator-study/.

Scholarships for Camden and Islington NHS Foundation Trust staff for research MSc study

By Sonia Johnson, on 25 July 2017

Camden and Islington NHS Foundation Trust announces scholarships of between 20% and 50% total part time fees to support clinical staff in North London Trusts to undertake the UCL MSc in Mental Health Sciences Research based in the UCL Division of Psychiatry, commencing September 2017. Awards can be used in combination with other scholarships or study leave funding. The course provides a practical and stimulating training in research skills, appropriate for mental health professionals with a strong interest in becoming researchers/academic clinicians.

These scholarships are open only to staff currently working within Camden and Islington NHS Foundation Trust. Scholarships are especially intended for clinicians, but applications from staff without clinical qualifications who have worked in the Trusts for at least two years will also be considered. Trainees who are qualified clinicians, such as junior psychiatrists on rotation, will also be considered. Service users undertaking paid roles such as peer support workers are also encouraged to apply.

Applications are via the UCL applications procedure for the MSc in Mental Health Sciences Research, supplemented by a statement regarding suitability for the award. Mrs Chris Coup, MSc administrator, can be contacted for details of the applications – c.coup@ucl.ac.uk.

Deadline: 31 August 2017

UCL MSc in Mental Health Sciences Research

Inequities in support for relatives bereaved by psychiatric patient suicide

By Alexandra L Pitman, on 24 April 2017

Inequities in support_32017 has already been a busy year for mental health policy announcements. On 9th January the Prime Minister announced a package of measures to transform mental health support, highlighting the “shocking reality” of 13 deaths by suicide a day in England. On the same day the Department of Health published a progress update on the suicide prevention strategy, setting out an intention to improve responses to people bereaved by suicide. This had been one of the two overarching objectives of the revised 2012 suicide prevention strategy, but three years on the progress report acknowledged that “delivery in this area has not progressed enough to ensure that there are good quality and consistent suicide bereavement services in every area across the country”.

These pronouncements on service provision after suicide bereavement have direct relevance to NHS mental health trusts. The recent 20 year review of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness reported that 18,172 psychiatric patients in the UK had died by suicide over the period 2004 to 2014, representing 28% of general population suicides. The MRC-funded systematic review we conducted in the UCL Division of Psychiatry has described the effects of suicide bereavement on mental health and suicide risk, and there is a growing awareness that each suicide has an impact on relatives, partners, friends, and mental health professionals. Guidelines set down in 2009 by the National Patient Safety Agency indicate that after the suicide of a psychiatric patient, mental health teams should offer families and carers “prompt and open information” and “appropriate and effective support” as well as involving them in a routine post-suicide review. Until now it has not been clear how often this happens in practice.

Inequities in support_2This month our analysis of National Confidential Inquiry data, in collaboration with the NCISH team at the University of Manchester, was published in the US journal Psychiatric Services. This found that relatives of psychiatric patients who died by suicide from 2003 to 2012 were not contacted after the death by members of the mental health team in 33% of cases. In our analysis we had hypothesised that specific, potentially stigmatizing, patient characteristics would influence whether the family was contacted after a psychiatric patient’s suicide. We found that a patient’s forensic history, unemployment, and primary diagnosis of alcohol or drug dependence or misuse were independently associated with a reduced likelihood of staff contacting the relatives in the event of their suicide. We noted that these were markers for suicide risk in themselves. However, minority ethnic group, and recent alcohol or drug misuse were not associated with staff contacting relatives. Violent method of suicide was associated with an increased likelihood of being contacted.

We felt these findings suggested that relatives experience inequities in access to support after a potentially traumatic bereavement. This was a concern given the recognised association of suicide bereavement with suicide attempt, and the possibility that patients’ relatives share risk factors for suicide. Mental health trusts should use these findings to revise their policies on serious and untoward incidents; incorporating protocols for the provision of support to relatives and to trust employees after a patient’s suicide. Considering the impact on fellow patients, whether on wards or in social networks, is also important. Resources such as Help is at Hand, published by Public Health England in 2015, list organisations providing support and information and should be disseminated where indicated. Recent commissioning guidance published by Public Health England makes recommendations, informed by our research, on delivering support after a suicide as part of a wider suicide prevention strategy.

