Lead academic Professor Paul Farrand introducing the 2017 Mental Health Challenge
Tim Francis (Mental Health Commissioning Manager) shares his views on the work the students produced
Mark Blackmore (Time to Change) shares his views on the work the students produced.
Mental Health Challenge academic Professor Paul Farrand featured in Daily Mail as part of #headstogether campaign!
Mental Health: The Treatment Gap
Available to all undergraduates interested in mental health, this is a fascinating and impactful challenge broadening your understanding of the barriers to accessing mental health treatments, and how these could potentially be overcome.
The mental health treatment gap represents the difference between the prevalence of a mental health difficulty and the number of people accessing evidence based treatments (Kohn, 2004). With the prevalence of mental health difficulties increasing across the world (Steel et al, 2014), the treatment gap is having an increased impact on the individual, their families, society and the economy and places general levels of wellbeing under threat.
Within this grand challenge you will work with peers in small ‘enquiry groups’, each focusing on a particular barrier contributing to the mental health treatment gap. In doing so it is hoped you will develop a better appreciation of the barrier being focussed on in the enquiry group and will be encouraged to consider potential solutions to help improve access to psychological therapies to enhance wellbeing.
You will have the opportunity to network with a range of external stakeholders to share their perspectives on barriers contributing to the treatment gap, including mental health and health professionals, service users and community groups and organisations making contributions to this area, You will also be exposed to the work of clinical researchers and training academics within the Clinical Education, Development and Research (CEDAR) group within Psychology. Members of the CEDAR group have national roles within the NHS Improving Access to Psychological Therapies (IAPT) programme and are helping to improve access to psychological therapies across the world in countries such as Canada, Hong Kong, Japan and New Zealand.
In 2017, the Mental Health Challenge welcomed a series of expert speakers, including Ursula James (IAPT Programme Manager, NHS), James Woollard (Senior Clinical Fellow in Mental Health, NHS), and Colin Bray (Service Development Manager, Devon Libraries), as well as talks by academics from other disciplines at the University: Johanna Harris (English) and Melvyn Hillsdon (Sport and Health Sciences). Students also had the opportunity to interact with members of the Lived Experience Group.
Students chose which theme they wanted to focus on, and within their theme they were allocated into small groups that were as interdisciplinary diverse as possible. Having taken inspiration from the speakers, the students spent the week carrying out their own project looking at what could be done to reduce the mental health treatment gap. Student groups in the ‘why people don’t seek help’ theme came up with ideas for increasing the likelihood of individuals seeking mental health support. Students in the ‘computer based self-help’, ‘reading’ and ‘physical activity’ groups focused on how each of these areas could improve wellbeing, and how participation in each of these areas could be improved. All students produced outputs as part of their project, which included campaigns, posters, educational programmes, and a video. Each of the outputs are shown below.
On the Friday of Grand Challenges Week, students presented their projects to all other students on the Challenge and an expert panel. In the afternoon, they showcased their work at an exhibition in the Forum, which was attended by students from all Challenges, University staff and members of the general public.
At the end of the week, students reflected on the skills that they had developed during the week, and areas where they felt that there was room for improvement.
The timetable for the 2017 Challenge shows how the week was struxtured.
These are the outputs that students on the 2017 Challenge produced.
Why People Don't Seek Help: Language and Wellbeing
Students in this group looked into why students at Exeter might not want to access help from Wellbeing Services and thought that the language used on the website may be off-putting. They rewrote the text using more welcoming language, and then ran a study (as described in their poster) to assess the perception of both the original and the revised text. They found that respondents preferred the revised text, suggesting that language use affects the perception of psychological treatment. They are looking to carry their project forward by discussing their findings with the Head of Wellbeing Services and the Director of Education and Student Support.
Why People Don't Seek Help: Parent Awareness
Students in this group created an initiative to educate both teenagers and parents about mental health, and hoped that this would promote healthy dialogues that allow the child to feel comfortable in expressing their feelings. Their idea was for year 9 students to carry out group projects based around mental health as part of their PSHE lessons. The teenagers would express their research through creative means, such as drama, dance, art, cookery, songs etc, and this would all be presented at an annual showcase, which parents would attend.
Students in this group also wrote a 3200 word Mental Health Treatment Gap action plan for their initiative.
Why People Don't Seek Help: Stop Romanticising My Diagnosis
Students in this group came up with a campaign, which was not an end in itself, but a message to change the terms of debate in which mental illness is discussed. They felt that images of depression in the media are romanticised, and that people are only engaging with the issue superficially. They are campaigning for mental illness to be conveyed in realistic, concrete terms rather than vague, distorted and romanticised imagery, and created this poster. The future aims of the campaign are to publicise their hashtag #morethan1picture further to get more people sharing personal stories, and increasing awareness of the realities.
Why People Don't Seek Help: Mind the Treatment Gap
Students in this group came up with a public health campaign to improve understanding and awareness of the most prevalent mental health issues. Their aims were to empower people to talk about their difficulties more easily by giving visibility to what is usually invisible, and to reduce stigma by increasing the understanding of the perspectives of people with mental health difficulties. They did this by producing a series of posters which pictured common scenarios. They decided to link their project with the Mental Health charity, Mind.
