Mental health and wellbeing

Welcome to a School of Medicine Faculty Research Theme (FReT)

Mental Health and Wellbeing

We aim to improve care for people with mental health problems by generating new insights and new evidence-based treatments. Our research covers a broad range of topics spanning common mental health problems (anxiety and depression) to severe mental illness across UK and global healthcare contexts.

Below you will find details about our team members, research studies, and networks.

Our updates

Here we keep you informed about the latest projects and developments within our community.

Meet our team

Learn more about the individuals behind our success, each bringing unique skills, perspectives, and dedication to the table.

The team has led and/or been involved in various research studies that focus on common mental health problems (inc. anxiety, depression and distress) and contributing factors, such as, social isolation and loneliness. See below for a selection of our research.

BASIL (Behavioural Activation in Social IsoLation)

This programme of work was adapted at the start of the covid-19 pandemic building on an NIHR-funded programme MODS Managing multiple health conditions in Older aDultS.

The Chief Investigator is Professor Simon Gilbody, University of York, and Professor Carolyn Chew-Graham leads the qualitative work within BASIL and MODS as well as being part of the training team for the Support Workers in BASIL and MODS.

Find out more about BASIL

BALM (Behavioural Activation for Low mood and anxiety in Male NHS frontline workers: The BALM programme)

CHOOSE study (Children and young people psychiatric diagnoses before and during the Covid-19 pandemic)

CHOOSE study is funded by SPCR.

Led by Dr Pearl Mok, Greater Manchester Safety Centre, University of Manchester

This research aims to look at how many children and young people in the UK have been diagnosed with a psychiatric disorder or have self-harm recorded in their GP records, comparing the periods before and during the Covid-19 pandemic. We are also interested in treatment and referrals made with/for this population. We will then work with children and young people, parents and other key partners to develop recommendations for GPs, other healthcare services, social services, schools and colleges, on how to help children and young people with their mental health difficulties.

We are working closely with the McPin Foundation, mental health charity, who are supporting the PPIE in this study.

CLARENCE (CuLturally Adapting pRimary care mENtal health for the UK Central and eastern European community)

CLARENCE is a Wellcome Trust funded PhD research project led by Dr Aaron Poppleton, a General Practitioner and Clinical Academic in School of Medicine and the Institute for Global Health.

CASPER PLUS (Collaborative Care in Screen-Positive Elders)

CASPER PLUS was a study of a primary care-based psychological treatment, called 'collaborative care' for older people with depression. The study sought to establish clinical and cost effectiveness. Read our NIHR report. Article about CASPER PLUS.

Fireside study

The FIRESIDE study seeks to understand whether it is acceptable to utilise Fire and Rescue Service “Safe & Well” visits to support the detection of, and sign-posting for, mental health problems (anxiety and depression) among older adults.

Junior doctors and distress

An exploratory mixed method study to identify working conditions and work cultures associated with psychological distress and suicidality among junior doctors working in the NHS.

Research-informed film on junior doctors: @WellbeingNhs

MIR study (Mirtazapine added to SSSRIs for treatment resistant depression in primary care)

This is a randomised controlled trial which aims to test whether the addition of the antidepressant 'Mirtazapine' is effective in reducing the symptoms of depression compared with a placebo in patients who have been treated with Serotonin Selective Reuptake Inhibitor (SSRI) or Serotonin Noradrenaline Reuptake Inhibitor (SNRI) for at least six weeks. MIR

NOTEPAD study (NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression)

The NOTEPAD study was a collaboration with Age UK North Staffs, and tested the feasibility of training third sector workers to deliver and intervention to older people with anxiety and depression. Read our NIHR report. See other study outputs including published papers and training materials.

RIDDLE study (Realist review of Interventions for Depression Delivered by ‘non-traditional’ providers to oLder pEople)

This study aims to solve the riddle of how, when and where interventions to detect mental health problems in older people, delivered by "non-traditional" providers (e.g. fire and rescue service, police, library services), work.