I am grateful to Isabelle Hunt, Sharon McDonnell, Louis Appleby and Nav Kapur at NCISH for agreeing to this collaboration. We presented the findings at the RCPsych General Adult Psychiatry and Child and Adolescent Psychiatry joint faculties’ annual conference in Birmingham in October 2016, which was an opportunity to disseminate the findings to clinicians. Onwards dissemination to mental health staff and clinical leaders has the potential to improve the support offered to people bereaved by suicide, in keeping with national suicide prevention strategy.

Click this link to access the article.


  • Pitman A, Hunt I, McDonnell S, Appleby L, Kapur N.  (2017) Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings Psychiatric Services 68(4); 337-344 doi: http://dx.doi.org/10.1176/appi.ps.201600004



Pausing for thought: Community Navigator Study Working Group Meeting 7

By Jessica Bone, on 7 March 2017

This was our seventh working group meeting and the first since last summer. Our research team, experts by lived experience, and clinicians from Camden, Islington and Barnet all came together to review our progress so far. Since the working group meetings in the development phase of the study, a team of three Community Navigators has been recruited, completed training and started preliminary testing of the programme of support. The Community Navigators wrote a blog on their experiences of training with us.

We started this meeting looking at feedback from our Community Navigators and some of the participants that have taken part so far. In total, eight participants have tried out support from a Community Navigator and have had between one and seven sessions. Feedback was very positive. Participants particularly enjoyed their meetings with the Community Navigators and receiving personalised guidance about new things to try or places to go. Although it is quite early to tell, people said they were feeling a little better, were getting out more and some had increased confidence. However, they did have concerns about maintaining this progress after their Community Navigators’ support ends and some found it challenging trying new things.

mapping tool and connections plan small









Our Community Navigators had lots to say about the study so far. They had a clear understanding of their role and what they are trying to achieve, and have really enjoyed getting to know participants. As with all roles, they did identify challenges, particularly with making as much progress with people as they’d hoped. We discussed some strategies to overcome these challenges, one of which was to have some top-up training on using a solution-focused approach. Together with the guidance received in supervision, which the Community Navigators really valued, this should help the Community Navigators continue to develop the support they are able to offer. The Community Navigators also thought the mapping and goal setting tools developed by the working group (pictured above) were helpful to use in their meetings.

So, now that we’ve had some feedback, what are the next steps?

Participant guide cover smallOne of the things that came out of the interviews was that some participants didn’t self-identify with feeling lonely.  This could be an issue as part of what we’re trying to achieve in this study is to help people feel less lonely. However, the questionnaires that people completed at the start of the study indicated that all participants were experiencing some level of loneliness, even if they didn’t describe themselves using this label. As the working group felt that the people who would benefit most from the support of a Community Navigator would be those with some feelings of loneliness, we’ve decided to ask people to complete a brief loneliness scale before we offer them the chance to take part in the study. We also realised that we need to try and describe this programme of support as clearly as possible to potential participants, so that they are on-board with its aims. We’ve developed a participant guide (pictured above) which we hope will help people to understand what the Community Navigator programme is all about.

If you’ve been following the blogs on the development of the Community Navigator programme, you’ll know that we tried out running the Groups4Health programme for those taking part in the pilot phase. This a group intervention, developed in Australia, which provides people with the knowledge, skills, and confidence to increase their social connectedness, and in particular, their group-based social identifications. You can read more about it on their website. The Community Navigators who facilitated these groups really enjoyed them and told us how interesting they were. Unfortunately not as many participants as we’d hoped made it to these group sessions.  We used this working group meeting to discuss why we thought this was, and how we can increase group attendance in the next phase. We then split into smaller groups and discussed four options going forward:

  1. A brief version of Groups4Health, covering the material in three sessions
  2. Skills workshops on motivating yourself and maintaining positive and healthy relationships
  3. Meetings to introduce the programme and to share interests and experiences of community navigation
  4. No group, but linking people up who have shared interests

Let us know your thoughts on which you would choose!

