The (UMHC) was created by Student Minds in partnership with leading higher education bodies and thousands of staff and students. 91ֱ�� was amongst the first group of universities to sign up as members of the , which brings together universities committed to making mental health a university-wide priority, to share practice and create cultural change. 

The is a voluntary accreditation scheme that supports universities to understand their areas of strength and development to inform ongoing improvement in mental health and wellbeing, recognising good practice along the way. 

As part of the assessment process, we conducted a robust, evidenced-based assessment of our whole-university approach against the principles of good practice within the , including any challenges, weaknesses, and areas of improvement. A self-assessment report, a student-led report and a two-day onsite visit from Student Minds which involved over 100 staff and students, were all part of the assessment process.

Overall, Student Minds stated: “in many areas we can be confident that the University is sector-leading” and that they were “encouraged that the University is going in the right direction.” Student Minds felt that “the University is largely doing well to meet the Principles of Good Practice and is doing an incredible job to work towards having a whole university approach to mental health.”   

In awarding the University with the UMHC Award, Student Minds highlighted several examples of excellent practice, including: 

• Within the External Partnerships and Pathways theme, Student Minds “were particularly impressed with the University ’s commitment to the partnership work across the Greater 91ֱ�� Universities Student Mental Health Service. This is widely being acknowledged as novel, innovative and sector leading.” 
• Within the Progression theme, Student Minds “recognised as excellent practice that the University now offers 3.5 years (versus the standard 3 years) of funding to funded PhD students in recognition of the positive impact of this on completion and PGR student wellbeing.” 
• Within the External Partnerships and Pathways theme, Student Minds noted that “the University is part of a sexual violence network across 91ֱ�� that includes the HEI’s, police, council, and NHS. This approach is potentially sector-leading and an example of excellent practice in developing external partnerships.”

Speaking about the UMHC Award, Sarah Littlejohn, Director of Campus Life and UMHC Lead said: “The UMHC Programme has given an additional focus and impetus to our existing institutional priority of student and staff mental health and wellbeing. It has helped to shine a light on our whole-University approach, encouraging us to reflect on our current practice across all the different framework themes. We are proud to have achieved the UMHC Award which marks the latest part of our journey in our commitment to continuous improvement around mental health and wellbeing, and our dedication to its ongoing development.” 

The University will continue as members of the UMHC Programme and will now start to use the Award Outcomes Report to inform and feed into our work in this area. Our priorities for the next 6-12 months will focus on the UMHC Framework themes of Student Voice and Participation, Learning, Teaching and Assessment and Inclusivity and Intersectionality. 

Aisha Akram, Wellbeing and Liberation Officer, University of Manchester Students’ Union commented: 'I'm really pleased that we have received this award and I particularly appreciate the commitment to including myself and my fellow officers at the Students Union within countless panel discussions, in order to ensure that the University's commitment to the student experience with our support service is driven by student feedback. 

“We will continue to work with the University to ensure that we all stay committed to working in this area and building on the recommendations offered to us. I'm excited to enhance collaboration between the Students’ Union and the University to push for the best possible student experience.”

Head of Colleague Wellbeing, Helen Brewis, said:  “I’m delighted we have achieved the UMHC Award, reflecting the commitment we place on the wellbeing of our students and colleagues and how we have worked as a whole university community on our approach to mental health.

"Over the last two years, we have significantly developed our approach to supporting our colleagues’ mental health and wellbeing. The process of working towards the award has helped us to reflect on what is working well and where we can do more. We look forward to using the recommendations from the Award Outcomes Report to continue developing our approach to promoting and supporting good mental health and wellbeing at work.” 

• For further information about UMHC Award holders, please visit the  
• For further information about the UMHC Programme, please email UniversityMHCharter@manchester.ac.uk.

“A ban would cause young people to find alternatives to existing social media platforms that may be harder for parents, educators, researchers and legislators to study and monitor,” said Dr Eiko Fried, Associate Professor in Clinical Psychology at Leiden University. “Rather than imposing restrictions, efforts should be directed towards educating young people, their guardians and educators on navigating the digital landscape safely, and on regulations which ensure that social media companies design age-appropriate features and algorithms.”

Wellbeing inequalities: LGBTQ+ young people report lowest life satisfaction

Overall, this year’s #BeeWell survey results, which analysed data on young people from across all 14 Local Authorities in Greater 91ֱ��, Hampshire, Isle of Wight, Portsmouth and Southampton, found that young people are generally satisfied with their lives. However, there are noteworthy inequalities in life satisfaction, mental wellbeing and emotional difficulties across gender and sexuality.

• 41.2% of young people who identify as lesbian or gay reported a high level of emotional difficulties (e.g. worrying a lot, feeling unhappy, having problems sleeping). This figure rose to 44.5% for young people who identify as bisexual or pansexual. This is compared to 12.1% of heterosexual young people. High scores in this area could indicate that young people may require additional, preventative support
•  When considering gender differences, 22% of cisgender girls reported a high level of emotional difficulties compared with 6% of cisgender boys. The proportion reporting high levels of emotional difficulties rose to 33.9% for transgender and gender diverse young people and 21% for those questioning their gender
• These inequalities are also seen in life satisfaction and mental wellbeing scores, with gay and lesbian young people experiencing the lowest wellbeing and reporting that they are least satisfied with their lives, followed closely by bisexual and pansexual young people, and those who identify as transgender and gender-diverse

Building on the results, the #BeeWell programme is working with schools, partners and the wider community to act on these and other findings in the data. This has included an exciting collaboration with The Duke of Edinburgh’s Award which is working to deliver the scheme for young people in those neighbourhoods identified as having the lowest wellbeing.

“The Duke of Edinburgh’s Award brings young people together and enables them to discover new passions, gain new skills and connect with their community - however, opportunities for personal development and enrichment, which we know help boost confidence, give people hope and drive success, aren’t always accessible to everyone – we’re working hard to change that,” said Ruth Marvel, CEO of The Duke of Edinburgh’s Award.

“Using insights from #BeeWell, over the last 18 months, we’ve licensed eight new organisations in Greater 91ֱ��, offering the DofE to some of the country’s most marginalised communities. Looking ahead, we’re excited to widen access to the DofE further, as we identify areas in Hampshire, the Isle of Wight, Portsmouth and Southampton. Through this work, we hope to give young people the positive experiences, skills and capabilities they need to succeed in the future, which in turn, will boost wellbeing and optimism and that’s something we all so want to see.”

“It is great to see hope and optimism is improving for our young people - however, it is disappointing to see that the inequalities, particularly in regard to gender, are still so stark when it comes to life satisfaction and wellbeing,” said Professor Jess Deighton, Director of Innovation Evaluation and Dissemination at  Anna Freud. "We now need to work together to target these groups, understand what they need and start making the impact that is required to enable these young people to be heard and for their wellbeing to be improved."

“The findings from the #BeeWell survey provide us with an invaluable insight into the needs and aspirations of young people," said Anthony Harper, Deputy Director for Children's Care at the NHS Hampshire and Isle of Wight Integrated Care Board. "It will support us in our drive to ensure early identification and support is available to children and young people where and when they most need it.”

“I am a firm believer in the importance of expanding the voices of young people in our society and giving solutions to the challenges we face,” said Uyuhansi Fernando, North East Councillor, Hampshire Youth Parliament. "All young people should have equal access to opportunities that help their wellbeing. I am confident that by listening to the voices of young people through #BeeWell, we can have a better understanding of the modern world ahead of us.”

#BeeWell Neighbourhood Data Hive

Following the release of the headline findings from the #BeeWell survey, an interactive public dashboard will show more detailed results and insights into young people’s wellbeing across 64 different neighbourhoods in Greater 91ֱ�� and 46 different neighbourhoods in Hampshire, Isle of Wight, Portsmouth and Southampton. This will be published online at the end of March 2024, with a view to inspiring action across local government and civil society.

Read our full report here: .

For further information on the #BeeWell survey and its initiatives, please contact beewellprogramme@manchester.ac.uk 

The new analysis shows that between 2019 and 2021, 46,200 people lost their lives due to Death of Despair in England – the equivalent of 42 people every day.

However, in the North East of England more than twice as many people lost their lives due to Deaths of Despair compared to London.

Deaths of Despair is a collective term for deaths from alcohol, drugs and suicide, which tend to occur much more frequently in socially deprived communities.

The study, led by academics from Health Equity North (HEN), The University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater 91ֱ�� (ARC-GM) examined local authority data to identify geographical trends and risk factors that contribute to these kind of deaths.

The analysis found that northern regions and coastal areas of England are experiencing a much higher burden of mortality from these avoidable causes.

Out of the 20 local authority areas that experience the highest rates of Deaths of Despair, 16 are in the North, and all of the top 10 areas are in the North.

Conversely, none of the 20 local authorities with the lowest rates of Deaths of Despair are in the North.

The analysis also looked at associated factors that predict the risk of these kinds of deaths; living in the North was the strongest predictor. Local authorities with higher proportions of unemployment, white British ethnicity, people living alone, economic inactivity, employment in elementary occupations, and people living in urban areas had higher rates of Deaths of Despair.

The study found that:

• On average, 14.8 per 100,000 more people die from Deaths of Despair in the North compared to the rest of England
• Even after accounting for multiple social and economic factors, living in the North of England was associated with a 5.8 per 100,000 increase in Deaths of Despair rate
• More than twice as many people died from Deaths of Despair in the North East of England than they did in London (54.7 per 100,000 and 25.1 per 100,000 respectively)
• The highest rate of Deaths of Despair in England (at local authority level) is in Blackpool – almost 2.5 times the national average
• Three areas in England, all in the North, experienced more than double the average Deaths of Despair – Blackpool (83.8 in 100,000 deaths), Middlesbrough (71.6 per 100,000 deaths) and Hartlepool (70.5 per 100,000 deaths)
• Alcohol-specific deaths made up almost half of Deaths of Despair in England, accounting for 44.1% of all such deaths
• Deaths of Despair accounted for 2.9% of all deaths in England
• Deaths of Despair were highest among people aged 45-54 (55 per 100,000)
• Deaths of Despair accounted for 2 in 5 deaths in people aged 25-29 (41.1% of all deaths)
• Coastal local authorities had a significantly higher average Deaths of Despair rate than inland local authorities (41.6 per 100,000 compared to 31.5 per 100,000)

The study is believed to be the first of its kind to explore geographical patterning and contributing causes of deaths of despair in England.

The researchers are calling on government to prioritise preventative policies which address the longstanding inequalities across England, with fair funding allocation distributed according to need.

Christine Camacho, lead author and PhD Fellow NIHR ARC-GM, said: “Our study shows that some of the risk factors of deaths of despair have a more pronounced impact in the North of England, where inequalities in health and wealth are persistent and have widened during recent decades.

“As well as specific public health interventions to prevent deaths from drugs, alcohol and suicide, we need to move further and faster with Levelling Up in England to tackle the underlying inequalities which are leading people to die from despair.”

, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at The University of Manchester, said: “Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored – it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature.

“This research provides policymakers with a novel insight into the associated social factors of deaths of despair, which can help when developing comprehensive strategies that not only target specific risk factors but also consider the intricate relationships among these causes, contributing to more effective prevention and intervention efforts.”

• In September 2023, there was a 27% rise in new autism referrals over the last year. 
• In July 2022, more than 125,000 people were waiting for an autism assessment by mental health services, an increase of 34% since the previous October. By July 2023, this number had risen to more than 143,000. Figures published in September 2023, show there were 157,809 patients with an open referral for suspected autism.
• 93% of children did not receive an appointment within 13 weeks of being referred. 
• The number of children yet to receive an appointment after 13 weeks has increased by 36% since Covid-19, and there has been a 21% increase in the last twelve months.  
• More than one in four parents have waited over three years to receive support for their child.
• The evidence shows that children born to mothers without educational qualifications will receive an autism diagnosis two years later than their peers, and that issues around timely identification and support are exacerbated for girls, who are more likely to be misdiagnosed and diagnosed later than boys, or not at all.
• Children and young people from ethnic minority backgrounds are experiencing lower rates of identification of autism and often experience more severe difficulties.

The report warns that the failure to provide the right autism support can lead to poor long-term outcomes for autistic children, including an increased prevalence of connected conditions such as mental ill health and a greater risk of school exclusion or not attending school. Data from the Connected Bradford database included in the report reveals that children who had been referred but were still waiting for an assessment were at greatest risk of being excluded from secondary school. 

Autistic children who had a diagnosis were less likely to be excluded from school, compared to those awaiting an assessment, suggesting a diagnosis and subsequent support has a protective effect. With waiting times increasing, there is a growing risk to education outcomes, with evidence suggesting that many autistic children are ending up in expensive Alternative Provision.

The report also describes how a major barrier to existing systems is the perceived need for a medical diagnosis of autism before any child can receive support, with the perception among schools that this is a requirement, preventing some children from accessing support. Given the long waiting lists, many autistic children are not receiving the support they need because they do not have a formal diagnosis.

It makes three key recommendations to Government which have the potential the decrease the long-term costs associated with not acting early:

• Building effective partnerships between education and health professionals for assessing and supporting autistic children. This should include delivering assessments in education settings and making a holistic offer of support in schools and nurseries before and after a formal diagnosis is made.
• Providing and extending access to mandatory Continuing Professional Development (CPD) courses for health, education, and social care professionals that improve understanding and awareness of autism (and related issues). These courses should include information on how to create “neurodiverse friendly” environments, and particularly raise awareness of autism in girls and ethnic minority groups. Additional training should be co-produced by individuals with lived experience and delivered to professionals and integrated into undergraduate health and education professional training to improve the identification of autistic girls.
• Creating formal partnerships at a local authority level comprising sector leaders (including schools, health, voluntary services, faith, universities, educational psychologists, and businesses) to oversee a prioritised governmental ward-level approach to addressing the autism crisis. The partnership should focus on its most disadvantaged wards and provide leadership in trialing data-driven, community and family co-produced, “whole system” approaches to improve autism support with and through education settings.

“The number of autistic children seeking support is at a record high and the number waiting for an assessment has rocketed since Covid,” said Anne Longfield, Executive Chair of the Centre for Young Lives. “The autism assessment crisis is leaving thousands of children without the support they need and parents having to battle their way through a nightmare process that can take years to resolve.