See our published paper reporting our findings from RIDDLE:

Kingstone, T., Chew Graham, C. A., & Corp, N. (2022). Interventions to identify and manage depression delivered by ‘nontraditional’providers to community dwelling older adults: A realist review. Health Expectations, 25(6), 2658-2679. https://doi.org/10.1111/hex.13594

SHADOW study (Seeking Help for Anxiety and Depression among cOmmunity-dWelling older adults)

This study reviews current evidence for interventions that look to facilitate help-seeking behaviours for mental health problems (depression/anxiety) in older adults (60+ years). We want to understand how these interventions are designed, whether they work, for whom and in what contexts. This study is funded by NIHR SPCR and led by Dr Tom Kingstone at Keele.

Stress and burnout in General Practitioners

Stress and burnout in General Practitioners is a study which explores the barriers and facilitators for General Practitioners to access support when they are experiencing stress/burnout and/or reduced emotional or mental well-being. This study is funded by SPCR.

Members of the team have been involved in several studies looking into comorbid physical and mental health problems. By ‘comorbid’ we mean where two (or more) health conditions occur together at the same time. Please see below for a summary of research conducted on this topic.

CHEMIST (Community pHarmaciEs Mood Intervention STudy)

The study aims to find out whether brief psychological support provided via community pharmacies may help people living with long-term health problems to maintain a healthy mood. The study is being undertaken at various community pharmacies within the North-East of England.

CRIISP (Consortium to Research Individual, Interpersonal and Social influences in Pain)

Researchers at Keele University are working with teams in 7 other institutions on the CRIISP programme:

Consortium to Research Individual, Interpersonal and Social Influences in Pain (CRIISP)

Our research will focus on how people perceive pain and how others affect their pain, as well as consider wider social and environmental influences on pain.

DeSTRESSpain study (pain-related distress)

The DeTRESSpain study, funded by Versus Arthritis, is led by Professor Tamar Pincus at University of Southampton. The research team aim to develop an intervention to support people with pain-related distress.

Chew-Graham led phase 1 which was a qualiative study, with interviews with people with persistent pain and with GPs. The first paper from this work has just been published.

Shivji NA, Geraghty A, Birkinshaw H, Pincus T, Johnson H, Little P, Moore M, Stuart B, Chew-Graham CA. Supporting people with pain-related distress in primary care consultations: a qualitative study. BJGP 2022. 0120. DOI: https://doi.org/10.3399/BJGP.2022.0120

Diabetes and Depression study

This Diabetes and depression study focussed on the illness perceptions and explanatory models in patients with type 2 diabetes and co-morbid depression. The findings of this study will contribute to the development of patient-centred interventions using Cognitive Behavioural Therapy (CBT) principles.

Distress and cancer

Taylor AK, Chang D, Chew-Graham CA et al. ‘It’s always in the back of my mind’: understanding the psychological impact of recovery following pancreaticoduodenectomy for cancer: a qualitative study. BMJ Open. 2021;11:e050016. doi:10.1136/ bmjopen-2021-050016
Taylor AK, Kauser A, Chang D, Phelan A, Chew-Graham CA. ‘You know where we are if you need us.’ The role of primary care in supporting patients following pancreaticoduodenectomy for cancer: a qualitative study. BJGP Open. https://doi.org/10.3399/BJGPO.2021.0154

ENHANCE study

This study examines the feasibility and acceptability of a new integrated care approach. The intervention focuses on the under-diagnosis and management of osteoarthritis related pain and anxiety and/or depression in patients with LTCs (asthma / COPD / hypertension or ischemic heart disease / diabetes) in primary care.

INCLUDE (INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs)

To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care.

Hider SL, Bucknall M, Cooke K et al. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; Identifying multimorbidity: Protocol for a pilot randomised controlled trial. Journal of Comorbidity 2018. Aug 2; 8(1):2235042X18792373.
Hider S, Bucknall M, Jinks C et al. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot and Feasibility Studies (Jan 2021) 7:9 https://doi.org/10.1186/s40814-020-00750-7

MODS (Multimorbidity in OlDer adultS)

This study seeks to evaluate the use of behavioural activation to support mental health needs of older people with multiple long-term conditions.

