Keep up-to-date
Get in touch
The South West Mental Health Gap Practice Research Network (SW MH Gap PRN)
Understanding what currently happens and how best to support people in the gap between primary and secondary care (known as the ‘missing middle’) is an important area of work to explore as mental health services seek to respond to the needs of this historically underserved group.
In collaboration with people who have lived experience of using mental health services, NHS and voluntary, community and social enterprise (VCSE) services, the Universities of Exeter and Plymouth, have come together to jointly co-lead the ‘South West Mental Health Gap Practice Research Network’ (SW MH Gap PRN). This network will build upon the knowledge and expertise that currently exists within mental health care systems, such as NHS Talking Therapies, for anxiety and depression (NHS-TT) in primary care and secondary mental health care trusts to identify, innovate, support and evaluate the care being delivered.
Why is this important?
Clare Oakhill (Lived experience project group member) says:
"Reaching out for help with your mental health can be incredibly difficult, and it's often made harder when you find yourself falling through the gap between primary and secondary care. You know you're unwell but are told you're not ill enough, often leaving you feeling alone and without meaningful support. You continue to fight and spend a long time just holding on, struggling to cope day to day whilst hope fades. You become exhausted and hopelessness takes hold. Your mental health deteriorates further until you're no longer able to function, and you begin searching for other ways to manage, or escape the psychological pain you're experiencing because you've already learnt help isn't there."
"But it doesn't have to get to that point. If support is offered earlier, in the gap where people are struggling but don't meet traditional thresholds then we can make a real difference. When someone is heard and supported at the earliest stages of their distress, they're less likely to reach crisis. The spiral into hopelessness, disconnection, or harmful coping strategies can be interrupted before it takes hold."
Our aims are to:
- Provide training and development to upskill practitioners. We will organise a range of continuing professional development (CPD) events on topics nominated by local mental health services.
This includes a range of CPD events and will be supplemented with development and learning talks highlighting emerging knowledge and evidence of best practice for practitioners across the mental health system.
- Identifying areas and supporting innovation and evaluation of practice in real world settings.
The SW MH Gap PRN is keen to support local mental health systems to identify, adapt, or innovate practice. A regional approach to this work allows for the development of larger scale projects working across ICB areas or by offering opportunities for cross site learning as different areas develop new and innovative models of practice that can be shared.
Local systems and services can work with the universities on projects that they would like to evaluate. The universities and the local NIHR ARC have a small resource to support and partner with local services. A list of potential areas of interest have been identified by the project group and local services (see separate webpage)
The universities are keen to disseminate evidence of the good practice that is already taking place within the region using the knowledge exchange website https://sites.google.com/nihr.ac.uk/cmhtknowledgeexchange/home.
The intention of this work is to develop a coherent narrative to support local services to develop a vision alongside ICB`s and their commissioners to identify what works well. This will help to validate practice-based innovation alongside the generation of knowledge about what works effectively in more formal research.
Upcoming CPD events and training
Join Professor Barney Dunn (University of Exeter) for a half day online workshop on Monday 27th April 2026 (1.30-5pm) for an introduction to 'Augmented Depression Therapy' (ADepT), a novel evidence based talking therapy designed to build wellbeing and functioning alongside reducing symptoms of depression.
Click the link to book your place for this online workshop: https://www.eventbrite.co.uk/e/an-introduction-to-augmented-depression-therapy-adept-tickets-1976138669958?utm-campaign=social&utm-content=attendeeshare&utm-medium=discovery&utm-term=listing&utm-source=cp&aff=ebdsshcopyurl
Join us for Professor Stephen Kellett's inaugural lecture at the University of Exeter on Thursday 14th May 2026, 12.30-1.30.
The lecture will be available to attend online or in-person. More details are coming soon.
The SW MH Gap PRN is running a series of talks with the University of Exeter Mood Disorders Centre 'Think Tank' seminar series on Thursday's from 12.30-1.30 from September 2025- Summer 2026. You can find out all the details of this hybrid event here.
- Wednesday 28th January 2026- 'Working with people with bipolar in mental health services' with the AccEPT clinic and RISE clinic. Recording available soon.
- Wednesday 14th January 2026- 'Health economics in practice; Getting started' with Professor Annie Hawton. Recording available here: https://youtu.be/W45S8Q-PAaI
- Monday 8th December 2025- 'Brief CAT: A day workshop to help learn the Sheffield 8-session CAT protocol' with Professor Stephen Kellett
- Wednesday 2rd December 2025- 'Adapting CBT practice for autistic adults in NHS Talking Therapies services' with Professor Ailsa Russell
Current Projects
Cognitive Analytic Therapy (CAT) is effective for improving and maintaining better mental health, however there are no studies examining the effectiveness and acceptability of CAT delivered by training therapists.