“The pressure and stress this is putting on families and children can have terrible and damaging consequences for mental health and for children’s education chances. Autistic children with a referral who are waiting for an assessment are at significantly greater risk of exclusion from school, with all the further risks that can bring. If waiting times continue to increase, so can the risk of increased exclusion and poorer educational outcomes for autistic children.

“The evidence shows the need to move to a system of support that responds to the needs of autistic children, rather than waiting for diagnosis before any help appears. Without urgent reform, we cannot hope to improve the life chances of the next generation.”

• The inequalities identified in Year 1 of the #BeeWell data have persisted; girls are reporting significantly lower levels of wellbeing than boys, and LGBTQ+ young people have significantly lower wellbeing than their cisgender heterosexual peers. The data remains consistent when comparing two different cohorts of Year 10 pupils across the two years.
   
• Wellbeing scores have declined slightly as young people have moved from Year 8 into Year 9. This is in line with wider research about how young people’s wellbeing declines as they get older.
   
• As young people get older, they are less likely to feel like they get enough sleep to feel awake throughout the school day. 41.8% of Year 9 students report that they aren’t getting enough sleep to concentrate at school, which is around 9 young people in an average class of 22. This is compared to 36% of Year 8 pupils who said they do not get enough sleep in 2021.
   
• There has been a decline in young people reporting that they have good places to spend free time. In 2021, 75.5% of young people in Year 8 agreed or strongly agreed that they had good places to spend free time, compared to 67.6% of those young people when they were surveyed again in Year 9 in 2022.

The #BeeWell survey results have overall remained consistent over the two years of the programme, meaning that there is an increased confidence on how accurate the findings are – as over 60,000 young people have told us their views.

In response to the findings, the #BeeWell Coalition of Partners and Greater 91ֱ�� schools have already begun to take action to respond to what young people across the city-region are telling us. This includes investment to support the wellbeing of LGBTQ+ young people, to encourage girls to get involved in physical activity, and the completion of a social prescribing and youth-led investment pilot in five neighbourhoods of Greater 91ֱ��.

With two successful years of Greater 91ֱ�� leading with the #BeeWell programme a second programme will be launched in Hampshire, The Isle of Wight, Portsmouth and Southampton (HIPS) from September 2023, in a new partnership with the four local authorities. The expansion of the programme marks the second Integrated Care System area to deliver the #BeeWell Programme and will help to establish any differences between different parts of the country. The programme is already being kickstarted in the region with the process of co-designing the local survey with young people already underway in 15 pathfinder schools.

Building on experiences and learning in Greater 91ֱ��, and national endorsements from the Fair Education Alliance and Times Education Commission, the new partnership with HIPS is the next step of #BeeWell's ambition to ensure that wellbeing is prioritised and measured consistently and rigorously in schools and communities in every corner of England by 2030.

“We have a 10-year plan to take #BeeWell to scale nationally and create a public policy agenda for young people that gives equal weight to wellbeing and attainment," Neil added. "The next step of this plan is our expansion to the Hampshire and Isle of Wight Integrated Care System area. This is critical to understanding local variation, issues of sustainability, scaling up, and synergy.  The learning generated will inform the development of the #BeeWell model to ensure our approach can be embedded and sustained across wider geographies over time, as we seek to fulfil our mission of making young people’s wellbeing everybody’s business.”

"The #BeeWell surveys have facilitated a real breakthrough in conversations about young people’s health, wellbeing, and activity,” said Cllr Mark Hunter, Greater 91ֱ�� Portfolio Lead for Young People. "The results have helped to shape some important changes in Greater 91ֱ�� to support young people and their wellbeing. This year’s findings show that more action needs to be taken to tackle the inequalities in wellbeing between girls and boys, and with LGBTQ+ young people. The support of Greater 91ֱ��’s schools has been integral to #BeeWell, and in Year 2 shows how schools have used the survey results to make positive changes for their pupils. I am looking forward to Year 3 of the survey and the positive changes the results will initiate.”

“The #BeeWell data has enabled us to understand our community with greater focus - we are able to react strategically to areas of fragility and celebrate the strengths and feedback we gain from our young people," said Glyn Potts MBE DL, Headteacher at Saint John Henry Newman Catholic College in Oldham. “Put simply, it is the closest we have to a microscope into the minds of our young people and enables us to be reactive to their needs and a stronger community.”

“The Youth Steering Group weren’t surprised that there remain inequalities in young people’s wellbeing in Greater 91ֱ�� - unfortunately, it is what we see in school every day, particularly pressure on girls," said Ruby, a member of the #BeeWell Youth Steering Group. “It’s good that the data remained consistent – it means things aren’t getting worse and gives us hope that things can get better.”

"The Youth Steering Group would like to open a conversation about how difficult it is for young people to find the balance between your emotions and all the things you have to get done in a day before you can get enough sleep. There are a lot of expectations on young people with homework, revision, caring for ourselves as well as others, especially as you get older. We want to extend this conversation to include adults' wellbeing, too, as they set expectations for younger generations on managing everything that matters to our wellbeing.”

For more background on the #BeeWell project, visit . 

The service - which is open to students at the University of Bolton, University of Salford, University of Manchester, 91ֱ�� Metropolitan University and the Royal Northern College of Music - provides mental health assessment, support and treatment to students, so that they can fulfil their university experience and ambitions.

The service works closely with existing university mental health services (such as University Counselling and Wellbeing services) and other mainstream mental health services (including voluntary and community organisations) to provide a joined-up approach to preventing students across the region from ‘slipping through the gaps’.

Dr Timothy Alnuamaani, Consultant Psychiatrist at the Greater 91ֱ�� University Student Mental Health Service team, GMMH, said:

“As students move into higher education, they may be embarking on independent living for the first time, moving to new cities and making new friends. They are often moving away from their usual support networks. They may also not be registered with a GP in the university area, or may move address frequently.

The service launched in September 2019 - just months before the start of the COVID pandemic. Throughout the pandemic, the service stayed open and continued to offer face to face and online appointments. Support and treatment such as group therapy also continued online.

Since the launch, over 960 students have been supported by the service.

Student feedback from September 2019 up to the end of Jun 2022 found that 97% rated the staff as good or excellent, 97% rated the information given to them as good or excellent, and 98% rated the overall experience as good or excellent.

One student, who would like to remain anonymous, said:

“There is no doubt in my mind that the student mental health service has saved my life. When I started with the service, I felt completely lost and broken. It felt as if the service dropped out of the sky when I desperately needed it most.

“The staff were absolutely fantastic, I can't put it into words, but fantastic doesn't do them justice. To put a body back together is one thing, but a mind? That is far less textbook.

“I received nothing short of the support I needed, in the way I needed it, for as long as I needed it; right from being quite unwell, to being knee deep into recovery, all the way until I confidently felt I could hold my own.

“I am in utter disbelief of how much of a difference the support and therapy has made, and how it has in turn, enabled me to achieve things that weren't even on my radar because I thought they were out of reach.

“This year I did not just scrape through my finals, but I managed to perform better than I ever have. I ranked in the top 6% students in my subject in the country which I still cannot believe - it landed me my dream job. None of this would have been at all possible without the support from the service. I can't believe a service like this exists and I feel very lucky that I was able to access it.”

Simon Merrywest, Director for the Student Experience, University of Manchester, and Co-Chair of the Student Mental Health Service Board, said:

“This unique partnership has transformed the support available to students studying in Greater 91ֱ�� and in need of a range of interventions provided by the NHS.

“Evaluation of the service has already demonstrated significant benefits for students and university wellbeing teams, whilst simplifying referrals into the NHS and helping to secure more timely access to the most appropriate support”.

Greater 91ֱ�� was one of five regions to pilot a university model. Following this success, in June 2022, that up to £3 million will be invested over the next academic year to roll the model out across the country.

For more information about how a referral can be made into the Greater 91ֱ�� Universities Student Mental Health Service,

The UK’s first national pledge calling on senior leaders in NHS mental health trusts, public bodies and commissioning to declare their commitment to reduce ethnic inequalities in mental health care launches today (Wednesday 5^th August 2020) with 30 inaugural signatories.

A ‘Statement of Intent’, the pledge is spearheaded by the in response to the lack of progress made over the past 30 years to tackle ethnic inequalities for those diagnosed with a severe mental illness, and the disproportionate risks Black, Asian and minority ethnic (BAME) communities face in mental health services.

Against the backdrop of George Floyd’s killing, the Black Lives Matter anti-racist protests worldwide, and the systemic inequalities highlighted by Covid-19, CEOs, medical and nursing directors of NHS Mental Health Trusts, commissioners and public bodies (as pledge signatories) will take action to:

1. Initiate fundamental service level changes to reduce ethnic inequalities in access, experience and outcomes.
2. Measure, monitor and report the nature and extent of ethnic inequalities and progress made.
3. Work in partnership with local BAME communities, service users and relevant community agencies.
4. Provide national leadership on this critical issue.
5. Ensure inclusive and sustainable change in our localities and communities.
6. Support timely and progressive research and policy development.
7. Contribute to a biannual progress update as part of this Statement of Intent.

James Nazroo, Co-Director, Synergi Collaborative Centre and Professor of Sociology, The University of Manchester: “Ethnic inequalities in the experience of mental health services for severe mental illness are stark, and they have continued for many years. So, it is great to see so many political and health and social care leaders sign up to this pledge, and the commitments within it. In Greater 91ֱ��, we have seen real dedication to working in partnership across sectors and with VCSE organisations and local communities to identify and implement solutions to address these inequalities. The inequalities are deep and difficult to address, but the partnerships involved, and the leadership offered, gives us a real opportunity for success.”

Warren Heppolette, Executive Lead, Strategy and System Development, Greater 91ֱ�� Health &Social Care Partnership, said: “Greater 91ֱ�� Health & Social Care Partnership wish to send out anunequivocal message, through this pledge, that we fully commit to supporting the elimination of ethnicinequalities in our mental health system. It is important that everyone understands the importance ofstriving to deliver ethnic equality and how they can personally support the pledge.”

Kamaldeep Bhui, Director, Synergi Collaborative Centre, and Professor of Psychiatry, University of Oxford: “I’m delighted as Director of the Synergi Collaborative Centre to launch this powerful alliance between the NHS, local government, charity providers and BAME community groups in a national movement to transform mental health systems to be less institutionally racist, more enabling, thoughtful and inclusive; one that respects the workforce and acknowledges that all people need health care in the NHS. This is a moment in which the defensiveness and disguises for racism have fallen away. Yet this moment will pass, if we are not mindful, meaning that the usual practices will re-establish themselves to further compound and sustain racial disparities in health.”

Researchers at have worked with , an online mental health service for young people, to produce a report on digital mental health support for children and young people.

Launched in 2004, Kooth provides counselling, advice, and support to young people (aged 11-18) struggling with their mental health. It is run by XenZone, an innovator in digital mental health.

The report is a characterisation of the person-centred, holistic work carried out by Kooth on a daily basis. In defining the “Theory of Change” for Kooth , researchers have identified the characteristics and mechanisms of the service that lead to better mental health and wellbeing.

Some of the key findings from the report include;

• The physical absence of a therapist allows children and young people to express themselves, focusing exclusively on their situation and their feelings without fear of judgement or dismissal.
• The anonymity of the service means the young person feels it is safe to open up and can get to the key issues they wish to address more quickly.
• The site’s accessibility means that young people can use it when they need to, going back for more support as required. The young person therefore, is in control of the pace of support, which shifts the power dynamic away from the therapist.

This Theory of Change will be used to inform a new set of outcome measures XenZone is developing and intends to validate. The data collected will be used to make recommendations to the NHS on best practice for evidencing the impact of digital mental health support services in England.

Dr Terry Hanley led the research and co-authored the report. He said; “There is a growing need to define what mental health and wellbeing support looks like today so that we have an accurate understanding of the potential of new approaches and new modes of delivery.

“It also follows that we need to evolve our understanding of outcome measures so that we avoid using old systems to measure newer, broader services. The ambition of this project, therefore, was to articulate and share the Theory of Change for the Kooth platform; future work will address the outcomes required to evidence this work.”

Kooth is supported by Sir Norman Lamb. Speaking about the report, Sir Norman said; “It outlines the different routes they take and defines the most helpful mechanisms for change, which may lead to better outcomes and, ultimately, happier lives.”

He added; “It isn’t a study you’ll find anywhere else. The deep and rich data that XenZone has accumulated over the last 15 years is unique.”

The full report can be downloaded from .

With 25 years’ experience of working with students, Sarah Littlejohn offers her thoughts on how universities, staff and peers can help manage students’ mental health.

Currently the within the at the University, Sarah has more than 25 years of experience working with students in the higher education sector. Much of her career has been at the University, but she has also worked as a psychotherapist, trainer and supervisor, with specialist training in Cognitive Analytic Therapy.

She has been leading the development of the Greater 91ֱ�� University Student Mental Health Service (which had its launch event on Monday 18 November) a dedicated centre to support higher education students with mental health needs. The service is a joint project with the other Greater 91ֱ�� universities, as well as the NHS, and is funded in part by the region’s devolved health budget.

In many ways, Sarah is still seeing the same problems among students as when she attended university, such as struggling with the transition to a new stage, or difficulties in feeling like they belong. “What’s changed,” she notes, “is that universities have become much more attuned to developmental challenges and hurdles.” They are more aware that “the typical undergraduate is growing up at university, as well as getting a degree.”

Part of this growing awareness is the increasing variety of help on offer. Aside for the new mental health service, the University is also a part of the , an online mental health community. “Big White Wall is available to staff and students,” Sarah points out, explaining; “all they need is their University email address.”

Other forms of help come from an unlikely source – fridge magnets and keychains. The University has been distributing mental health advice and helplines via these items, something Sarah believes can make a significant difference. “You may not call them,” she says, “but the fact you know they’re there can be helpful to some people.”

One of the things which student surveys have revealed is how great a difference seemingly small actions can make. “Every contact counts,” Sarah comments, “whether it’s a smile from a building porter, or a “How’s it going?” from an academic tutor.” The University offers to all of its staff.

Most of all, however, Sarah believes the culture around adversity and mental health at universities needs to change. “People often come to university and are told it’s going to be the best years of their life,” she says, “and we hope it is, but within that, there will be times of struggle, loneliness and anxiety, and these are all absolutely normal.”

If you're a student and feel you need more support please visit the University's . You can  to the full conversation and the rest of the University's podcasts on .

Starting his first technology business aged just 14, Professor Vikas Shah MBE is one of the UK’s most high-profile serial entrepreneurs and philanthropists.