Stoma Support study

Individuals with inflammatory bowel disease (IBD) and who have stoma surgery frequently experience distress, and are at increased risk of developing depression with a higher likelihood of being prescribed antidepressant medication compared to those without a stoma. Stoma-related distress may be particularly salient in young people (aged 16-35) who may also be undergoing major life transitions.

This SPCR-funded study aims to co-design the content and format of an evidence-based, theory-informed online intervention to provide support for stoma-related distress in young people. The intervention will comprise two components:

a brief information and training package for healthcare professionals to enhance identification and management of stoma-related distress
a resource to support young people to self-manage and reduce distress, through improving their confidence and self-efficacy in dealing with distress, and equipping them with coping skills and strategies

SYMPHONI (SYstems approach to Mental and Physical Health in people with lONg-term conditions)

Funded by CRN Impact and Innovation call for implementation (12-month project) hosted at MPFT
This project aims to explore the barriers and enablers of engaging with healthcare reviews for people with multimorbidity to address mood and lifestyle factors such as obesity, smoking and low physical activity.
We are using individual patient interviews and focus groups with professional stakeholders, informed by Community of Practice approaches.

WAVE study (Work And Vocational advicE)

This study seeks to find out whether a brief vocational advice intervention for patients that receive a fit note for time off is effective (and cost-effective) in reducing the number of days lost from work.

Wynne-Jones G and Chew-Graham CA. Why GPs must not lose their role in supporting people back to work. Life and Times, BJGP. 2022 DOI: https://doi.org/10.3399/bjgp22X719141

IDEA study (Indicators of DEmentiA outcomes)

IDEA is a qualitative study of patients with dementia, caregivers of those with dementia, and healthcare professionals on outcomes and markers of disease progression.

MEDDIP study (MEasurement of Dementia Disease progression in Primary care)

MEDDIP is an epidemiological study seeks to identify markers of dementia progress using primary care data.

Please see below for a summary of research conducted on the topic of grief.

Mapping Grief

While grief is a universal human response to loss, understanding the psychological dynamics which might contribute to complex reactions and coping difficulties, fit within a wider frame of concern for mental health. The Range of Response to Loss Model (RRL) is a theory of grief which articulates these dynamics and the Adult Grief Scale (AAG) is an associated measure used to map/profile individual grief. It is used especially with people who seek help in bereavement and is a model and measure used across a wide range of health and social care settings.

Find out more about mapping grief.

Grief and loss

Linda Machin (PhD) was formerly a lecturer in social work and counselling at Keele, and is now an Honorary Research Fellow of the University. Linda developed a theory of grief, the Range of Response to Loss model and a number of practice measures associated with that e.g., the Adult Attitude to Grief scale, which are being widely adopted in bereavement and hospice services in the UK and beyond. She continues her specialist focus on grief, pre and post bereavement: engaging in further research with the International Observatory on End-of-Life Care at Lancaster university; training psychosocial practitioners; and advising national services e.g., Cruse - Bereavement Care, Sue Ryder Care, in their strategic adoption of her grief measures and the development of a new triage tool.

Grief

Grief is often thought of as singularly linked to an experience of bereavement, but it is a reaction triggered by any significant life loss – a broken relationship, important changes in physical or mental health, financial concerns, social isolation – as well as the death of someone close.

The initial impact of a significant life loss will activate instinctive feelings and thoughts that have been shaped by family and wider cultural influences and assimilated into our personality. The consequent variation in the individual way grief is first experienced and expressed can be seen on a spectrum from those who are overwhelmed by loss to those who avoid engaging with it by appearing in control or people who range across the two extremes. Distressed emotions and disturbing thoughts often feature as immediate reactions to bereavement/loss.

A second dimension of grief is characterised by the conscious attempt to cope with the consequences of the bereavement/loss:

accepting the reality/finality of the loss,
its personal impact on feelings and thoughts,
the social and relationship changes which need to be made/accommodated,
making sense of what has happened.