Why People Don't Seek Help: Kidz Kind
Students in this group produced a protocol for an educational workshop, aimed at children aged 8-9. The workshop they designed comprised of two sessions, with the goals of helping children to understand emotions, teaching them strategies for coping and raising awareness of mental health to reduce stigma. As part of one of these sessions, they designed a board game. The group felt that the stigma surrounding mental health was one of the most significant reasons for people deciding not to seek help, and so wanted to create something to break this stigma. They chose to target young children to break the stigma from its grass roots. This is the poster and presentation they produced.
Computer Based Self Help Therapy
Students in this group looked into online delivery of mental health therapies. They found that there were a lot of different apps available for improving wellbeing, and that online treatment was potentially more accessible, flexible and cost-effective than face to face treatment. However, they felt that there is still a lack of awareness that computer based therapies exist. They produced a video to promote the use of online treatment as a coping strategy, showing a day in the life of two people with depression; one using a mental health app and the other not using an app.
Reading to Improve Wellbeing: Fresh Reads
Students in this group created an interactive book club, based on the rationale that reading fiction has a positive impact on an individual’s ability to understand themselves and others, making them more skilled in social interaction. The project focuses on improving the wellbeing of students, through reading and discussing short stories and poems. The website will feature a different theme each month, with literature which resonates with these themes. The themes chosen will be in line with the academic year, i.e the September focus would be loneliness or homesickness and the exam period theme would be stress. This is their promotional poster. They are hoping to continue the project in this academic year.
Reading to Improve Wellbeing: The Bibliotherapists
Students in this group produced a scientific proposal for an experiment, which explored the effects of different kinds of reading (either aloud, or silently) on wellbeing, specifically anxiety. Different roles were assigned to individuals in their group, based on their educational background. For example, English and Classics students researched the best form of literature to use in the study, whereas the Science-based students provided the scientific framework and rationale to be used for the study. They produced a poster to present the proposal for their experiment, which could potentially pave the way for future findings into the beneficial effects of reading.
Physical Activity to Enhance Wellbeing: 'Mind your Head' Gets Active
Students in this group came up with the idea of a free graded exercise programme, based on the principle of behavioural activation. They recognised that participation itself could be challenging for someone with mental health problems, so they tried to make it as user friendly and accessible as possible. They created a leaflet which explained their concept, and general benefits of being more active. They also created three walking/running routes around Exeter which people could do at their own leisure or with one of the established groups. They are hoping to continue this project in collaboration with the Mind your Head Society.
Physical Activity to Enhance Wellbeing: Brain Peeps
Students in this group focused on raising awareness of how physical activity could combat susceptibility to mental illness. To do this, they planned an event to run during Freshers’ Week. They would have facilitators based in the Forum approaching people and asking them for suggestions and testimonials about how to become more active and how physical activity has helped them before. They would encourage people to write their tips and ideas on their poster. They would also discuss common misconceptions with people, for example that physical activity doesn’t need to be intense exercise.
Enquiry groups are the subtopic of the challenge that students focus on for Grand Challenges Week. These are the enquiry groups that ran in 2017.
This enquiry group will explore a range of factors that may reduce the likelihood of individuals seeking mental health support, or seeking intervention to improve their wellbeing. Whilst the focus will be upon patients in general, specific barriers that may affect university students seeking or accessing help to improve their wellbeing or to treat a mental health difficulty will also be explored to enable group members to draw upon their own knowledge and experiences. The understanding developed within this enquiry group may be used to inform the enquiry group output, developing an intervention to address patient level barriers.
The delivery of Cognitive Behavioural Therapy (CBT) through computer platforms is recognised by the National Institute of Clinical and Health Excellence (NICE) for the treatment of depression and specific anxiety disorders, as a low intensity therapy within a Stepped Care approach. Whilst computer based delivery is evidence based, offers greater flexibility in delivery, provides patients with increased choice and offers the potential for costs savings for the NHS, uptake amongst service providers is lower than anticipated. This has raised concerns within the NHS that prevalence targets set with respect to improving access to psychological therapies will not continue to be met. Developing a greater awareness regarding the availability and diversity of CBT approaches alongside appreciation of the costs and benefits associated with CBT may be used to help inform the enquiry group output; the development of a ‘pitch’ to encourage greater uptake of CBT by services commissioned through the IAPT programme.
The sheer number of people seeking treatment for mental health problems has placed the NHS and mental health service providers under immense pressure. Whilst the delivery of psychological therapies must be overseen by NICE, there remains potential to supplement evidence based therapies by considering other more innovative interventions that have the potential to improve wellbeing. This enquiry group will focus on a current innovation; reading fiction to maintain and enhance wellbeing at times of life transition, such as leaving home for the first time to go to university. There is the potential for student outputs to obtain data that can be used to inform the development and implementation of a reading based intervention to ease transition into university life, currently being led Dr Johanna Harris from the English Department.
Within England the IAPT programme has invested heavily in the delivery of evidence based psychological therapies through mainstream service providers. However, such a narrow focus is not suited to everyone and this is a limitation, especially when other evidence based approaches exist. For example, NICE recommends the use of physical activity programmes for the initial treatment of mild to moderate depression. The focus in this enquiry group will be upon examining the use of physical activity, not only for the treatment of depression but also as a way to maintain or enhance wellbeing. This will help to inform the enquiry group output focussing on ways to promote physical activity either amongst people to help maintain wellbeing, people with depression as a treatment or service providers.