As well as being an Honorary Professor of Business and Entrepreneurship at the Alliance 91ֱ�� Business School (AMBS), he is CEO of the Swiscot Group and an investor in the tech sector. Vikas has a formidable CV and has been extremely successful throughout his entire professional and working life.

But, regardless of all these achievements, he came close to taking his own life. It is something he is very open about and, for World Mental Health Day, he has about his ongoing struggles with anxiety and depression.

One of the key things Vikas warns of is that being successful in your personal and professional life shouldn’t come at the cost of your health, no matter what. He says there is an unhealthy perception in some professions that the more hours you put in, the better you must being doing: “There’s this weird mantra in entrepreneurship, which is a curiously European, British thing, where people think they have to work 20 hours a day.”

It is something Vikas has first-hand experience of and now strongly warns against: “When you burn out, it’s horrible, and it teaches you a hard lesson. If you don’t take time out for yourself, you very quickly find that what you do for a living becomes who you are, and that’s a very dangerous place to be.”

Outside of work pressures, Vikas also thinks there is a toxic masculinity in society that not only contributes to various mental health issues in men, but even stops them from talking about it. He adds: “The caricature of masculinity that magazines purvey and persuade people they need to buy into is really dangerous.

“In the same way that toxic femininity pervaded women’s magazines and persuaded everyone they had to be size zero and all think kind of thing. But I think that is one really specific issue. I think the wider issue is around the fact that men as a group vocabulary for discussion emotion.”

Vikas now uses every opportunity he can to speak out and raise awareness about mental health issues and implores others to do the same, as it might literally save their lives as it did with his: “It was only because I’d made a phone call to the Samaritans, that I didn’t do it [take his own life].

“The weight of not saying it was so profound, that the act of being able to speak to a stranger took the weight off a little bit. It committed it to the real world – it wasn’t a demon in my head anymore.”

As well as being a business man, Vikas is now also a renowned public speaker with a massively popular and interviews with some of the world’s most prominent leaders and thinkers including Buzz Aldrin, Melinda Gates and Sir Richard Branson. You can to the full conversation and the rest of the University's podcasts on .

We’ve all heard that ‘food is good for your mood’. Now, a new study into mental health and nutrient supplementation has taken a leap forward by establishing the gold standard for which nutrients are proven to assist in the management of a range of mental health disorders.

As well as an established relationship between poor diet and mental illness, there is now a vast body of research examining the benefit of nutrient supplementation in people with mental disorders.

To unpack this research, an international team of scientists led by researchers at the University of Manchester and NICM Health Research Institute, Western Sydney University examined the ‘best of the best’ available evidence. The aim was to provide a clear overview of the benefit of specific nutrient supplements - including dosage, target symptoms, safety and tolerability - across different mental disorders.

The world’s largest review of top-tier evidence, , examined 33 meta-analyses of randomised control trials (RCTs) and data from 10,951 people with mental health disorders including depression, stress and anxiety disorders, bipolar disorder, personality disorders, schizophrenia and attention-deficit/hyperactivity disorder (ADHD).

Although the majority of nutritional supplements assessed did not significantly improve mental health, the researchers found strong evidence that certain supplements are an effective additional treatment for some mental disorders, supportive of conventional treatment.

All nutrient supplements were found to be safe when recommended dosages and prescriptive instructions were adhered to and there was no evidence of serious adverse effects or contraindications with psychiatric medications.

Summary of results:

• The strongest evidence was found for omega-3 supplements (a polyunsaturated fatty acid) as an add-on treatment for major depression – reducing symptoms of depression beyond the effects of antidepressants alone.
• There was some evidence to suggest that omega-3 supplements may also have small benefits for ADHD.
• There was emerging evidence for the amino acid N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia.
• Special types of folate supplements may be effective as add-on treatments for major depression and schizophrenia, however folic acid was ineffective.
• There was no strong evidence for omega-3 for schizophrenia or other mental health conditions.
• There is currently a lack of compelling evidence supporting the use of vitamins (such as E, C, or D) and minerals (zinc and magnesium) for any mental disorder.

Lead author of the study, , Honorary Research Fellow at The University of Manchester and Senior Research Fellow at NICM Health Research Institute, said the findings should be used to produce more evidence-based guidance on the usage of nutrient-based treatments for various mental health conditions.

“While there has been a longstanding interest in the use of nutrient supplements in the treatment of mental illness, the topic is often quite polarising, and surrounded by either over-hyped claims or undue cynicism,” Dr Firth said.

​Senior author on the study, NICM Health Research Institute’s  said as the role of nutrition in mental health is becoming increasingly acknowledged, it was vital that an evidence-based approach be adopted.

“Future research should aim to determine which individuals might benefit most from evidence-based supplements and to better understand the underlying mechanisms so we can adopt a targeted approach to supplement use in mental health treatment.” Professor Sarris said. “The role of the gut microbiome in mental health is a rapidly emerging field of research, however more research is needed into the role of ‘psychobiotics’ in mental health treatment.”

The review involved researchers from Western Sydney University, King’s College London, The University of Manchester, The University of Queensland, ORYGEN National Centre of Excellence in Youth Mental Health, The University of Melbourne, University of Toronto and KU Leuven.

The research paper can be accessed in the October issue of World Psychiatry and online at 

Leaders of graduate institutions from 16 countries across six continents today agreed on a set of principles and practical actions supporting graduate student mental health and well-being.

The statement was released at the conclusion of the 13th Annual Global Summit on Graduate Education, “Cultural Contexts of Health and Well-being in Graduate Education,” co-hosted by the Council of Graduate Schools (CGS) and The University of Manchester, with support from Educational Testing Service (ETS) and ProQuest. The Global Summit is an annual event designed to promote international best practices in master’s and doctoral education.

This year’s theme was chosen by an international steering committee to recognise the critical importance of graduate student mental health and well-being in a global context, a focus that can't be answered using a single method or approach. Addressing these concerns while working to destigmatise mental health treatment has become a priority in the graduate education community, but to date, there has been no coordinated global effort to address this issue.

Summit participants shared examples and background on the national and international context of graduate student mental health and well-being in their countries and institutions.

Session topics addressed the organisational and administrative challenges to supporting graduate student mental health and well-being, including:

• Addressing national trends and perspectives in cultural attitudes, differences in terminology, current research, legal contexts, demographic differences, and health care systems;
• Creating a Campus Culture that Proactively Supports Wellness;
• Addressing the Role of Mentors and Advisors;
• Supporting “At-Risk” Student Populations; and,
• Prioritising Professional Development and Career Counseling.

Professor Luke Georghiou, Deputy President and Deputy Vice-Chancellor at The University of Manchester, commented that: “Well-being and mental health issues among postgraduate researchers are high on the agenda at The University of Manchester. It has been immensely useful to have learned that this is a shared problem in all parts of the world, and most importantly to share experience on approaches to prevention and early detection of issues, and how to support students and staff in addressing them.”

CGS President Suzanne T. Ortega noted: “One of our shared goals is to foster learning environments that provide all current and future graduate students with the tools and support to succeed. Our discussions over the last two days brought to light new ideas and strategies to take back to our campuses.”

Participants in the summit included deans and other leaders of graduate schools and representatives of national and international associations devoted to graduate education. Along with the United Kingdom and the United States, the countries represented were: Australia, Belgium, Brazil, Canada, Chile, China, Egypt, Finland, Germany, Hungary, Malta, New Zealand, Rwanda, and South Africa.

The full statement can be read below:

2019 Strategic Leaders Global Summit

Cultural Contexts of Health and Wellbeing in Graduate Education

September 1-3, 2019 | 91ֱ��, England

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. – World Health Organisation definition

Statement of Principles and Practical Actions

After the 2019 Global Summit on Graduate Education, it is evident that supporting health and wellbeing is a priority for the international graduate education community. The prevalence of mental health issues among students is recognized in all parts of the world. Universities have engaged in a broad set of responses to help to identify and address this but efforts have not always addressed the unique needs of graduate students. There is a growing realization that doctoral candidates face a particular set of challenges arising from issues such as expectations of high achievement, supervisory relationships and career insecurity. We recognize that our universities are both an enriching and stressful environment, and we must work to create spaces and communities that support wellbeing in an integrated way that addresses the needs of students, faculty, and staff and the academic mission of the university. The wellness of our students directly affects the overall operation of the university.

Practical Actions

• Focus on prevention and resilience by building communities and offering resources and training.
• Contribute to a culture of inclusion that supports mental health and wellbeing for all members of the university community.
• Adopt a consistent terminology to distinguish between mental health, mental illness, and mental wellbeing.
• Situate the student voice at the center of mental health and wellbeing initiatives.
• Coordinate programs and practices supportive of mental wellbeing.
• Develop and implement strategies to identify students in need of support and establish clear pathways to available services.
• Delineate between the roles of supervisors and mental health professionals by clarifying expectations and responsibilities for supervisors.
• Provide training and resources to support supervisors.
• Identify and address the causes of excessive stress, such as institutional policies and practices, meeting high expectations, career uncertainty, supervisor relationships, and financial constraints.
• Develop plans for responding to the mental health consequences of traumatic events.
• Evaluate in a consistent and comparable way the impact of measures taken to promote better graduate student mental wellbeing.

The 2019 Strategic Leaders Global Summit on Graduate Education is generously supported by Educational Testing Service (ETS) and ProQuest.

A major new health research programme, led by researchers from The University of Manchester, has been announced today (11 July 2019) to tackle Greater 91ֱ��’s biggest health challenges, as part of a £135m national investment.

The National Institute for Health Research () is funding the establishment of 15 Applied Research Collaborations (ARCs) across England to develop innovative research projects that will directly improve patient care and treatment.

The NIHR ARC for Greater 91ֱ�� will become part of from 1 October 2019, bringing together researchers, health and care providers, patients and communities to deliver large programmes of research.

Professor Ben Bridgewater, Chief Executive of Health Innovation 91ֱ��, said: “Our role is to conduct research that addresses the needs of Greater 91ֱ��’s 2.8m citizens and accelerate implementation of the findings and proven innovations through our devolved health and care system. This has a direct impact on people’s health and wellbeing, transforms local services and supports the creation of jobs, growth and prosperity for all.

“The ARC’s research activity will be pivotal in finding new and better ways of preventing illness and delivering care, ensuring that Greater 91ֱ�� continues to be at the leading edge of health innovation, care and treatment.”

Over the next five years, the ARC will focus research on helping older people to stay healthy for longer, supporting people with mental health problems, making better use of technology, organising services to address local needs and ensuring services are sustainable. This will be underpinned by expertise in evaluation and implementation science.

The University of Manchester's , Director for the NIHR ARC Greater 91ֱ��, said: “Through the ARC, we will deliver excellent research that addresses key challenges, as well as supporting professionals to translate this into practice. Our broad research themes reflect the specific priorities of Greater 91ֱ�� and build on our exceptional research capabilities.

“We will work with our partners to translate their priorities into answerable research questions, ensuring that our jointly-produced research is relevant, useful and applicable to local service needs and affects policy and practice within GM and beyond.”

The ARC builds on the work undertaken by the current NIHR Collaboration for Leadership in Applied Research in Health and Care () Greater 91ֱ��, which has carried out applied research and supported its impact in practice over the last six years. This includes improving care for people after a stroke, supporting carers of those requiring end of life care, developing improved access to primary care and improving complex wound care in the community.

Professor Ruth Boaden, Director of the NIHR CLAHRC Greater 91ֱ��, said:

“I’m delighted that the ARC will continue to develop the work of the CLAHRC. It’s great to see how the ARC’s priorities will be aligned to the evolving needs of our local population in Greater 91ֱ��. CLAHRC GM is leaving a proud legacy of new knowledge and resources addressing some of the biggest challenges in health care; as well as great relationships, and the development of research skills and capacity among our partners. I am sure that the ARC will be able to build on this excellent work when it starts in October.”

will be the host NHS provider of the ARC and the University of Manchester will be the host academic institution.

Self-harm in middle-aged men increased significantly following the 2008 financial crisis, according to a study led by researchers at The University of Manchester.

The research from the Multi-Centre 91ֱ�� of Self-harm in England, funded by the Department of Health is published online by The British Journal of Psychiatry today (30 May).

The team investigated self-poisoning and self-injury in three cities, finding a quarter of all emergency department presentations for self-harm were made by men and women aged 40 to 59.

Risk of further self-harm was also high, with 25% attending hospital for self-harm again within 12 months.

The team, who examined the rate of self-harm in England from 2000-2013, showed that self-harm in middle-aged men increased by nearly 50% between 2008 and 2012.

The results followed the pattern of national suicide rates in middle aged men, though there was no equivalent increase in middle-aged women.

The researchers also found that self-harm in middle-aged men was associated with alcohol use and unemployment, as well as housing and financial problems.

Men in midlife who harmed themselves were more likely to repeat self-harm or die in the follow up period than women, but were less likely to be under the care of mental health services.

Dr Caroline Clements, lead author of the paper, said: “This is the first really detailed study of self-harm in people in midlife involving nearly 25,000 presentations to hospital. There were striking increases in the rate of self-harm in men which may well have been related to economic as well as clinical factors.”

Prof Nav Kapur, the senior author of the paper said: “Men in midlife are a group we are particularly worried about because of their high rate of suicide. This study shows how important self-harm is too. It’s the main risk factor for suicide but crucially it’s an opportunity to intervene.

“Our research highlights the potential importance of economic factors, so providing advice for unemployment, housing, and financial problems is likely to be helpful. But improving access to services and tackling alcohol misuse could have a big impact too.

“Some men, though, might be reluctant to seek help for their problems and there are a number of initiatives around the country trying to reach men through sporting or other awareness raising campaigns.”

In England, the highest suicide rates are in men and women aged 40 to 59 years, with rates in men increasing to a peak of 25 suicide deaths per 100,000 population in 2013. Similar patterns were found internationally.

Between 2000 and 2013, 363/100,000 men in midlife self-harmed compared to 449/100,000 women, in England.

Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research.

In the most comprehensive study of this topic ever carried out, The University of Manchester team say though danger to patients is still relatively low, community services and GPs must be aware of the critical period in the first few weeks of discharge - when they are most at risk.

Though the report drew on data derived the entire population of Denmark, its results are relevant to the UK, which has a similar population and health system, say authors Professor Roger Webb and PhD student Florian Walter.