After lots of debate weighing up the pros and cons of the different options, we all thought that number 3 would work best, but that we should also build in the best parts of the other options. We decided to organise at least two group meetings – one during the first half of participants’ support from their Community Navigator, and one towards the end of the programme. A third session may be added, depending on whether people want it. Attendance is optional but Community Navigators will encourage and support everyone to join in.

The group will provide opportunities for people to meet, chat about the programme and their progress, and share any helpful resources and experiences. The group will follow the principles of our programme with a socially-focused person-centred approach; each meeting will have a loose agenda tailored to the needs of those taking part. The working group also pointed out the importance of having cake at these meetings, so refreshments will be provided!

We’re all looking forward to our next working group meeting, where we’re going to use the feedback gathered so far to update the programme’s Theory of Change.

Sadly one of our Community Navigators is moving on to a new full-time job at the end of March, but we are currently recruiting a new Navigator to join our team.

You can share your thoughts with us on Twitter or get in touch with Jess by emailing jessica.bone.15@ucl.ac.uk. You can also find out more about the study on our main webpage, https://www.ucl.ac.uk/psychiatry/research/epidemiology/community-navigator-study/.


Compass-150 pixels

Forthcoming Nature Paper

By Noorjaben B Monowari, on 25 November 2016

171116 NatureCover

In a new systematic review featured on the front cover of Nature and amidst a rapidly changing global political landscape owing to legalization, the availability of synthetic analogues (commonly termed spice), cannavaping and an emphasis on the purported therapeutic effects of cannabis,  Dr Bloomfield and colleagues review the complex effects of THC, the main ingredient in cannabis, on the brain’s reward system. They describe the ways in which these may alter brain function to increase the risk of mental health problems.  Owing to the complexity of the cannabinoid-dopamine interactions that take place, there is conflicting evidence from human and animal studies concerning the effects of THC on the dopamine system. Acute THC administration causes increased dopamine release and neuron activity, whereas long-term use is associated with blunting of the dopamine system.  and provide a framework for future pharmacology research  they argue must examine the long-term and developmental dopaminergic effects of THC.

Reflections on Community Navigator Training: Getting Navigation Ready

By Jessica Bone, on 10 November 2016

The training for the Community Navigator programme took place throughout September 2016. The five day itinerary was thoughtful and comprehensive, and we gained insight into the rationale behind the research. During the first day, there was time to discuss previous research findings and the evidence base which highlights the adverse health impact of loneliness and social isolation. This provided a useful theoretical overview and rationale for the study, as well as our role within it. Building on this, we all reflected upon the differences between emotional and social loneliness and considered possible barriers to people identifying as being ‘lonely’ – such as a feeling of being stigmatised. We also acknowledged various social, cultural and political factors which can contribute to exclusion, isolation and loneliness.

Our training programme incorporated a visit to Wellbeing Enterprises in Runcorn, a project which undertakes social enablement and engagement work with people referred via their GP. All three of us found this an interesting and informative day. It was particularly useful to go out and shadow some of the team members working there. We met several of the people referred, observed meetings in GP surgeries and generally gained a more in-depth understanding of their role and how the project supports people to build social connections.