Support for people who grieve is important. The challenges of loss are best met within our own social network – friends, family, and colleagues. While for some people counselling may be necessary for most people it should not be the first option of support. What is most important is:

someone who understands not everyone grieves in the same way, and that some of the early theories e.g., 5 stages of grief, have been unhelpful in recognising the range of differences in grief response,
someone who can listen without giving advice or using it as a platform for their own experience,
someone who is patient with the ups and downs of grief and the time it takes,
someone who knows when to encourage ‘resting’ from grief and offers support in diversionary activity,
someone who knows when to ask for help for themselves as a supporter.

References:

Bonanno, G. A., & Lilienfeld, S. O. (2008). Let's be realistic: When grief counselling is effective and when it's not. Professional Psychology: Research and Practice, 39(3), 377–378. https://doi.org/10.1037/0735-7028.39.3.377

Stroebe M, Schut H, Boerner K. Cautioning health-care professionals: bereaved persons are misguided through the stages of grief. Omega (Westport) 2017; 75: 455–473. DOI: 10.1177/0030222817691870

Services which might be of use:

Local: The Dove Service: Hope St, Stoke-on-Trent ST1 5DD, Phone: 01782 683155 (Founded in 1984 by Linda Machin)
National: Cruse - Bereavement Care: Helpline 0808 808 1677

Members of the team have been involved in research looking at medically unexplained symptoms, which is where symptoms (e.g. pain) exist but for which a definitive diagnosis is lacking. We are not suggesting that medically unexplained symptoms should be considered a ‘mental health problem’, but we recognise how these symptoms impact mental health and how psychological therapies could support people to understand and manage these symptoms.

The Metaphors study

This study explored whether Metaphors usefully represent the underlying cognitive behavioural therapy (CBT) principles for medically unexplained symptoms (MUS), and how acceptable such generic and MUS specific Metaphors are to patients and practitioners.

Chew-Graham, C. A., Heyland, S., Kingstone, T., Shepherd, T., Buszewicz, M., Burroughs, H., & Sumathipala, A. (2017). Medically unexplained symptoms: continuing challenges for primary care. British Journal of General Practice, 67(656), 106-107.

Members of the team have led and/or been involved in several studies examining perinatal mental health, such as perinatal anxiety and post-natal depression. Please see below for a summary of this work.

CLASP study (CLAssification, outcomeS and interventions for Perinatal anxiety)

This two-year study is funded by the School for Primary Care Research (SPCR). The aim of the study is to improve identification, management and quality of care for women with perinatal anxiety (PNA).

Perinatal Anxiety Study : Healthcare Professional

A qualitative study to explore perspectives of Health Care Professionals in primary and specialist care about perinatal anxiety.

Perinatal Anxiety Study: Women with Lived Experience

This study explores the perspectives of women with lived experience of perinatal anxiety.

PhD study: Defining optimal interventions for Perinatal Anxiety (PNA) in a primary care population: a multi-methods study.

Dr Victoria Silverwood: Wellcome Trust Clinical PhD GP Fellow at the School of Medicine, Keele University.

This thesis aims to understand and summarise current evidence and stakeholder perspectives around interventions for PNA which will inform the co-development of a blueprint of the important elements required for developing an intervention for PNA.  

This thesis contains three research studies and presents a final blueprint:  

Non-pharmacological interventions for the management of PNA in primary care: A meta-review of systematic reviews. 
Women’s perspectives of interventions for PNA: A secondary analysis 
Stakeholder perspectives of interventions for PNA: A primary qualitative study 
A blueprint for interventions for PNA in primary care: what are the important elements?

A maternal mental health PPIE group has been involved throughout this PhD, contributing to each study design, data analysis and dissemination. A stakeholder event is planned for November 2023 where the final blueprint for PNA interventions will be developed.  

Dr Victoria Silverwood is a GP and spends half her week in clinical practice alongside completing this PhD which is funded by the Wellcome Trust.