Therefore, we are conducting an evaluation of CAT delivered by training therapists from September 2025 in the South West of England and Manchester.
We will deliver teaching for training CAT therapists around the utility of integrating routine outcome monitoring monitoring within their practice. Alongside this we will collect data to evaluate the effectiveness and capability of this.
Project status: We are delivering the teaching in September and October 2025.
UpLift-X is a multi-site trial evaluating the clinical and cost effectiveness of an online, Cognitive Behavioural Therapy (CBT) informed transdiagnostic group therapy (Barlow's Unified Protocol) for emotional difficulties in NHS Talking Therapies services.
This trial will give patients more choice of 'high-intensity' (also known as 'Step 3') treatments in NHS Talking Therapies services and is a potential way to reduce waiting lists.
This trial is funded by Innovate UK. The core trial team at the University of Sheffield and Rotherham Doncaster and South Humber NHS Foundation Trust, together with industry partners have developed a novel digital platform for remote group therapy which will support clinicians and participants throughout the therapy and trial.
Therapists involved in this trial will be delivering five different versions of the group therapy. All five versions cover the same therapy skills, but are in different order. This may help to tell us which aspects of therapy might support early response within treatment.
The Devon site (PI: Dr Asha Ladwa) is one of a number sites around the country recruiting to the UpLift-X trial.
Project status: The Devon site is recruiting and delivering groups.
As a result of the RESPOND trial we are working with the local Devon NHS Talking Therapies (NHS-TT) service to run mindfulness based cognitive therapy (MBCT) groups for clients who have not responded to high-intensity therapy for depression.
Project status: The NHS-TT MBCT practitioners have received their training and will run MBCT groups from October 2025 with an evaluation running alongside this.
Other Projects
This is one example of innovation within existing services that this network can support with.
A Prolonged Grief Disorder (PGD) pathway was established in response to a local NHS Talking Therapies for anxiety and depression (NHS-TTad) service identifying a significant subgroup of clients were presenting with prolonged grief reactions alongside depression, anxiety and/or PTSD in the aftermath of the COVID-19 pandemic.
What were the aims?
This led to an evaluation of the feasibility and effectiveness of the PGD pathway and the delivery prolonged grief disorder therapy (PGDT) within the Devon NHS-TT service.
Who were involved?
Sarah Goff (Operational and Professional Lead in TALKWORKS Devon NHS TTad service), led the evaluation in partnership with the Mood Disorders Centre, University of Exeter, and a specialist Prolonged Grief centre at Columbia University, USA
How was the evaluation run?
Experienced high-intensity therapists in the service were trained to deliver PGDT. This was supported through a bespoke training and supervision pathway within the service.
During the pilot of the pathway (April 2022-April 2024) 91 clients received PGDT, 81 of whom were included in this evaluation.
What were the findings?
- PGDT was feasible in this NHS-TTad service - 83% (67/81) completed at least 4 treatment sessions and drop out rates were low (16%).
- PGDT was effective in this service
- There were large improvements in combined depression and anxiety outcomes (82% reliable improvement; 72% recovery; 68% reliable recovery)
- and large improvements in grief symptoms (77% achieved reliable improvement on the 'Brief Grief Questionnaire' and 63% recovered)
The take home message- It is feasible and probably effective to implement a PGDT pathway in an NHS-TTad service
You can find the full evaluation article here
Updates since the evalaution
- The pathway has continued in the Devon NHS-TTad service.
- There was a recent 'Introduction to Prolonged Grief Disorder Therapy (PGDT)' online workshop with Bespoke training which is now available on demand to view.
- A qualitative evaluation of client's experiences of receiving PGDT has been been published and you can read it for free here
This co-produced article between Experts by Experience (EbE) and scientific experts for a special issue in Nature Reviews Psychology focuses on how to manage the emotional impacts of co-production work in mental health research.