Wellbeing Enterprises logo






On return to UCL, we considered the Community Navigator role and how we might engage people referred, including the importance of respecting their knowledge and experiences, and being mindful of people’s preferences in activities and social connections. One of the key challenges identified was how we can best keep a clear social focus without replicating clinical support already provided or becoming involved in other issues like housing. Without a clear focus, the role may be perceived as offering a counselling or befriending service or having a generic support function. We agreed that explaining the Community Navigator role clearly at the outset to people will be vitally important for managing expectations. In the time-limited role (ten sessions), planning work carefully and developing a collaborative understanding of the aims will maximise benefits and avoid potential misunderstandings. Accordingly, we discussed the goal setting tools and ways in which these could be used to maintain focus and chart progress.

As we are based across Camden, Islington and Barnet, we utilised some of the training to consider community resources available and how we can identify and explore these resources in more depth. We thought about resources that we already know about, and put together the mind map shown below. Locating appropriate groups and activities which are welcoming and inclusive will be a key factor. It was agreed that checking out these factors and developing our relationships with providers is important, meaning that referrals can be made with greater confidence. This means people will be more likely to have positive experiences.

Mind map of resources

One of the training days focused on how Community Navigators could work with people to identify and define their social networks. We role played using the mapping tools developed by the research team and working group. It was agreed that these tools help to identify important relationships, places and activities for people and will provide a visual representation of their social networks. This will enable them and us to identify how to expand and build on existing connections and revisit previously enjoyed activities and interests. We discussed how, for some people, revisiting relationships from the past may cause some distress. We will need to manage this carefully and sensitively and, in some circumstances, support from the clinical teams may be necessary. Having experts by experience involved in this aspect of training allowed us to consider more challenges and dilemmas.

Finally, throughout the training programme, we discussed solution-focused approaches and the theories underpinning these. There was discussion regarding how this approach is a ‘good fit’ and consistent with the aims of Community Navigation. This includes the emphasis upon recognising and developing existing strengths and resources, ways of emphasising positive aspects of peoples’ lives and the focus on what is ‘going well’ in spite of challenges.

We all very much enjoyed the training. There was a good balance between information provision and discussion alongside interactive exercises, role plays and group reflection. This format enabled us to have input into the development of the Community Navigator role and what it might look like in practice. It was also very helpful to have input from clinicians from both trusts, Anna (Barnet CCT) and Rob (Camden and Islington CDAT team) who gave their time generously and shared their expertise in ways which were immensely valuable to us all. Thanks also to the wonderful supportive research team at UCL and McPin for their kindness, patience and good humour, as well as provision of lunch, snacks and copious amounts of tea and coffee!

What training do you think people need in a Community Navigator role? We’d love to hear your thoughts especially if there’s something essential that you think we’ve missed! Comment below or contact Jess via jessica.bone.15@ucl.ac.uk. You can also find more information on our study website and  follow us on Twitter @ucl_loneliness.

This blog was written by our Community Navigator, Jane Plimmer, with input from the other Navigators, Cecilia MacDougald and Zubair Matin.


UCL Psychiatry’s Naaheed Mukadam interviewed on TRT World

By Jake Fairnie, on 28 September 2016

UCL Psychiatry’s Naaheed Mukadam was interviewed on TRT World for Alzheimer’s Awareness Month earlier this week. Watch it here (Naaheed’s section starts 6 minutes 46 seconds in):



Experience does not necessarily make clinicians better at predicting survival

By Jake Fairnie, on 16 September 2016

Clinicians ImageResearch from the UCL Psychiatry Marie Curie Palliative Care Research Department has been reported on the front page of The Times, as well as by The Daily Telegraph and The Sun.

The study reveals that clinicians’ estimates are frequently inaccurate with a tendency to over-estimate rather than under-estimate survival.

Final development: Community Navigator Study Working Group Meeting 6

By Kate C Fullarton, on 31 August 2016

Our sixth meeting – the final one in the development phase of the study – began with one of our researchers, Johanna, giving an update on the recruitment of the community navigators. We have recruited three community navigators and we wish them a very warm welcome to the team. We then had a quick look at a draft of the community navigator manual, which provides an overview of the study, the support programme and the community navigator role, and asked the group for feedback. We will be able to share the manual once it is finalised so keep your eye on our project news for updates.