According to the team, the most common threat to life among patients after discharge is fatal poisoning compared to accidents among the general population.

The research was funded by Medical Research Council, European Research Council in partnership with Centre for Integrated Register-based Research and National Centre for Register-based Research at Aarhus University. It is published in the Journal of Clinical Psychiatry today.

The analysis compared over 1.6 million Danes with a subset of 47,000 people who were discharged from their first inpatient stay between 1982 and 1996.

Utilising national administrative datasets, the research team were able to track the group of patients, who averaged age 25 when they were discharged until they died or 31 December 2011.

They looked at method of suicide, types of accidental death, types of fatal poisoning and death by homicide.

Though there is a strong association between hospital discharge and unnatural death, there is no evidence of a causal link between the two, say the researchers.

According to the research, suicide was 32 times more likely after discharge: 171.7 people in every 100,000 died after leaving hospital, compared to 5.3 in every 100,000 for the general population

Intentional self-poisoning was 41 times more likely: 57.1 people in every 100,000 died after hospital discharge, compared to 1.3 in every 100,000 for the general population

And death from fatal psychotropic drugs poisoning , irrespective of intent was over 90 times more likely: 25.6 people in every 100,000 after hospital discharge, compared to 0.2 in every 100,000 for the general population.

Professor Webb said: “When we look at detailed causes of death, each one is markedly raised whether that’s traffic accidents or poisoning.

“So it’s clear this group of people is more vulnerable to dying from a variety of different unnatural causes after discharge, although the risks for each of these causes are nonetheless relatively low in absolute terms.

”However, it’s important to point out hospital is not a cause of unnatural death as these patients are a young cohort already from high risk groups; therefore the risk of dying could be even higher without hospitalisation.”

Florian Walter said: “This is the first study to look at the full range unnatural causes of death among mental health patients after discharge from hospital ever carried out.

“The Danish system is ideal for this sort of research because Danes are given a unique identification number which provides data that are entered into several national registers.”

A previous study by Walter, published in JAMA Psychiatry in 2017, found that patients are most at risk in the first month after discharge.

He added: “The overarching message is that transition from hospital to community is riskier for these people, especially during the first few weeks after discharge.

“Therefore mental health services need to develop broad strategies that include enhanced post-discharge surveillance. These strategies must account for the fact that discharged patients have higher risks of dying unnaturally in lots of different ways.

“We also think better liaison between inpatient and community services is important so that services can be more vigilant about patients taking their medication correctly at the doses prescribed.”

The paper: a national cohort study is published in the Journal of Clinical Psychiatry.

Carers for people with cancer are between 5 and 7 times more likely to have mental health problems than the general population, according to a landmark new study.

The Dimbleby Cancer Care funded study identifies a major public health concern, according to the lead author Gunn Grande, Professor of Palliative Care at The University of Manchester.

The study, ‘Psychological morbidity* and general health among family caregivers during end of life cancer care: a retrospective census survey’ reveals 83% of family carers of people with cancer have clinically significant distress – compared to just 15% of the general population. The study retrospectively measured carers’ psychological health and general health during the patient’s last three months of life.

The study, which was supported by NIHR CLAHRC GM and carried out by the Universities of Manchester, Newcastle and Groningen in the Netherlands, has been published in the journal, Palliative Medicine. The team received responses from 1,504 carers through a national four-month post bereavement postal survey in the autumn of 2015. The survey was sent via the Office for National Statistics to 5,271 relatives who registered a death in May 2015. Local carers groups helped shape the material.

The survey revealed:

• Psychological morbidity at clinically significant levels was substantially higher among carers than the general population (83% versus 15%), with prevalence 5-7 times higher across all age groups.
• Overall carers’ general health scores were lower than population scores, median 75 (interquartile range 50-80) versus 80 but differences were more marked at younger ages.
• Female carers had worse psychological morbidity and general health than male carers.

Gunn Grande, Professor of Palliative Care at The University of Manchester, led the study. She said: “We were aware that carers’ psychological health suffers when caring for the terminally ill, but we were surprised at the sheer scale of the problem. We found that the vast majority of carers suffered psychological morbidity at a level where further clinical investigation is recommended and where, for instance, their ability to concentrate, make decisions and deal with problems may be affected. If we can ensure that carers feel better supported, we are likely to reduce some of the more extreme stresses of caregiving, so that carers are more able to carry on their valuable work without being ‘broken’ by the experience”.

The Dimbleby Cancer Care Research Fund has awarded over £2.7million in funding since 2004 to research projects looking at all aspects of cancer care. Chair of the charity, broadcaster, Jonathan Dimbleby said:

“This latest research reflects what unfortunately we see every day through our work; caring for someone with cancer can have a huge impact on your own health. The role these carers play is vital, but they need better support, which is why Dimbleby Cancer Care exists.

“Caring for a loved one going through cancer can be both distressing and challenging and we are there to support them, be it through our information centres, our psychological support, complementary therapies and benefits advice teams or our recently launched Cancer Care Map website, which for the first time enables us to reach across the UK. It is clear from this research that ongoing support for carers is very much needed and would prevent a breakdown in caregiving and may ultimately, in the long term, produce cost savings for the NHS.”.

This is the second of three sets of findings to be published from the study. The first set, published last year showed that family carers of people with cancer on average provide almost 70 hours of care a week to look after their relatives in the last three months of life. The final results focusing on the economic value to society of their work will be published at a later date.

Dimbleby Cancer Care was set up in 1966 in memory of broadcaster Richard Dimbleby and is based at Guy’s Cancer Centre in Southwark, London. It provides practical and psychological support to people living with cancer and to their families and carers. The charity runs the UK wide online directory of support services  which helps people locate care and support services in their local area wherever they are in the UK and has its own information and support centres at Guy’s Cancer Centre and Queen Mary’s Hospital, Sidcup.

 is one of The University of Manchester’s - examples of pioneering discoveries, interdisciplinary collaboration and cross-sector partnerships that are tackling some of the biggest questions facing the planet. #ResearchBeacons

The University of Manchester has been awarded £150,000 to develop new ways of supporting the wellbeing and mental health of postgraduate research students.

The funding, from the Higher Education Council for England (HEFCE), will allow the University to improve targeted wellbeing and mental health services to and, where needed, access to specialised NHS services.

The University of Manchester has almost 4,000 postgraduate research (PGR) students, with over a third of these coming from outside the EU. Because of the different ways in which these students interact with the University and the particular pressures they may come under, the new project will seek to develop more specific policies and services.

These will include: developing a new monthly wellbeing check which will be completed by students and supervisors, and working with the existing PGR Representatives’ Network. There will also be resources, such as mindfulness tools which will be developed with outside specialists and made available to students and staff.

The project will employ two full-time members of staff – one in the Students’ Union and one in the University’s Graduate Education Team.

There will also be extensive consultation and regular meetings with students themselves. Aleksandra Besevic, a member of the PGR Representatives’ Network who is studying consumer behaviour in sustainable fashion, said: “I’m very happy that the University has secured the funding to improve postgraduate wellbeing. I have been working on student wellbeing in the Faculty of Science and Engineering which has made a difference to the community and bringing students together.

“Wellbeing is often overlooked by the students themselves, so it is important to have activities arranged by students for students. I hope this will improve postgraduate wellbeing across the whole University and foster a balanced working environment.”

The money for this project has come from HEFCE’s which provides targeted investment in activities led by universities and colleges. The fund supports a range of student and sector priorities, including innovation in higher education, efficiency and effectiveness, and student interest issues.

The University has already been successful in achieving Catalyst funding for projects around improving support for and another to tackle .

In this round 17 awards were made in total across the sector and 91ֱ�� was one of only four institutions to receive the maximum allocation of £150,000.

, Associate Vice-President (Research) and Director of , said: “The health and wellbeing of our students is something where the University, working with partners, has been highly innovative. This particular piece of funding will allow us to thoroughly scope out the needs of this group of students and put measures in place which are tailored to their particular needs.”

The project team will include University staff with expertise in wellbeing and mental health, working in partnership with selected external partners from: the Greater 91ֱ�� Mental Health NHS Foundation Trust, Vitae, MIND, BluSCI, Six Degrees, Student Minds and the Institute of Employment Studies.

The project is due to finish in early 2020 and results will be shared across the HE sector as new services are implemented.

Speaking about the latest round of funding, HEFCE Chief Executive, Professor Madeleine Atkins, said: “This programme to develop extra support for postgraduate research students is timely, and complements the resources HEFCE already provides to support student safeguarding and to address barriers to student success.

“We are delighted to support these innovative projects in the important area of mental health and wellbeing, and look forward to successful outcomes and the sharing of good practice for the benefit of all postgraduate research students.”

UPDATE: 18 April 2018

The University has also received £50,000 in funding for ‘Passivity, the Bystander and Religious Based Hate Crime’ a new project which will continue the work of and bring people together to discuss, analyse and understand ‘the bystander’ in relation to religious based hate crime.

Alongside the Students’ Union, staff and students will come together to improve religious literacy among students and staff, including myth-busting, support the development of effective role models for students of different religions or beliefs and develop and sustain positive campus relations between different groups.

Eventually the project will support the production of a series of materials and events that will be used on an ongoing basis across campus.

Young people belonging to alternative subcultures, such as goths, emos or metal fans, are at a greater risk of self-harm and suicide than those who do not, according to a research review out today.

, a clinical psychologist from The University of Manchester, says health, educational and social services need to be more aware of the risks to these young people.

“Victimisation, stigma and hate crime may explain the greater risk these individuals face. A prime example of that is the aggression faced by Sophie Lancaster in 2007,” said Dr Taylor.

“Sophie was tragically murdered by a group of young men purely because of her affiliation to Goth culture.”

The systematic review of 12 English language papers published in the British Journal of Clinical Psychology was conducted by experts at The University of Manchester, University of Liverpool, the psychological services organisation Changing Minds UK, Leeds Beckett University and The University of Central Lancashire.

The findings reflect the growing concerns over the risks of young people: Suicide is a leading cause of death in adolescents and the second leading cause of death in 15-29 year olds according to a 2017 report by the WHO.

Dr Taylor, from The University of Manchester, said: “The belief that alternative subcultures may be at an increased risk of self-harm and suicide is considered by some to be a myth.

“But the literature we reviewed does suggest that these individuals are indeed in greater danger.

“But this research requires interpretation within the wider context of public concern around alternative subcultures and their impact on the mental health of young people.

“The public and media have at times, unhelpfully, demonised alternative subcultures and music as a cause of problems including self-harm.

“That is why organisations such as the Sophie Lancaster Foundation have an important job of increasing awareness about victimisation of alternative subcultures.

“Getting the message to health, education and social services staff is also an important consideration.”

Dr Mairead Hughes, from The University of Liverpool said: “There is not enough evidence to tell us why it is that people belonging to these subcultures are at greater risk.

“Young people who have faced more adversity may be more likely to become part of a subculture, but this does not seem to fully explain the increased risk.

“stress associated with being different and belonging to a minority group may also explain some of the risk”

The paper “” is published in the British Journal of Clinical Psychology

A canine visitor to The University of Manchester’s medical school is no mutt when it comes to making medical students happy.

Billy the Cavalier King Charles Spaniel, higher education’s first dogtor, is taking part in a scheme for medical students to ease their stresses and strains.

Billy, wearing his doggy uniform, visits the medical school twice a month attending specially designated sessions with medical students

The idea compliments published University of Manchester research which finds that pets are good for your mental health.

And it is one of many the University activities designed to enhance the wellbeing of students and staff, culminating in the annual Wellbeing Week.

There are daily mindfulness sessions and workshops dealing with topics as wide ranging as tackling procrastination or tackling perfectionism. Now Billy is part of the mix for medical students.

Claire Mimnagh, who is a Communication Skills Administrator in the Medical school, was the person who thought of the idea.

She said: “Medicine is an intensive course and our students work incredibly hard. So we feel it’s important to make sure our students can find time to relax.

“Billy brings together our dog-loving students. They love his company and after spending a bit of time with him, feel great. You just have to see the smiles on their faces to realise what a hit Billy is.

“Our students love him - and he evidently loves them; his tail just doesn’t stop wagging.”

Billy’s owner is actor Sue Warhurst who works at the Medical School role playing patients to allow students to practice their consultation skills.

Dr Kelly Rushton, one of the researchers on the pet study said: “We know that having contact with pets can provide benefits for people with mental health problems by alleviating feelings of stress and providing comfort.”

“This scheme sounds as though it’s trying to do something along those lines, and I would personally have loved this opportunity when I was a student.”

For the family and friends of people who self-injure, as well as the doctors and services that try to support them, a key question is often: why do they do it?

refers to acts of self-harm where there is no intent to end one’s life. is a broader term that can also include suicide attempts. Here we’re looking at non-suicidal self-injury, a complex phenomenon that appears to be driven by a number of different psychological mechanisms.

What reason do they give?

A useful starting point is often the reason people who are harming themselves give for their self-injury. This is because to them self-injury is generally serving a function. There is often a goal, a purpose or some desired end-state a person can share.

, summarising the research so far, we found for many people (63-78%) self-injury is an attempt to cope with highly distressing feelings.

Many individuals who self-injure . Emotion regulation refers to our ability to respond to and control our emotions. , from the way we attend to situations that arise, to the way we cope with an emotion once we have noticed it.

(for example, shame and guilt) appear to trigger specific acts of self-injury. the difficult feelings that precede the self-injury subside afterwards, at least temporarily.

How can self-injury regulate emotions?

The mechanisms that explain exactly why self-injury might have this effect on the way an individual feels are not so clear. The internal release of chemicals such as pain-relieving opioids following self-injury is often cited as a possible explanation for its effects on emotional distress, .

are that self-injury might help people distract themselves, or shift their awareness from emotional pain.

Self-injury in order to punish oneself (for example, in response to feeling you’re a bad person or have done something wrong) is another . Individuals who self-injure often have a . So it may be that for some individuals, self-injury becomes a way of expressing or releasing these negative feelings towards themselves.

Research is ongoing around these possibilities, and it may be that no one explanation fits for every individual.

Why some struggle to regulate their emotions

So if self-injury is a means of regulating emotions, why can’t these individuals regulate their feelings in the same way other people do?

Challenging life experiences, including early abuse and trauma, can leave individuals with and prevent them from forming effective ways of coping or getting support.

Other forms of social adversity may also be important. If we look at groups in society particularly at risk of self-injury, we see it’s often those groups that are most marginalised. , those belonging to the , and even those belonging to , are all at greater risk.