The article outlines a framework that can be helpful when supporting collaborators and professionals involved in co-production work. The framework highlights:
- The need to build a sense of validation and acknowledge the emotional nature of the topic
- Build a sense of safety around the location, timing, and if working online around joining a meeting, with clear confidentiality boundaries
- Predictability to build mutual trust. This may include having a transparent and fair collaborator recruitment process, clear and timely communications, a terms of reference and complaints procedure, and clear guidance around reimbursement
- Promoting agency by agreed realistic and achievable goals, consultation with collaborators, training opportunities, key acronyms and language explained, and collaborators meaningful involvement across the project lifespan
The full article by Amy Burnham, Katie Marchant, Trish Oliver, Mary Ryan and Barney Dunn can be found online here: https://www.nature.com/articles/s44159-025-00415-3
This trial was developed through Lived Experienced individuals voicing the need for next step treatment options for individuals who are still unwell following high-intensity treatment for depression in NHS Talking Therapy (NHS-TT) services. For these individuals there is little next step psychological treatment options.
One option may be Mindfulness Based Cognitive Therapy (MBCT). MBCT is an evidence based psychological therapy, which combines mindfulness practices with elements from cognitive therapy to support individuals manage and prevent recurring depression. MBCT is an 8-week group intervention currently available in NHS-TT services to support depression clients with relapse prevention. The RESPOND trial was set up to understand whether MBCT can be used within NHS-TT services to support clients who have not previously responded to high-intensity depression therapy.
What were the aims?
To look at the cost and clinical effectiveness of delivering MBCT for individuals who had not previously responded to high-intensity therapy in NHS-TT services.
Who were involved?
The trial ran between January 2021-January 2024 and recruited from three sites in England; Devon, London and Sussex. The chief investigator for the trial was Professor Thorsten Barnhofer. The AccEPT Clinic and Devon Partnership NHS Trust recruited for the Devon site. Barney Dunn was the Principal Investigator of the Devon site, and Asha Ladwa was the trial manager (June 2022-September 2023).
A patient and public involvement and engagement (PPIE) panel led by Mary Ryan supported the trial.
The trial was funded by the National Institute for Health and Social Care Research (NIHR) Research for Patient Benefit (RfPB) Programme.
How was the trial run?
Individuals were recruited for the trial through NHS-TT services in England. A total of 234 participants were recruited who had not responded to a high-intensity psychological therapy for depression and had current depression at intake into the trial.
Participants were randomly allocated to received MBCT+ treatment as usual (TAU) or TAU only. MBCT consisted of 8 weekly group sessions online (delivered via videoconferencing) with an experienced MBCT practitioner. Individuals in the TAU condition were free to access treatment if they wished. Assessments were carried out at baseline, 10-and 34-weeks (6 months) post-randomisation.
More details about the inclusion criteria and methods of the trial can be found in the trial protocol.
What were the findings?
A total of 118 participants were randomised to receive MBCT+TAU, and 116 to TAU.
At 34-weeks (6 months) post-randomisation follow up, individuals in MBCT+ TAU group had significantly lower depression symptoms than those in the TAU alone group. These effects were small to moderate.
MBCT+TAU was also superior to TAU in reducing generalised anxiety symptoms and increasing mental wellbeing.
MBCT+TAU was cost effective, and cost £10.12 per person per session, assuming a group size of 13.
What are the implications of this trial?
MBCT should now be offered as an option for these individuals who are still unwell following previous high-intensity therapies for depression.
What's next?
The trial was published in the peer reviewed academic journal 'Lancet Psychiatry' and can be read here.
A series of ongoing research from the trial examining patient and therapist perspectives on feasibility and acceptability is also being conducted.
In Devon, we are implementing MBCT groups for individuals who have not responded to depression treatment, within the local NHS-TT service. See the above tab 'MBCT for depression non-responders in local NHS-TT service' for up to date information about the ongoing project.
Useful Resources
Recording available soon
An introduction to health economics in practice workshop. You can access the recording of the workshop on-demand here: https://www.youtube.com/watch?v=W45S8Q-PAaI
A webinar from the Mental Elf exploring treatment options for difficult to treat depression with experts by experience, clinicians, practitioners, researchers and policy makers.
You can access the webinar for free at anytime on YouTube: https://www.youtube.com/watch?v=JuMAaaJYMj0
An Introduction to Prolonged Grief Disorder Therapy (PGDT) workshop. You can access the on-demand workshop through the Bespoke Training Platform
As part of our research update series with the University of Exeter's Mood Disorders Centre Think Tank seminar series, Dr Julieta Azevedo presented on current research and future directions in Dialectical Behaviour Therapy.
The presentation is available for free to view at anytime through this link: https://youtu.be/JLOLVuQ7l6o
Interested in support from the South West Mental Health Gap PRN?
Follow this link and complete the form to get in touch: https://exe.qualtrics.com/jfe/form/SV_00aC7xabasBqxsG