ROSHNI-2 study (Randomised Control Trial of a group psychOlogical intervention for poStnatal depression in britisH mothers of south asiaN origin)  

A multi-centre randomised clinical trial which studies a group of psychological interventions for post-natal depression in British mothers of South Asian origin. ROSHNI-2.

See below for a summary of our research on the theme of self-harm. Also see our engagement activities and content section for further information.

C-MAP (Culturally adapted Manual Assisted Problem solving training)

This study conducted a multi-centre trial to evaluate the clinical and cost-effectiveness of C-MAP in patients with a history of self-harm in Pakistan.

Kiran T, Chaudry N, Bee P, Tofique S, Farooqe S, Quershi A, Taylor AK, Husain N, Chew-Graham CA. Clinicians’ perspectives of self-harm in Pakistan: a qualitative study. Frontiers in Psychiatry. May 2021. https://doi.org/10.3389/fpsyt.2021.607549

Self-harm in younger people

The COPING study will work in partnership with young people aged 16-25 with lived experience of self-harm and GPs to develop a treatment guide (called COPING) for GPs to use with young people to reduce repeat self-harm.

Self-harm in older adults

See our engagement activities and content section for further information and link to a podcast

Self-harm in people with musculoskeletal problems

Prior J, Crawford-Manning F, Whittle R et al. Vertebral fracture as a risk factor for self-harm: A retrospective cohort study. BMC Musculoskeletal Disorders. 22 article 757 (2021) DOI: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04631-9

See below for a summary of our research on the theme of Severe Mental Illness (SMI), which covers conditions such as schizophrenia, psychosis and bipolar disorder. Also see our engagement activities and content section for further information from several workshops on bipolar disorder, antipsychotics, and smoking and SMI.

Closing The Gap (CTG) network

Keele University is a member of the CTG network. The network seeks to understand why people with severe mental illness have some of the worst physical health issues of any section of the population. The network is led by colleagues at the University of York. >>link.

Physical health inequalities in imprisoned women with serious mental illness: Following the award of funding from the ‘Closing the Gap’ Network (CTG), this project aims to develop a new, multidisciplinary (and cross-institution) collaboration of clinicians, researchers, individuals with lived experience, charities to address the physical health inequalities of women in prison. Read more about this project in our blog.
Chew-Graham CA, Gilbody S, Curtis J, Holt R, Taylor AK, Shiers DS. Still ‘Being Bothered about Billy’ – managing the physical health of people with severe mental illness. BJGP August 2021 DOI: https://doi.org/10.3399/bjgp21X716741

EXTEND Study: Personalised care for early psychosis

Keele University is a research partner in the NIHR-funded EXTEND programme, which is investigating the impact of duration of Early Intervention in Psychosis services (EIPs) on health outcomes. EXTEND is a collaborative programme, bringing together research institutions, NHS Trusts, and embedded public and patient involvement and engagement. Professor Carolyn Chew-Graham is Lead Investigator for the qualitative studies embedded within EXTEND.

Find out more about the Extend study.

iSWITCHED

Developing and user testing iSWITCHED (implementing SWITCHing EDucational intervention) to support switching antipsychotics to improve physical health outcomes in people with severe mental illness. Please visit the iSWITCHED webpage for further information about this study.

SMI and Oral health

People with severe mental illness have their lives restricted and shortend by comorbid physical health. It is less well recognised that they are likely to have poor oral health due to gum disease and tooth decay.

The impetus for The Right to Smile Consensus Statement arose from an oral health group established by the Closing the Gap Network, a UKRI funded initiative to develop a mental health network exploring ways to reduce the health gap faced by people experiencing severe mental ill health. Our Oral Health Group comprises people with lived experience, carers, mental health practitioners, dental professionals, researchers, and policy makers. We share an ambition to reduce the inequalities in oral health faced by people experiencing severe mental ill health.