Experiences of victimisation and marginalisation can have an impact on the way a person feels about themselves, and this in turn may leave them at risk of self-injury.

For some, these difficult earlier experiences prevented them from finding other ways of coping with difficult feelings. For example, for a person who experienced abuse or victimisation it can be understandably hard to trust others, and this may become a block to seeking social support.

Social and interpersonal causes

There’s also hearing about others’ experiences of self-injury (from friends and peers or through the media) may leave individuals more likely to injure themselves. Hearing of another’s experience could set up an .

Engaging in self-injury can also be a means of . It seems likely social functions of self-injury such as this are still related to difficulties in coping with emotions. After all, our social relationships reflect a key way in which people typically respond to and cope with adversity. The social side of self-injury has been under explored, but is increasingly being studied.

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries .

, Associate Professor of Psychology, and , Clinical Lecturer,

This article was originally published on . Read the .

Experts have called for a significant and urgent increase in resources to support the mental health of young people in schools, after a study uncovered a ‘perfect storm’ of increased need and decreased provision.

The study explored the impact of current policies on the mental health work that school staff are involved in. The results showed that young people are increasingly talking to school staff about mental health issues – with welfare reform and broader cuts to other services adding significantly to the pressures people face - but there are fewer resources available, and staff feel under-equipped to deal with the increasing level of emotional concerns.

The researchers believe that this will potentially lead to an increase in the number of teachers leaving the profession.

The Prime Minister has noted her desire to reform children and young people’s mental health services, and the Government has recently published a Green Paper on the issue. However, the researchers have found that the proposals in the paper do not satisfactorily address the fundamental concern that further funding and resources are required to provide a suitably skilled workforce.

They recommend that the proposals need to take account of the impact of social and political factors on student wellbeing and extend to include the statutory provision of counsellors in all schools. Mental health awareness courses have been suggested for those working in schools, but the researchers say that these are not a substitute for qualified mental health professionals.

“Schools are under pressure to ensure that young people succeed academically and their mental health needs are catered for, but staff are highlighting that they are at the limits of what they can do to support the emotional wellbeing of pupils, and that austerity is putting them under more pressure,” said .

Download the full report: ''.

Students from a girls’ grammar school have worked with educational psychologists from The University of Manchester to develop an accessible and appealing mental health strategy for their school.

Lecturer in Education & Child Psychology Dr Cathy Atkinson has worked with colleagues including Dr George Thomas, a recent 91ֱ�� graduate who is now an honorary lecturer and an educational psychologist working for Bright Futures Educational Trust, to devise the strategy alongside pupils at Altrincham Grammar School for Girls who act as ‘wellbeing ambassadors’ for their fellow students.

The researchers planned sessions using resources which they thought were visual and appealing, but the wellbeing ambassadors had strong views about their relevance to young people, and proposed their own creative and innovative solutions. 

One of their ideas was an accessible quiz to determine when and how to seek help. The ambassadors consulted with other students, and developed their own communications strategy to promote the subject around the school.

“We understand that recognising the signs associated with mental health problems, intervening to provide early support and signposting to other sources of help are crucial in promoting our students’ ongoing wellbeing,” said Jenny Ogunmyiwa, Vice Principal at Altrincham Grammar School for Girls. “Our wellbeing ambassadors are working hard in school to ensure that student contributions are used to promote a greater understanding of mental health within the student body and to develop effective mental health support.”

Dr Atkinson and Dr Thomas are presenting their research at the British Psychological Society’s Division of Educational & Child Psychology annual conference, which takes place from 11-12 January in Brighton.

University of Manchester researchers have found that reports of self-harm in girls aged between 13 and 16 rose by 68% between 2011 and 2014. Overall, girls had much higher rates than boys.  

The study, published in the and carried out in over 600 general practices, also found that young people living in the most socially deprived areas with often the most complex needs, were the least likely to be referred to specialist services.

The study was funded by .

Self-harm  - intentional self-poisoning or self-injury -  in children and adolescents is a major public health issue in countries across the world. Experts acknowledge self-harm as the biggest risk factor for subsequent suicide.  Suicide is now the second most common cause of death in the under 25s worldwide.

Unlike most previous studies, Dr Cathy Morgan and a team from The University of Manchester, examined self-harm recorded in general practice rather than in hospital.

To estimate rates of self-harm, they analysed data for 16,912 patients aged between 10-19 years from 674 general practices, who harmed themselves during 2001 to 2014. 

To assess mortality, they compared data from 8,638 of the patients with 170,274 unaffected children, matched by age, gender and general practice.

For girls, the rate of self-harm was 37.4 per 10,000, much higher than 12.3 per 10,000 in boys. It rose by 68% in girls aged 13 to 16 from 45.9 per 10,000 in 2011 to 77.0 per 10,000 in 2014.

Referrals to specialist mental health services within 12 months of self-harming were 23% less likely for young patients registered in practices in the most deprived areas, even though the rates of self-harm were higher in these areas. 

Children and teenagers who self-harmed were nine times more likely to die unnaturally than unaffected young people with an especially marked increased risk of suicide and acute alcohol/drug poisoning death.

Professor is Professor of Psychiatry and Population Health at The University of Manchester.  He chaired the National Institute of Health and Care Excellence (NICE) Guidelines on Self-harm and is one of the authors of the study.

He said: “Though the higher rates of self-harm in girls than boys and a strong link with the risk of later suicide has confirmed previous work, perhaps our most striking finding was the apparent rapid increase in self-harm recorded for  girls aged 13-16.

“Of course we need to bear in mind the weaknesses of our study – we used routine general practice data and some episodes of self-harm might have been missed. And the level of detail for things like method of self-harm was limited.

“But these results do emphasise the opportunity for earlier intervention in primary care to reduce suicide risk. We know talking treatments can help. There is also a need for more integrated care involving families, schools and health and social care providers and the voluntary sector to enhance safety among these distressed young people and to help secure their future mental health and wellbeing.”

He added: “We can’t really explain this possible rapid increase in self-harm among girls. It could reflect better awareness or recording of self-harm in primary care.

“But it could also be a result of increasing stress and higher levels of psychological problems in young people. There is some evidence indicating that common mental health disorders are becoming more common within this age group   The internet and social media can be really helpful in preventing self-harm but could have negative effects too and this is a focus of significant research and activity. 

“It’s very important that young people, parents and carers aren’t unduly alarmed by these findings.

“We know that for many young people things get better and they no longer hurt themselves as adults. But of course we must take self-harm seriously; it’s important to understand its underlying causes.”

The work was funded by: The National Institute for Health Research through the Greater 91ֱ�� Primary Care patient Safety Translational Research Centre (NIHR GM PSTRC), grant no. GMPSTRC-2012-1.

You can also see Prof Kapur and Dr Morgan talking about their research

A groundbreaking talking treatment has been developed and successfully trialled with a group of Black and minority ethnic (BME) schizophrenia service users, carers, community members and health professionals.

Dr Dawn Edge from The University of Manchester led a team that developed the model in a study funded by the National Institute for Health Research (NIHR) which she says could be a breakthrough for BME patients whose mental healthcare is both sub-optimal and costly for the NHS.

The new therapy, called Culturally-Adapted Family Intervention, or ‘CaFI’ for short, emerges in the context of decades of poor engagement between Black communities and mental health services.

People of African-Caribbean origin, including those of ‘Mixed’ heritage, are nine times more likely to be diagnosed with schizophrenia than White British people. Black Africans’ risk of diagnosis is six times greater. 

Having tried the new therapy, service users, carers, therapists and service providers reported improved symptoms and better understanding and communication between patients, families, and services.

Dr Edge, a Senior Lecturer who is also the University of Manchester’s Academic Lead for Equality Diversity and Inclusion, says racism, discrimination, adversity and alienation are key contributors to the problem.

She said: “People from BME communities tell us that the constant stress of racism and surviving in often hostile environments can make trigger mental illness. 

“Moreover, when a Black person is experiencing psychological distress, mental health services are often unable to distinguish between their responses to everyday stressors and illness, compounding the problem.

“Not surprisingly, African-Caribbeans and people from other BME backgrounds are often reluctant to engage with mental health services as they do not think they will be understood or treated fairly. 

“In consequence, they tend to come into contact with services much later in their illness, often in a state of crisis, involving the police and being ‘sectioned’ under the Mental Health Act.  Once in services, their care is more likely to be coercive than White British peoples.

“For example, Black patients are much more likely to be held in seclusion, forcibly given medication and regularly readmitted.

“On average, they remain in hospital twice as long as White British people and are more likely to be discharged on costly Community Treatment Orders (CTOs).”

Dr Edge added, “We have demonstrated that it is possible to develop this treatment and to improve African-Caribbean patients’ and families’ engagement with mental health services. 

“We now need to test CaFI nationally to see if it delivers better outcomes and is cost-effective in comparison to usual treatment.

“This is the first time that a psychological therapy, specifically designed to meet the needs of this community, has been developed, which is intriguing given that this is one of the most long-standing challenges facing mental health services.

“To me, equitable access to effective mental healthcare is a social justice issue. Moreover, family-focused psychological care makes good economic sense. It reduces NHS and social care costs not just for service users but also for carers.”

The research to develop and test the new treatment was conducted over three years at Greater 91ֱ�� Mental Health NHS Foundation Trust. 

CaFI was trialled with 26 family units, of which 24 completed all 10 therapy sessions. Half the service users who took part had no contact with their families –and were given the support of ‘care coordinators, friends or community members from a range of ethnic backgrounds 

The research findings and future plans will be presented at an event to mark the end of the study and celebrate the involvement of the African-Caribbean community on 8 September at the Amani centre, Moss Lane East, 91ֱ��, M16 7DG.

The full video is availanle

Children and young people who die by suicide have often experienced the death of a family member or friend, in some cases also by suicide, according to a new report by The University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH).  

The NCISH report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme*, published on 13 July, examines the findings from a range of investigations such as coroner inquests, into the deaths by suicide of people aged under 25 between January 2014 and December 2015 in England and Wales, extracting information about the stresses they were facing when they died.

The researchers found 25% of under-20s and 28% of 20-24 year olds - around 125 deaths per year - had experienced bereavement. In 11% of all the under 20s examined, this death was also a suicide, usually of a family member or friend. The report emphasises the emotional impact of bereavement on young people and recommends that bereavement support should be widely available.

, Director of NCISH, said: “Suicide is the leading cause of death in young people in England and Wales. Although there is no single cause, bereavement was an important theme in many of the deaths we examined. Some of the young people had experienced the suicide of someone close to them - it's tragic that the trauma of suicide may lead young people to take their own lives."
 

The study estimates there are around 75 suicides per year in students under 25 and found that suicide in students under 20 occurred more often in April and May, conventionally exam months. Only 12% of those who died were known to be seeing student counselling services. The researchers call on universities to do more to promote mental health on campus and support students who may be at risk.

A quarter of under 20s who died were found to have searched for suicide methods on the internet, posted suicidal messages on social media, or had been bullied on-line. Further action is needed to improve internet safety for young people and remove harmful content, according to the research team.

The study identifies the treatment of self-harm as the most important service response in preventing suicide in young people.  Previous self-harm was common in the young people in the study, occurring in around half of under-20s and 41% of 20-24-year-olds., Head of Suicide Research at NCISH, said: “Self-harm, even when injuries seem minor, is one of the most important indicators of suicide risk and should always be taken seriously. We know that the interventions currently available can be effective but they aren’t available everywhere. Ensuring there are self-harm services for young people in every area is a suicide prevention priority.”

The report highlights the 18 deaths by suicide per year in LGBT young people who have often been victims of bullying and the 14 deaths per year in "looked after" children aged under 20, many of who had housing or mental health problems. It also explores suicides that appear to occur “out of the blue” and confirms that some young people who take their lives give few warning signs. Professor Appleby added: “We found a number of common themes in the lives of the young people who died, including exam pressures and bullying in the under 20s, and workplace, finance and housing problems in the 20-24 year olds.”

All deaths of people aged 10-19 were included in the sample. A random sample of 20% of deaths of people aged 20-24 were selected from all suicides in this age group in the two-year study period.

The University of Manchester - along with Queen Mary University of London and Words of Colour Productions – has been commissioned to establish an independent centre of excellence on ethnic inequalities, severe mental illness and multiple disadvantage.

With an award of £1,245,000 from Lankelly Chase Foundation, the Synergi Collaborative Centre will deliver a five-year national programme focused on transforming health services for ethnic minority people with severe mental illness.

Over the five years, the centre will:

- Collate, interpret and communicate data and knowledge on ethnic inequalities in mental health and related systems, and how this relates to severe and multiple disadvantage
- Bring together the full range of stakeholders through models of co-production, and co-curation of knowledge, to develop and implement solutions
- Place lived experience narratives centre stage
- Use creative, digital and evidence-based platforms to share these narratives
- Become a focal point for action, leading to systems change regarding ethnic inequalities in mental health services
- Identify opportunities to reduce and prevent ethnic inequalities to improve the health of individuals and populations

The centre will take a collaborative approach, using the principles of co-production of knowledge and a creative mix of robust research methods.

Cathy Stancer, Director of Equalities and Rights at Lankelly Chase, said: “Lankelly Chase’s area of concern is why people dealing with the most severe problems get the least effective support, often resulting in catastrophic outcomes. Through the many projects we have supported, we know that ethnic inequality in mental health remains an intractable issue needing new energy, creativity and collaboration. The creation of the Synergi Collaborative Centre follows several years of engagement with ethnic minority-led organisations who agreed that the way evidence, practice and communities connect is a crucial step towards changing systems.”

Kamaldeep Bhui CBE, Professor of Cultural Psychiatry & Epidemiology at Queen Mary University of London, and Consultant Psychiatrist at East London Foundation NHS Trust, said: “The Synergi Collaborative Centre will assemble all sections of society to offer a fresh perspective on ethnic inequalities in severe mental illness, while taking account of the multiple disadvantages which act as drivers of inequalities. This area has secured little effective action due to disagreements about the evidence, sensitivities around accusations of racism and minimising the lived experience of ethnic inequalities. By capturing experiences of multiple disadvantage throughout the life course, the centre will inform the production of co-created narratives, which will be widely shared to drive systems’ reform.”