We then turned our attention to the Theory of Change that we have been developing over the course of the working group meetings, through the evolving models, which you can see on our blogs from weeks 1, 2 and 3. The aim of a Theory of Change is to provide a visual description of the process through which the support programme leads to the desired outcome, in this case, a reduction in loneliness. This Theory of Change will develop through the study, as we seek feedback from the community navigators, people receiving their support, and other people involved in the study. Below, you can see the latest draft of our Theory of Change. What do you think? Does this capture how you think the community navigator programme might work?


Theory of change 3


One of our experts by experience then introduced the latest plan for the community navigator training. The community navigators will receive five days of training specific to their new roles. The planned training days are jam-packed and will be delivered by members of the research team, clinicians from the CCT and CDAT team, experts by experience and navigation experts from Wellbeing Enterprises. We also discussed the importance of allowing space for community navigators to reflect on their existing strengths, learn from each other, and guide us about what they want to get from the training, and we’ll make sure this is incorporated into the training.

The study’s project manager, Bryn, then asked the group if, and how, they would like to be involved in delivering the training. Ideas included input from clinicians about the client group and their social needs and pairing community navigators with members of the working group with lived experience of mental health problems to try out some of the components of the programme, such as the mapping exercise and goal setting. This would give community navigators an opportunity to practice their skills and to get insights from the experts by experience about what they think works well. It was also suggested that providing the community navigators with techniques to help overcome setbacks should be incorporated into the training, and we’ll be adding this before training begins in September. We then split into groups to think of scenarios to use throughout training, which will help the community navigators to think through exactly how they would go about supporting a range of people with different interests and needs.

After a much needed coffee break, we came back to revisit the mapping tool, which we looked at initially in week 3. Johanna asked the group to discuss the following questions regarding the mapping tool, which is shown below:

  • Are we just mapping people or people, places and activities?

There was general consensus that people, places and activities should be included in the mapping process.

  • What is the time frame we are mapping?

The group agreed it would be useful to include present, past and future relationships if they are relevant to the individual the community navigator is supporting. A member of the group suggested that the community navigator begins the mapping activity by asking about present relationships, but considers past and future in their approach.

  • Are we rating positive/negative impact of people/places/activities like the McPin Foundation do with their Wellbeing Maps or are avoiding rating and mapping closeness?

There was general consensus that it would not be useful to categorise relationships as positive or negative in this study as we are adopting a solution-focused approach, and that neutral colours should be used throughout the document to ensure that this does not happen.

  • When would the tool be used? Just at the beginning or throughout or again at the end?

The group suggested that it might be interesting for the participants to compare a map completed at the beginning of the study to their map at the end. However, most importantly, people felt that the map should be used flexibility, depending on what the individual thought would be useful for them.

Mapping my social world 2

















We then also returned to the goal setting tool, which we looked at in previous meetings.  We considered four example tools, produced by our researcher Kate, which were inspired by Wellbeing Enterprises’ ‘Five ways to Wellbeing’ pledge tool. The ‘My Connections Plan’ shown below, with some minor changes, was the group’s preference. This was because it includes a section on ‘Strengths and resources to help me’ to remind people of their assets, as well as a ‘Time frame’ section, to give people an end-point to aim for with each goal. Can you think of any ways that you’d improve this plan further? Get in touch and let us know!


My connections plan


After a very productive meeting we briefly reflected on how much we have achieved as a group over only a few months. We also said goodbye to our research Kate, and we look forward to welcoming Jessica Bone on 1st September. Our next working group meeting will be early next year, and we expect the community navigators will join us to feed back on what it is actually like working in the role. Now, it’s time to finalise the manual, train the community navigators and recruit the participants for community navigators to work with!

Get in touch with Jess via jessica.bone.15@ucl.ac.uk if you have any thoughts about the study or follow us on Twitter @ucl_loneliness.