The consensus statement can be found online
A blog highlighting this work to primary care clinicians can be found at BJGP Life
WISE-GP has also produced information about this statement

Right to smile logo

SPIRIT study (Schizophrenia Prediction of Resistance to Treatment)

Study funded by NIHR Research for Patient Benefit. Development and early testing of SPIRIT a clinical tool to predict treatment resistance to anti-psychotics in First Episode Schizophrenia. Informed by an excellent Patient and Public Involvement and Engagement group.

SWITCH study

Qualitative study to explore views of healthcare professionals and people with schizophrenia on switching of anti-psychotic medication, barriers, facilitators and current practices.

Nash A, Kingstone T, Farooq S, Tunmore J, Chew-Graham CA. Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals perspectives. BMJ Open Feb 2021. http://dx.doi.org/10.1136/bmjopen-2020-042497

Whilst this work was done by members of the MH&WB FReT, we are not suggesting that Long COVID is a mental health condition.

We have two Long COVID studies at Keele:

Hi-COVE study (Hearing from the unheard: impact of long-COVID in minority ethnic groups in the UK

This study is led by the University of Westminster and looks to explore experiences of Long COVID from the perspectives of people from minority ethnic groups.

PHARM-LC study (What role can community PHARMacy play in supporting people with Long Covid?)

Research to understand what role community PHARMacy can play in supporting people with Long Covid. Follow this link for further information.

SPLAT-19 study (Symptom Patterns and Lived experience of Long- COVID in children and adolescenTs)

This study is led by Victoria Welsh at Keele University and examines symptom patterns and experiences of Long COVID from perspectives of children and adolescents.

Our other key research and publications on Long COVID:

Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID: https://doi.org/10.3399/bjgpopen20X101143
'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID: DOI: 10.1111/hex.13223
Long COVID in children and young people: uncertainty and contradictions: https://doi.org/10.3399/bjgp22X719501
Long COVID RCGP learning module
Why every school needs to worry about Long COVID

Please see below for a collection of additional activities, networks and content involving and/or developed by members of the team.

Keele Academic Mental Health Group

The School of Medicine (then Research Institute for Primary Care and Health Sciences) established a research partnership with Midlands Partnership NHS Foundation Trust in 2014. The group comprises clinicians, academics and other mental health professionals and aims to improve care for people with mental health problems in primary and specialist care.

CARE 75+ (The Community Ageing Research Study 75+)

We are working with West Midlands Clinical Research Network to recruit to the CARE 75+ study which aims to understand how to better identify and manage frailty within primary care. This is done by collating an extensive range of health, social and economic outcome data from community dwelling people from the age of 75 and over.

Closing The Gap: Health and Wellbeing (CTG:HWB) cohort

The CTG:HWB Cohort is an important resource that underpins the Closing the Gap network and allows the team to approach people with severe mental ill health (SMI) to participate in the Closing the Gap network research programme. Keele University and Midlands Partnership NHS Foundation Trust are supporting this cohort.

Closing The Gap Primary Care Special Interest Group

This group provides a forum to discuss current evidence and develop new research ideas to support CTG objectives within the context of primary care. The group is co-led by Carolyn Chew-Graham (Keele) and Caroline Mitchell (University of Sheffield)

Ethnic inequalities in mental health and primary care

YouTube video

Ethnicity and mental health

This animation has been created by researchers at Keele University in collaboration with academic partners and public members. The animation highlights inequalities experienced by people from ethnically minoritized backgrounds in relation to accessing mental health care.

FRRESH (Forum for Rural RESearch on Health and well-being)

The FRRESH initiative aims to address the current rural gap in research through community engagement to drive research development. The forum has been established to provide a fresh perspective on rural health and wellbeing and is funded by Keele Innovation Fund.

Self-harm in older adults

As part of World Suicide Prevention Day, The Royal College of General Practitioners published a podcast that features mental health clinical champion, Dr Elizabeth England, and Chair of RCGP scientific foundation board, Carolyn Chew-Graham, discussing self-harm and suicide prevention.

Institute for Global Health

We are proud to be a part of the Institute for Global Health at Keele University