Marcia Willis Stewart QC (Hon), the newly appointed Chair of the centre’s Advisory Board, added: “It is an honour and a privilege to assist the Synergi Collaborative Centre with its relevant goals regarding ethnic inequalities, severe mental illness and multiple disadvantage. The timing of this project is particularly important as there is longstanding concern over key issues such as access to relevant services, social exclusion and social cohesion nationally. The work that the centre plans to undertake is also necessary amid the groundswell of public and political interest, and an acknowledgement of the complex cluster of historical issues surrounding severe mental illness and ethnic inequalities, which is why the funding by Lankelly Chase is welcomed.”

will be overseen by a multi-disciplinary Advisory Board of experienced practitioners and people with lived experience of mental illness and ethnic inequalities.

 is one of The University of Manchester’s  - examples of pioneering discoveries, interdisciplinary collaboration and cross-sector partnerships that are tackling some of the biggest questions facing the planet. #ResearchBeacons

New research has revealed that apps installed on smartphones can be used to significantly reduce anxiety.

, from The University of Manchester, led the first ever meta-analysis of all published evidence on the effect of smartphone-based therapies on anxiety in 1,837 people.

The study, published in the Journal of Affective Disorders, is a collaboration between The University of Manchester, Harvard University, University of Melbourne and the Black Dog Institute in Australia.

It showed that overall, smartphone interventions reduced anxiety significantly more than control conditions – suggesting new digital therapies could be useful for managing the condition.

Smartphone apps, argue the team, may be best used for augmenting face-to-face therapy and other psychological treatment – rather than replacing standard care.

Because psychologists are seeing increasing numbers of young people suffering from anxiety disorders, mental health services struggle to meet their needs.

But up to now, the effectiveness of using apps to reduce and manage anxiety as a possible solution to the problem - has been heavily disputed.

Joseph Firth said: “Smartphones could be a novel way to help treat anxiety: they are now owned by the majority of people, and are particularly popular with younger people.

“And that presents a new opportunity for psychological care provision in a non-stigmatizing, self-managing format.

“Looking at individual studies we find that smartphone apps which aim to promote overall mental health and well-being, rather than focusing specifically on anxiety alone, may be most consistently effective.

“There is currently no evidence to suggest that using apps alone can outperform standard psychological therapies, or replace the use of anti-anxiety medications. This is an area for future research to explore.”

Dr John Torous from Harvard University said “As digital technologies continue to advance, and our scientific understanding of mental health deepens, smartphones may well present a novel method for wide-scale delivery of personalised, effective and affordable treatment for anxiety and other mental disorders.”

The research team are now further analysing how smartphone apps can also be used in the treatment of depression – and results will be out soon.

The paper, '', was published in the Journal of Affective Disorders. DOI: 10.1016/j.jad.2017.04.046

People who come to hospital after self-harm are unlikely to be helped by the use of risk scales when they see mental health staff, according to new research published in the British Journal of Psychiatry.

The study, led by from The University of Manchester and funded by a NIHR Programme Grant for Applied Research (), casts a critical light on the use of risk scales as part of assessments for people with self-injury or self-poisoning, a major problem in the UK.

Risk scales, they find, are no better at identifying who will go on to self-harm again than asking a clinician or patient a single question about how likely they think a repeat episode is to occur.

Good quality assessment and treatment of people who present to hospital after taking an overdose or injuring themselves is a core part of clinical practice and can help reduce risk of repeat self-harm and even suicide.

Clinical checklists or scales to predict risk are more controversial but they remain in widespread use.

Scales typically collect information on a range of risk factors such as age, sex, previous self-harm, psychiatric treatment, and the method of injury.

The research team investigated the use of risk scales in actual practice: several widely used scales were compared to patient and clinician estimates of risk.

Nurses and psychiatrists carried out risk assessments in 514 patients referred to psychiatric liaison services following self-harm in five large hospitals in England.

Overall, 145 patients (30%) repeated self-harm within six months. The scales, they discovered, were generally poor at predicting repeat self-harm.  The single item clinician and patient questions outperformed the other risk scales, including the widely used, ´SAD PERSONS Scale´.

However, the researchers concluded that even clinician and patient ratings of risk were not good enough to be used in practice because they would miss nearly 20% of repeat episodes and over half of people identified as being at high risk, would not go on to repeat self-harm.

, the project manager and main researcher on the project explained: “Our earlier research showed that scales are widely used in hospital services despite controversies over their use. This study provides robust evidence that they have limited clinical utility following self-harm and are probably unhelpful. The use of scales in assessments may actually damage the potential for the patient and clinician to collaboratively assess the risk of future self-harm and determine appropriate care plans.”

Professor Kapur added: “The NICE guideline on the longer-term management of self-harm is clear. It suggests that risk scales should not be used to predict risk of repeat self-harm or determine patient management. Our previous work suggested services across the country were not following this guidance. This study confirms that the notion of risk assessment as risk prediction is a fallacy. Instead of being preoccupied with scores on a scale we should be focussing on doing the simple things well and providing high quality care.”

The paper, '', was published in the British Journal of Psychiatry. DOI: 10.1192/bjp.bp.116.189993

The paper ‘Association between psychological health and wound complications after surgery’ was published in the . 

A review of worldwide studies has found that add-on treatment with high-dose b-vitamins - including B6, B8 and B12 - can significantly reduce symptoms of schizophrenia more than standard treatments alone.

The research - on the effect of vitamin and mineral supplements on symptoms of schizophrenia - is funded by and University of Manchester, and is published in Psychological Medicine, one of the world’s leading psychology journals

Lead author Joseph Firth, based at the University’s , said: “Looking at all of the data from clinical trials of vitamin and mineral supplements for schizophrenia to date, we can see that B vitamins effectively improve outcomes for some patients.

“This could be an important advance, given that new treatments for this condition are so desperately needed.”

Schizophrenia affects around 1% of the population and is among the most disabling and costly long term conditions worldwide.

Currently, treatment is based around the administration of antipsychotic drugs.

Although patients typically experience remission of symptoms such as hallucinations and delusions within the first few months of treatment, long-term outcomes are poor; 80% of patients relapse within five years.

The researchers reviewed all randomized clinical trials reporting effects of vitamin or mineral supplements on psychiatric symptoms in people with schizophrenia.

In what is the first meta-analysis carried out on this topic, they identified 18 clinical trials with a combined total of 832 patients receiving antipsychotic treatment for schizophrenia.

B-vitamin interventions which used higher dosages or combined several vitamins were consistently effective for reducing psychiatric symptoms, whereas those which used lower doses were ineffective.

Also, the available evidence also suggests that B-vitamin supplements may be most beneficial when implemented early on, as b-vitamins were most likely to reduce symptoms when used in studies of patients with shorter illness durations.

Firth added: “High-dose B-vitamins may be useful for reducing residual symptoms in people with schizophrenia, although there were significant differences among the findings of the studies we looked at.”

“There is also some indication that these overall effects may be driven by larger benefits among subgroups of patients who have relevant genetic or dietary nutritional deficiencies.”

Co-author Jerome Sarris, Professor of Integrative Mental Health at Western Sydney University, added: “This builds on existing evidence of other food-derived supplements, such as certain amino-acids, been beneficial for people with schizophrenia.

“These new findings also fit with our latest research examining how multi-nutrient treatments can reduce depression and other disorders.”

The research team say more studies are now needed to discover how nutrients act on the brain to improve mental health, and to measure effects of nutrient-based treatments on other outcomes such as brain functioning and metabolic health.

The paper is published by the journal, Psychological Medicine. DOI: 10.1017/S0033291717000022

Pets can help people manage their long-term mental health conditions, according to University of Manchester research published in the open access journal BMC Psychiatry.

The consistent presence and close physical proximity of their pets was described in this NIHR-funded study as providing an immediate source of calm and therapeutic benefit for the pets’ owners. The researchers suggest that pets should be considered a main source of support in the management of long-term mental health problems.

Lead author, from The University of Manchester said: “The people we spoke to through the course of this study felt their pet played a range of positive roles such as helping them to manage stigma associated with their mental health by providing acceptance without judgement.

“Pets were also considered particularly useful during times of crisis. In this way, pets provided a unique form of validation through unconditional support, which they were often not receiving from other family or social relationships. Despite the identified benefits of pet ownership, pets were neither considered nor incorporated into the individual care plans for any of the people in our study.”

Dr Brooks added: “These insights provide the mental health community with possible areas to target intervention and potential ways in which to better involve people in their own mental health service provision through open discussion of what works best for them.”

The researchers interviewed 54 participants, aged 18 and above, who were under the care of community-based mental health services and had been diagnosed with a severe mental illness.

Participants were asked to rate the importance of members of their personal network including friends, family, health professionals, pets, hobbies, places, activities and objects, by placing them in a diagram of three concentric circles. Anything placed in the central circle was considered most important; the middle circle was of secondary importance and the outer circle was for those considered of lesser importance.

Pets played an important role in the social networks of people managing a long-term mental health problem, as 60% placed their pet in the central most important circle and 20% placed their pet in the second circle.

The participants stated that one reason for this was that their pet helped by distracting them from symptoms and upsetting experiences such as hearing voices or suicidal thoughts. Participants from the study were quoted as saying:

“I felt in a sense that my cat was my familiar in that he understood or was an extension of my thoughts.”

“When I’m feeling really low they [pets] are wonderful because they won’t leave my side for two days.”

“You just want to sink into a pit and just sort of retreat from the entire world, they force me, the cats force me to sort of still be involved with the world.”

“I’m not thinking of the voices, I’m just thinking of the birds singing.”

The interviews supported existing evidence that some participants feel distanced from healthcare and uninvolved in discussions about services. Taking more creative approaches to care planning, such as incorporating discussions about pets, may be one way of helping to better involve participants because of the value, meaning and engagement that individuals have with their companion animals.

The paper, ‘’, was published in the journal BMC Psychiatry. DOI 10.1186/s12888-016-1111-3

An accompanying blog has also been pulbished which can be read .

An early intervention for autism aimed at helping parents communicate with their child has been shown to have an effect on reducing the severity of autism symptoms, and this reduction continued for six years after the end of treatment, according to a study published in The Lancet.

The study led by The University of Manchester, King’s College London and Newcastle University (UK) and funded by the Medical Research Council is the first to identify a long-term effect of an early intervention for autism, and is consistent with UK guidance supporting the use of early intervention.

The researchers found that children who had received the intervention aged 2-4 had less severe overall symptoms six years later, with improved social communication and reduced repetitive behaviours, although no changes were seen in other areas such as language or anxiety. However, they say that difficulties remain and additional ongoing support will usually be needed as the children get older.

“This type of early intervention is distinctive in being designed to work with parents to help improve parent-child communication at home,” says Professor Jonathan Green of The University of Manchester and Royal 91ֱ�� Children’s Hospital, who led the study. “The advantage of this approach over a direct therapist-child intervention is that it has potential to affect the everyday life of the child. Our findings are encouraging, as they represent an improvement in the core symptoms of autism previously thought very resistant to change.”

Autism spectrum disorder is a developmental disorder that affects about 1 in 100 people; it can have a profound effect on children’s social development into adulthood and results in an estimated £1-1.5 million in lifetime costs for families and the community. The type of early intervention used in this study focuses specifically on working with parents.

Through watching videos of themselves interacting with their child and receiving feedback from therapists, parents are able to enhance their awareness and response to their child’s unusual patterns of communication; they become better able to understand their child and communicate back appropriately in a focused way. Parents take part in 12 therapy sessions over 6 months, followed by monthly support sessions for the next 6 months. In addition, parents agree to do 20-30 minutes per day of planned communication and play activities with the child.

In the original trial, 152 children aged 2-4 with autism were randomised to receive the 12 month early intervention or treatment as usual. The study published today is the follow-up analysis of the same children approximately 6 years after the end of treatment. 121 (80%) of the 152 original trial participants were assessed as part of the follow-up study. Of these, 59 children had previously received the intervention and 62 had received treatment as usual. Autism severity was measured using the international standard measure of autism symptoms (ADOS CSS), which combines social communication and restricted and repetitive behaviour symptoms into an overall measure of severity scored 1-10, with 10 being the most severe.

At the start of the trial, both groups had similar scores (8.0 in the intervention group, 7.9 in the treatment as usual group). At follow-up, children in the intervention group scored an average of 7.3, and 46% (27/59) of the group were in the severe range. By comparison, children in the treatment as usual group scored an average of 7.8, with 63% (39/62) in the severe range. This corresponds to a reduction of 17% in the proportion of children with severe symptoms in the intervention group compared to treatment as usual.

At follow-up, there were also improvements in children’s communication with their parents for the intervention group, but no differences in the language scores of children. Additionally, parents in the intervention group reported improvements in peer relationships, social communication and repetitive behaviours. However, there was no significant difference between the two groups on measures of child anxiety, challenging behaviours (eg, conduct/oppositional disorder) or depression.

The authors note that the study included children with core autism symptoms rather than wider autism spectrum disorder, and therefore cannot be sure how these results would apply to children with less severe symptoms. They also add that the study was a follow-up at age 7-11 years so does not provide information in how children’s symptoms will develop in adulthood.

.

A University of Manchester study which looked at more than thirty years of research into bipolar, found that people with the disorder are 2.63 times more likely to have suffered emotional, physical or sexual abuse as children than the general population.

In the study, published in the British Journal of Psychiatry, the researchers identified 19 studies from hundreds published between 1980 and 2014 which gathered data from millions of patient records, interviews and assessments.

By applying rigorous statistical analysis to the data, the researchers compared the likelihood of people with and without bipolar disorder having adverse childhood experiences, such as physical, emotional and sexual abuse. The findings revealed a strong link between these events and subsequent diagnosis.

Bipolar disorder is characterised by extreme depressive and manic states which impair quality of life and increase suicide risk. An urgent need in this field is better understanding of risk factors that can be used to improve detection and treatment.

Dr Filippo Varese, one of the study authors, said: “Much research into bipolar has focussed on bio-genetics, but following previous work on schizophrenia, we felt that a similar effect could be found in bipolar. The link between experiencing a troubled childhood and subsequently being diagnosed with this serious condition is extremely strong.”

The authors defined childhood adversity as experiencing neglect, abuse, bullying or the loss of a parent before the age of 19. There was a particularly strong link between emotional abuse with this four times more likely to have happened to people with bipolar. However, the loss of a parent did not raise the risk significantly.

The ‘meta-analysis’ approach has been applied in this study for the first time in relation to bipolar disorder and childhood adversity and, as a result, the findings represent a much larger pool of data than has been previously available.

The findings have implications for those providing treatment, as they can factor in these childhood experiences when developing personalised therapy plans.

Dr Jasper Palmier-Claus, the lead author, added: “Handled sensitively, enquiries about a person’s childhood experiences can make a significant difference to how treatment proceeds and the types of support that can be put into place.”

The paper, ‘The relationship between childhood adversity and bipolar disorder: A systematic review and meta-analysis’, was published in the British Journal of Psychiatry.

Over 200 suicide deaths per year now occur in patients under mental health crisis teams, three times as many as in in-patients, according to a report by The University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). The full report is available .

One third of patients under crisis resolution/home treatment (CRHT) who died by suicide had been using the service for less than a week, and a third had been discharged from hospital in the previous two weeks. The report questions whether CRHT was the most suitable setting for their care, and raises concerns that crisis teams are increasingly used due to pressure on other acute services, particularly in-patient beds.

Professor Louis Appleby, Director of NCISH, said: “This year’s report reflects the increasing reliance on crisis teams in response to the strains felt by acute mental health services. Our findings suggest that we are accepting too much risk in the home treatment these teams offer, and that the crisis team is now the priority for suicide prevention in mental health.”

The authors also found that over half the 1700 mental health patients per year who died by suicide across the UK had a history of alcohol or drug misuse. However, only a small proportion had received specialist substance misuse treatment, suggesting a need for these services to be more widely available, working more closely with mainstream mental health care.

Professor Appleby said “The report looks at the growing impact of economic adversity. More patients who died by suicide were reported as having been unemployed or homeless, and 13% had experienced serious financial difficulties in the previous 3 months. We also identified a rising incidence of suicides by patients who had been in the UK for less than 5 years who may be less well connected to services that could support them."

The team reviewed 20 years of evidence from National Confidential Inquiry research, and found a changing pattern of risk factors facing mental health patients, with higher rates of isolation, recent self-harm, alcohol and drug misuse and economic adversity in those who died by suicide. They also found improvements in some aspects of suicide prevention, such as ward safety and acceptance of medication.

Professor Nav Kapur, Head of Suicide Research at NCISH said “The 20 year review has helped us to identify ways in which mental health care is safer for patients. We now know what services can do to reduce suicide risk, for example care planning and early follow-up on discharge from hospital, personalised risk management without routine checklists, and implementing guidance on depression and self-harm”.

NCISH also report on homicide by people who have been in contact with mental health services. The figures show a fall in patient homicides overall but a possible increase by patients with schizophrenia In England since 2009.

Professor Jenny Shaw, Head of Homicide Research, said "The numbers are small, so it is difficult to confirm a clear pattern, but it may be that homicides in this group have risen. Services can help by addressing drug and alcohol misuse and ensuring that contact is maintained for those patients who are likely to disengage from mental health care".

The Mental Health Clinical Review Outcome Programme, delivered by NCISH, is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, the States of Guernsey and the States of Jersey.

In the first study to consider these two adverse outcomes in the same cohort, researchers have shown a strong correlation between parental psychiatric disorder and the increased risk of suicide attempts and violent behaviour in their children.

The research was conducted by a collaborative team of epidemiologists from The University of Manchester’s Centre for Mental Health and Safety and Aarhus University’s National Centre for Register-based Research ,using records of all children born in Denmark between 1967 and 1997 - a total of 1,743,525 people. The cohort was cross-referenced and linked to any recorded history of mental illness in their parents via the Danish Psychiatric Central Research Register. First episodes of suicide attempt and violent offence conviction were investigated from the time when these children turned age 15 years.

Risks for offspring suicide attempt and violent offending were raised across almost all parental psychiatric disorders. The highest risks were found among families where one or both parents were diagnosed with antisocial personality disorder, cannabis misuse disorder or prior suicide attempt. On the contrary, parental mood disorders, and bipolar disorder in particular, conferred more modest risk increases.

A history of mental illness in both parents was associated with double the risks of suicide attempt and violent offending in offspring compared with having just one affected parent.

Dr Roger Webb, the study’s principal investigator based in the Division of Psychology and Mental Health at The University of Manchester, said the research has profound implications for both healthcare providers as well as social services.

“Psychiatrists and other professionals treating adults with mental disorders and suicidal behaviours should also look to the children of their patients – and assess their mental health and psychosocial needs. Early interventions could benefit not only the parents but also their offspring.”

The paper, ‘Parental psychiatric disease and risks of attempted suicide and violent criminal offending in offspring: A population-based cohort study’, is published in the journal JAMA Psychiatry ().

The link between sleep problems and suicidal thoughts and behaviours is made starkly clear in new research from The University of Manchester, published in the BMJ Open.

In this study, conducted by researchers from the University's School of Health Sciences alongside the University of Oxford, 18 participants were interviewed about the role sleep problems have on suicidal tendencies.

Three inter-related pathways to suicidal thoughts were identified arising from sleep problems. The first was that being awake at night heightened the risks of suicidal thoughts and attempts, which in part was seen as a consequence of the lack of help or resources available at night.

Secondly, the research found that a prolonged failure to achieve a good night's sleep made life harder for respondents, adding to depression, as well as increasing negative thinking, attention difficulties and inactivity.

Finally, respondents said sleep acted as an alternative to suicide, providing an escape from their problems. However, the desire to use sleep as an avoidance tactic led to increased day time sleeping which in turn caused disturbed sleeping patterns - reinforcing the first two pathways.

Donna Littlewood, lead author of the study, said the research has implications for service providers, such as health care specialist and social services.

"Our research underscores the importance of restoring healthy sleep in relation to coping with mental health problems, suicidal thoughts and behaviours.

"Additionally, night time service provision should be a key consideration within suicide prevention strategies, given that this study shows that those who are awake in the night are at an increased risk of suicide."

Donna L Littlewood, Patricia Gooding, Simon D Kyle, Daniel Pratt, Sarah Peters

BMJ Open 2016;6:8 e012113 doi:10.1136/bmjopen-2016-012113

Interviews carried out by The University of Manchester with GPs of parents whose children have died by suicide have revealed a lack of knowledge and confidence on how best to respond to and support those bereaved.

The new study, published in the British Journal of General Practice, explored GPs’ experiences and perceived needs (emotional, practical and training) when caring for parents bereaved by suicide.

The study was led by the University of Manchester in collaboration with , and funded by the Research for Patient Benefit (RfPB) programme. They recruited parents whose adult children (aged between 18-35 years) had died by suicide between 2002 and 2012 to identify their experiences and perceived needs.

With the parents’ consent, the research team interviewed their GP to identify their experiences and perceived needs caring for the bereaved parents. Thirteen GPs were recruited to the study.

Those bereaved by suicide are also significantly at risk of dying by suicide and an important focus of government strategy to help reduce the suicide rate amongst this vulnerable population. Those who have lost love ones struggle to cope and often feel isolated, stigmatised and unsupported. The bereavement has a serious effect on their own mental health and as a result many people turn to their GPs in the first instance.

The interviews revealed that the GPs know this to be the case but as non-specialists, needed support to deal with the difficulties these patients face. They were sometimes personally affected by the suicide of a patient as well and this impacted on their ability to work with the parents.

specialises in suicide bereavement research and as a result of this work her research team has designed training for primary care practitioners, such as GPs.

Bereaved families contributed their stories for use in the training which has been very well evaluated. Dr McDonnell is hoping to open this out across the UK.

Findings in this study have also informed the development of the first evidence-based suicide bereavement training internationally which guides health professionals on how to respond to and care for parents bereaved by suicide.

Dr McDonnell added: “This study has advanced our understanding of the vulnerability and perceived needs of GPs caring for parents bereaved by suicide. Findings have the potential to inform policy and practice.”

Paper, . Br J Gen Pract 2016; DOI: 10.3399/bjgp16X686605. The British Journal of General Practice

Aerobic exercise can significantly help people coping with the long-term mental health condition schizophrenia, according to a new study from University of Manchester researchers.

Through combining data from 10 independent clinical trials with a total of 385 patients with schizophrenia, Joseph Firth found that around 12 weeks of aerobic exercise training can significant improve patients’ brain functioning.

The study by Firth, Dr Brendon Stubbs and is published in , the world’s leading journal on Schizophrenia and one of leading periodicals in Psychiatry.

Schizophrenia’s acute phase is typified by hallucinations and delusions, which are usually treatable with medication.

However, most patients are still troubled with pervasive ‘cognitive deficits’; including poor memory, impaired information processing and loss of concentration.

The research showed that patients who are treated with aerobic exercise programs, such as treadmills and exercise bikes, in combination with their medication, will improve their overall brain functioning more than those treated with medications alone.

The areas which were most improved by exercising were patients’ ability to understand social situations, their attention spans, and their ‘working memory’ – or how much information they can hold in mind at one time.

There was also evidence among the studies that programs which used greater amounts of exercise, and those which were most successful for improving fitness, had the greatest effects on cognitive functioning.

Joe Firth said: “Cognitive deficits are one aspect of schizophrenia which is particularly problematic.

“They hinder recovery and impact negatively upon people’s ability to function in work and social situations. Furthermore, current medications for schizophrenia do not treat the cognitive deficits of the disorder.

“We are searching for new ways to treat these aspects of the illness, and now research is increasingly suggesting that physical exercise can provide a solution.”

He added: “These findings present the first large-scale evidence supporting the use of physical exercise to treat the neurocognitive deficits associated with schizophrenia.

“Using exercise from the earliest stages of the illness could reduce the likelihood of long-term disability, and facilitate full, functional recovery for patients.”

The paper ‘, published in Schizophrenia Bulletin is available open-access online from 8am on Friday 12 August. Article DOI: 10.1093/schbul/sbw115.

A new study from The University of Manchester, prompted by current government policy for a ‘seven-day NHS’, has found that suicide deaths by mental health patients are actually lower at the weekends.

A current government policy priority is to extend health services to a full ‘seven-day NHS’, partly due to claims that patients admitted at the weekend are more likely to die because of lack of specialist staffing and services.

The new paper, published in the British Journal of Psychiatry, is one of the first to explore the weekend effect in mental health. In contrast to previous studies of all hospital deaths, the paper found that the incidence of suicide was 12-15 percent lower at the weekend. The study was carried out by researchers at .

, from The University of Manchester and , led the study. He said: “We wanted to explore a possible weekend effect on patient suicide. We looked at specific groups being treated in hospital or the community who might be particularly vulnerable to changes in care. We actually found a markedly reduced suicide risk at the weekend. We also found a reduced risk in people who were admitted at the weekend.”

The researchers analysed 5,613 suicide deaths in England between 2001 and 2013. They examined deaths by suicide in inpatients, those who had been discharged from psychiatric hospital within the previous three months and those under the care of crisis resolution home treatment teams. By looking at the deaths and the days they occurred, they found that in all groups, suicide was less likely to occur at the weekend.

The study also investigated the idea of an August effect – a month when final-year medical students become doctors and junior doctors become a grade more senior. Some previous research has suggested this could affect patient care but the current study found no evidence of an increase in suicide during this month.

The study was unable to investigate causal reasons for the decline in deaths at the weekends, but the authors consider the possibility that because mental health services are more multi-disciplinary and community-based than some other medical specialities they are insulated from a reduction in the availability of doctors at the weekend. Alternatively the lower rate of weekend suicide could reflect increased social contact between patients and their families and friends.

It is also possible that in the case of a lower rate of death among admissions at the weekend, there is a lower threshold applied to admitting patients because highly specialised community services may not be as available.

Professor Kapur said: “Although the causes of suicide are varied and complex, we do know from our previous work that the way services are organised and staffed can have an effect. In this case however, our results did not suggest a weekend effect on suicide.”

, Director of the National Confidential Inquiry and one of the authors of the study, added that: “We should recognise that extending NHS services could have a number of potential benefits such as improving access to services, enhancing continuity of care, reducing morbidity, and improving the quality of care. However, our study of suicide in high risk patient groups does not support the claim that safety is compromised at weekends, at least in mental health services.”

The paper, ‘’, was published in the British Journal of Psychiatry. DOI: 10.1192/bjp.bp.116.184788

A University of Manchester-led study is testing whether an intervention with parents and teachers can help children with autism transfer newly acquired social communication skills from home into school.

Previous research found that a therapy to enhance parent-child communication in children with autism can help improve their social communication. However, it did not provide evidence that the benefit spread wider into the school environment.

Children with autism generally have difficulty generalising new skills from one context to another, and this represents a challenge in spreading the benefits of therapy into other aspects of everyday life and development.

Autism is a common developmental disorder, with a prevalence of around 1% of the population. Its estimated UK costs, for childhood autism, are greater than the costs associated with other conditions such as childhood asthma, diabetes or intellectual disability.

The ‘Paediatric Autism Communication Trial-Generalised’ (PACT-G) study, funded by Efficacy and Mechanism Evaluation Programme (a partnership between and ), will test new ways to transfer the child’s improving communication skills into the education setting. Aimed at 2-11 year olds, the study will look to extend the parent-child therapeutic model to work in education in parallel to working in the home.

It will assess the impact of the intervention across pre-school and middle childhood and compare outcomes with those from previous research. Its design will also enable the researchers to study the mechanism behind this transfer of skills across different settings, and highlight the most efficient means of helping children and families in this area.

University of Manchester Professor of Child and Adolescent Psychiatry, and Honorary Consultant Psychiatrist at the is leading the project and said, “This project is an exciting opportunity for us to test an extension of our approach using video feedback with parents of young children with autism to include similar training of professionals working with the children in their education setting. If this kind of integrated approach proves to add value for children’s development, then it will have important implications for service delivery in the future. The trial also gives us a unique opportunity to investigate how these children generalise skills across contexts – an important and fundamental question in the developmental science of autism.”

The research team will work with school staff using the same techniques they use with parents, as well as encouraging parents and Learning Support Assistants to communicate regularly together about goals and strategies. The aim is to generate a similar change in school to that generated with parents in the home.

Professor Green added, “We hope that these two effects will add together into a greater combined benefit for the child. This study is just beginning and we won't know the results for a few years, but it is part of an ongoing programme to look at the needs of children with autism at different ages and to see if we can get interventions that build on each other through development to improve the lives of these children and their families.”

One parent taking part in the study said “I realise the importance of understanding what he understands and making my communication directly relevant to the context of the interaction. It’s a real partnership where we discuss the meaning of his communication and I always go away understanding him so much better with insight.”

The study is a collaboration between , University of Manchester, Newcastle University, Kings College London, Guys and St Thomas NHS Trust Evelina Children’s Hospital.

For further information visit the

A long-term University of Manchester study of Danish children followed into adulthood shows that moving to a new home during childhood increases the likelihood of multiple adverse outcomes later in life. This unique residential mobility study of 1.4 million people tracked from their 15th birthdays until their early forties appears in the American Journal of Preventive Medicine.

Data were collected on all people born in Denmark from 1971 to 1997 documenting every residential childhood move from birth to 14 years. Each move was associated with the age of the child so that the impact of early-in-life moves could be contrasted with moves during the early teenage years. With a number of comprehensive national registries at their disposal, the team of researchers was able to measure and correlate subsequent negative events in adulthood, including attempted suicide, violent criminality, psychiatric illness, substance misuse, and natural and unnatural deaths.

“Owing to its uniquely complete and accurate registration of all residential changes in its population, Denmark is the only country where it is currently possible to conduct such a comprehensive national investigation of childhood residential mobility and risk of adverse outcomes in later life,” explained lead investigator, , from the University’s, .

The risk of adverse outcomes due to residential mobility during childhood was classified into three categories: self-directed and interpersonal violence: (attempted suicide, violent criminality), mental illness and substance misuse (any psychiatric diagnosis, substance misuse), and premature mortality (natural and unnatural deaths).

The study was at a whole population scale and did not establish causal links. The researchers concede that there could be many reasons for individual families moving, and that moving home may be beneficial to some families.

Thirty-seven percent of people studied relocated across a municipal boundary at least once before reaching their 15th birthdays, with multiple relocations occurring most frequently during infancy. Across all adverse outcomes studied, the highest risks were among individuals who moved frequently during early adolescence.

Statistical analysis was particularly robust. “Dose–response” relationships were evident for every outcome category and each additional move was associated with an incremental risk increase. For example, data analysis showed that risk increased with multiple moves at any age versus a single move, and that an even sharper spike in risk for violent offending was observed with multiple relocations within a single year. The attempted suicide risk increased steadily with rising age at the time of the move, and was markedly raised if multiple annual relocations occurred during early adolescence (12–14 years of age).

Socio-economic status (SES) of the families was determined by looking at: income (annual quintiles), highest educational attainment level (primary school, high school/vocational training, higher education), and employment status (employed, unemployed, outside workforce for other reasons). Lower SES was assigned when both parents scored low in at least one of the three areas. Higher SES required both parents to be employed and a high score in income or education. Middle SES encompassed all other combinations.

The initial hypothesis that adverse outcomes might be more prevalent in households with lower SES was not borne out by this study, where markedly elevated risk due to residential moves during early/mid adolescence applied to all SES levels.

According to Dr Webb: “Childhood residential mobility is associated with multiple long-term adverse outcomes. Although frequent residential mobility could be a marker for familial psychosocial difficulties, the elevated risks were observed across the socioeconomic spectrum, and mobility may be intrinsically harmful. Health and social services, schools, and other public agencies should be vigilant of the psychological needs of relocated adolescents, including those from affluent as well as deprived families.”

“,” by Roger T. Webb, PhD, Carsten B. Pedersen, DrMedSc, and Pearl L.H. Mok, PhD, DOI: http://dx.doi.org/10.1016/j.amepre.2016.04.011, published online in the American Journal of Preventive Medicine, in advance of Volume 51, Issue 5 (November 2016),

In a joint project between the Universities of Liverpool and 91ֱ��, researchers have examined the initial trial of a smartphone application designed to help people manage their problems.

The ‘Catch It’ app uses some of the key principles of psychological approaches to mental health and well-being, and specifically Cognitive Behavioural Therapy (CBT), helping users better understand their moods through use of an ongoing diary.

CBT is a therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

The widespread use of mobile phones makes effective therapies such as CBT potentially accessible to large numbers of people.

The Catch It app takes users through a process referred to as “Catch it, Check it, Change it.” Catch it aims to help the user identify thoughts and thinking styles associated with a shift in mood or a particular emotion.

The study, conducted by researchers from the University of Liverpool’s Institute of Psychology, Health and Society (IPHS), the University of Liverpool’s Computer Services and the University of Manchester’s , has been published in the British Journal of Psych Open.

Professor Peter Kinderman from the University of Liverpool said: “This type of therapy cannot remove problems, but it can help people deal with them in a more positive way. It is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

“Our research examined the uptake and usage rates of this application along with the faithfulness of user responses to CBT principles and their impact on reported negative and positive moods.”

A relatively modest proportion of people chose to download the app, once used, the app tended to be used more than once. Also, 84% of the user-generated content was consistent with the basic concepts of CBT.

Professor Kinderman, added: “There were statistically significant reductions in negative mood intensity and increases in positive mood intensity.

“Smartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted.”

University of Manchester researcher said: "It is exciting that this app has the potential to make psychological approaches more accessible to anyone. Our research demonstrates that using the app can help people to broaden their perspectives of their problems, making a positive difference to how they are feeling. With more research, we hope this app might benefit people with a range of mental health problems."

The full study, entitled ‘’, was published in the British Journal of Psychiatry Open.

DOI: 10.1192/bjpo.bp.115.002436

Increasing specialist community services like crisis resolution, helping make the transition to adult services smoother for young people, and implementing clinical guidelines are just some of the service changes that are linked to significantly reduced suicide rates in mental health services in England over the last 16 years, according to new research from The University of Manchester.

The study, published in The Lancet Psychiatry journal, by researchers at at The University 91ֱ�� also finds that suicide rates were higher in mental health trusts with higher levels of staff turnover, suggesting that organisational factors may be equally important in preventing suicide.

Previous studies examining which aspects of mental health service provision are most effective in preventing suicide are scarce, have been inconsistent in their findings, and limited in scope. This is the first study to look at the impact of specific mental health service improvements in a range of organisational contexts, on suicide rates.

In this study, the authors analysed the impact of 16 recommendations and service changes in all NHS mental health services across England on patient suicide rates between 1997 and 2012. They also looked at whether suicide deaths were related to the way mental health services were organised (using measures such as staff turnover, staff and patient satisfaction, patient complaints).

The research included data from 19,248 individuals who died by suicide in England over the 16-year period and were in contact with mental health services in the 12 months before they died. This represents over a quarter of all suicide deaths in England during this time. The researchers compared suicide rates before and after these recommendations and service changes were introduced.

By 2012, 58 services (94%) had implemented at least 10 of the service changes and 34 (55%) had implemented all 16. The individual service changes that were most widely implemented were removal of non­collapsible ligature points on wards, policies to reduce absconding on in-patient wards, and a mechanism to implement National Institute for Health and Care Excellence (NICE) guidelines.

The five mental health service changes linked to the biggest falls in suicide were: increasing the availability of specialist community services like crisis resolution and home treatment; better management of patients with dual diagnosis (ie, drug or alcohol misuse as well as major mental illness); reviews and information with families after suicide; introducing policies to help manage the transition to adult mental health services for young people; and implementing the NICE guidelines on depression.

The researchers found that implementing recommendations and service changes was associated with significantly lower suicide rates. Each of the 16 recommendations and service changes were linked with 20-30% decrease in the suicide rate (from around 12 suicides per 10,000 contacts with mental health services to approximately 9).

The study also linked suicide rates to some wider organisational factors including higher levels of non-medical (e.g. nursing) staff turnover and reporting of patient safety incidents. However, other factors like staff sickness and patient satisfaction did not appear to affect suicide rates.

Importantly, implementing the five most promising changes had a greater impact in mental health services with low levels of non-medical staff turnover and higher levels of overall reported safety incidents. “A workforce that is constantly changing is likely to affect the continuity of care and this could compromise safety,” explains Professor Nav Kapur, lead author and Head of Suicide Research at at The University of Manchester.

“High numbers of safety incidents might suggest a culture of openness in which staff and the organisation learn from adverse incidents, but they may also be a warning that there are real patient safety issues.”

According to Professor Kapur: “Our study suggests that many of these interventions may prevent suicide and save lives. The data also show that at least as important as these initiatives might be the organisational context in which they are introduced. These are important findings for mental health services worldwide, particularly in those countries where there is a focus on community care such as the USA, Europe, and Australasia.”

Professor Louis Appleby, Director of the National Confidential Inquiry and one of the co-authors of the study added: “This study shows that how clinical staff work can make a difference to patient suicide risk. Mental health trusts with low staff turnover, and where staff reviewed suicide deaths with families had lower suicide rates suggesting that healthy, learning organisations may also be safer.”

Paper, ‘’, was published in The Lancet Psychiatry Journal.

The Healthcare Quality Improvement Partnership () commissions the Mental Health Clinical Outcome Review Programme, NCISH, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), and the States of Jersey and Guernsey.

The University of Manchester’s Professor Louis Appleby has concluded a review for the General Medical Council, making recommendations to reduce the risk of suicide in doctors facing investigation.

Twenty-eight doctors with an open GMC case died by suicide 2005-2013. To address this issue, began working with the GMC in December 2015, reviewing the fitness-to-practise process with the aim of reducing the risk of suicide in doctors facing investigation. He delivered his findings last week.

Detailed proposals have now been drawn up by Professor Appleby, a psychiatrist and Director of . The presentation was attended by Royal Colleges, the British Medical Association and other senior figures in health across the UK. The proposals will now be developed by the GMC and published in final form.

These include working towards having fewer doctors referred for investigation, and having a dedicated medical post ensuing mental health is factored in to decisions.

Importantly, investigations should be handled sensitively and communicated through one individual. Employers should also play a greater role and more funding should be identified for support services.

Professor Appleby said: “The GMC can now turn a tragic problem into positive steps that others can follow. It can make mental health safety a thread that runs throughout the organisation, influencing training, standards, leadership and culture.

“A permanent focus on mental health safety will help doctors who might otherwise be at risk of suicide, but it can go further – in time it can extend the potential benefits of these proposals to patients and staff.”

More information these proposals can be found on , written by Professor Appleby.

Results of a new study into the relationship between nightmares and suicidal behaviours show that suicidal thoughts, plans or attempts were present in 62 percent of participants who experienced nightmares and only 20 percent of those without nightmares.

Multiple analyses by The University of Manchester researchers, published in the Journal of Clinical Sleep Medicine suggest that nightmares may act as a stressor in people with post-traumatic stress disorder (PTSD).

The nightmares may trigger specific types of negative cognitive thoughts – such as defeat, entrapment and hopelessness - which reinforce suicidal thoughts and behaviours. The pathways between nightmares and suicidal behaviours appear to operate independent of comorbid insomnia and depression.

“PTSD increases the risk of suicidal thoughts and behaviour, and our study shows that nightmares, a hallmark symptom of PTSD, may be an important treatment target to reduce suicide risk,” said principal investigator , PhD researcher in the at The University of Manchester. “This study emphasises the importance of specifically assessing and targeting nightmares within those individuals experiencing PTSD.

“In addition, monitoring and targeting levels of negative cognitive appraisals such as defeat, entrapment, and hopelessness, may reduce suicidal thoughts and behaviours.”

In previous research, has reported that nightmares are vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror. A nightmare disorder may occur when repeated nightmares cause distress or impairment in social or occupational functioning. Nightmares beginning within three months of a trauma are present in up to 80 percent of patients with PTSD, and these post-traumatic nightmares may persist throughout life.

Data for this study was collected from 91 participants who had experienced traumatic events, 51 of whom met criteria for PTSD currently, and an additional 24 of whom reported a prior diagnosis of PTSD.

Nightmares were measured by summing the frequency and intensity ratings of relevant items on the clinician-administered PTSD scale. Participants also completed questionnaire measures of suicidal behaviour, hopelessness, defeat, and entrapment. Given the interactions between insomnia, PTSD, and suicide, a measure of insomnia was included as a covariate. Analysis was also conducted with and without those participants who had comorbid depression.

The authors suggest there are additional pathways underpinning the relationship between nightmares and suicide that should be identified through further research.

Research support was provided by and the University of Manchester Presidential Scholar Award.

“.” Journal of Clinical Sleep Medicine http://dx.doi.org/10.5664/jcsm.5592

An exercise programme devised by researchers at The University of Manchester has dramatically reduced symptoms among young people with first-episode psychosis.

The long-term prospects for young people who are diagnosed with psychosis are typically poor, with high rates of relapse, unemployment and premature death. The antipsychotics they are prescribed also cause rapid weight-gain.

Although exercise has been shown to be an effective treatment for people with long-term schizophrenia, no studies have assessed its effects on psychiatric symptoms in young adults with early psychosis, until now.

The University of Manchester study recruited 31 people aged 18-35 who had been referred to local mental health trusts for treatment. With the participants help, the team designed personalised exercise regimes which were carried out under the supervision of a researcher for ten weeks at local leisure centres.

, the lead author on the study, said: “Establishing an exercise regime for people with psychosis is likely to be much more effective when they are younger, and in the earliest stages of treatment. Getting people into a routine early on also helps set habits for life, which can make a huge difference to their long-term physical and mental health.”

The participants in this study actually exceeded the target amounts of exercise; achieving 107 minutes of vigorous exercise training each week for 10-weeks.

This compares favourably with exercise programmes in healthy populations as well as in schizophrenia.

“Personalising exercise training to the activities which patients find most motivating helps them stick to their programme.”

At the end of the 10-week period, the participants completed a variety of standardised mental and physical health tests. As a control group, seven people who were treated by mental health services without an exercise programme were also tested.

On the standardised tests, the exercise group displayed a 27 percent reduction in psychiatric symptoms, which was significantly better than the control group. Their brain functions also improved, and they achieved a slight reduction in body weight – going against expected weight gain from normal treatment.

Joseph added: “This was only a pilot study, but the improvements, particularly in psychiatric symptoms, were dramatic. Personalised exercise at local leisure centres seems to be a cost-effective and successful way to help these young people recover”.

“By reaching people early on, exercise can provide a healthy and empowering add-on treatment for young people with psychosis. This could massively improve their social functioning and mental health, hopefully preventing long-term disability from ever arising.”

The study, ‘’, was published in the journal Early Intervention in Psychiatry. DOI: 10.1111/eip.12329

Additionally, feedback from the participants themselves has also been published in the journal BMC Psychiatry, as ‘ DOI: 10.1186/s12888-016-0751-7