Annual Report 2021-22

The new Experimental Medicine and Industry Partnership (EMIP) is led by Professor Catherine Harmer and Dr Susannah Murphy. It supports commercial organisations which are looking to implement experimental medicine approaches in their psychiatric treatment development programmes. The aim of the partnership, which is supported through the NIHR Oxford Health BRC, is to help bring scientific drug developments to the people who need them through best-in-world research and investigation.

A partnership between the University of Oxford, the Earlham Institute, Biogen Inc and Boehringer Ingelheim was announced this year. It was the first project funded by the international Psychiatry Consortium. The aim of the partnership is to investigate a new drug target for the treatment of schizophrenia. Senior Postdoctoral Researcher Dr Arne Mould is leading the project.

A multimillion-pound collaboration between the Diabetes Trials Unit, the Department of Psychiatry and Novo Nordisk is leading a new study to test a diabetes drug, semaglutide, to see if it can change the course of the earliest changes that happen in the brains of people at risk of developing Alzheimer's disease. The research, led by Dr Ivan Koychev from the Department of Psychiatry and Dementias Platform UK, is being funded by Novo Nordisk.

This year the department has expanded its Public and Patient Involvement (PPI) work. This valuable input from our PPI contributors is crucial to the research work we do. It helps our researchers to better understand the perspectives of patients and their families, who may have lived experience of an illness, or simply an interest in a particular research area. PPI also ensures we communicate our research as effectively as possible and that we are better able to target specific audiences.

The CHiMES Collaborative aims to champion a collaborative approach to Patient and Public Involvement and embed voices of lived experience in all levels of the research, aside from solely on a consultation basis. A co-applicant on a recent successful grant application is an expert by experience, and is now formally employed by the university on a part-time basis, in the same way as other members of staff on the team, attending weekly project meetings and academic meetings. This input has been incredibly valuable in ensuring that the lived experience perspective is present in the project. The co-chair of the project advisory board is someone with lived experience of being detained under the Mental Health Act, which helps to ensure the team is held to account in their governance structures and that they are addressing the issues pertinent to those involved in the research project. An independent evaluation is being conducted looking at how the lived experience voice has been embedded in the work. The team hopes to champion this model of foregrounding lived experience in research in future projects.

The UK Pandemic Ethics Accelerator commissioned Hopkins Van Mil to produce a rapid online public dialogue on the ethical dimensions of COVID-19. The findings of this public dialogue will inform the future work of the UK Pandemic Ethics Accelerator, as well as being valuable to wider policy and research. Participants highlighted the importance of building trust and transparency into government policies and actions, building meaningful public involvement into policy making and the need for further research into how to re-balance societal inequality.

The Ethics for Mental Health Digital Innovations for Young People in Africa (EMDIYA) project, led by Professor Ilina Singh, began last year and has a Young People's Advisory Group (YPAG) made up of 13 members from across five African countries. The YPAG has developed a network of a further 60 young people who provide important intelligence on the ethical questions surrounding digital mental health for young people in Africa, through workshops. A digital campaign for raising awareness of the ethics of digital mental health on the backdrop of the increase in digital health applications since the COVID-19 pandemic launched in December 2021.

Image by Dr Fortunate Machingura @CeSHHAR.

Professor Mina Fazel and her team in Child and Adolescent Psychiatry have been supported by the NIHR Thames Valley Applied Research Collaboration (ARC) to find better ways to disseminate the findings of their work directly to young people. They have a small team of school leavers helping them develop a stronger presence on social media to better share their research findings. They are using Instagram and TikTok. The young advisors have helped create new and attractive content about mental health problems, integrated care, how to improve sleep difficulties and addressing anxieties around the COVID-19 vaccination.

TikTok influencer post about the research has 37,000 views.

Impact of COVID-19 on Mental Health

The term long-COVID has been spoken about in great depth despite leading healthcare professionals and scientists still being unsure about the use of the term and what it actually means and for whom. This year a vast amount of research into the ongoing impact of COVID-19 has been undertaken. Professor Paul Harrison, Department of Psychiatry, and Dr Maxime Taquet, Medical Sciences Division, have led innovative research analysis using the US-based TriNetX electronic health record network. They identified over a third of COVID-19 patients were diagnosed with at least one long-COVID symptom. In a separate study the team discovered that one in three COVID-19 survivors received a neurological or psychiatric diagnosis within six-months of infection with the SARS-CoV-2 virus.

The PHOSP-COVID study, which involves a number of Oxford researchers across a range of disciplines, found that seven in ten patients hospitalised with COVID-19 did not fully recover five months after discharge and continued to experience negative impacts on their physical and mental health, as well as their ability to work. The latest results show that these people show limited further recovery one year after hospital discharge.

Professor John Geddes said:

'The PHOSP-COVID study is a major achievement, pooling data and expertise from across the country to better understand the lasting physical and mental impacts of COVID-19 on hospitalised patients. More than half a million people have been admitted to hospital with COVID-19 in the UK, so as a country, we are looking at a significant proportion of the population at risk of persistent ill-health and reduced quality of life.'

The Medical Research Council (MRC) is funding the £2.3m COVID-19 Clinical Neuroscience Study (COVID-CNS), which is investigating 800 COVID-19 patients who had neurological or neuropsychiatric symptoms whilst acutely ill. Professor Paul Harrison and Professor Masud Husain, Nuffield Department of Clinical Neurosciences, lead work at the Oxford site, following up study participants. The study will run until autumn 2022.

The emergence of vaccines against COVID-19 has seen much discussion about vaccine take-up, with governments across the world encouraging populations to get the vaccination when available. Professor Daniel Freeman conducted a large-scale study, the Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS 111), which asked UK adults to rate their anxieties about needles and blood, and asked them about their willingness to receive a COVID-19 vaccine. The study found that a quarter of the UK adult population screens positive for a potential injection phobia and these individuals were twice as likely to report that they were COVID-19 vaccine hesitant – they would put off getting vaccinated or never get the jab. In addition, the survey tested the responses of a representative group of 18,885 UK adults to a variety of COVID-19 vaccine messaging. Findings suggest that emphasising the personal benefits of vaccination may be the most effective way to persuade people who are sceptical about the jab.

Children and Young People's Mental Health

The COVID-19 Supporting Parents, Adolescents, and Children in Epidemics (Co-SPACE) study showed that one year on from the beginning of the pandemic, parents/carers reported considerable change in their children's behavioural, emotional and attentional difficulties throughout the pandemic, increasing in times of national lockdown and decreasing as restrictions eased and schools reopened. On the basis of early Co-SPACE findings, further funding was also secured from UKRI and the MRC/NIHR for two major randomised controlled trials to support parents with their child's mental health, in public health and clinical settings. With support from the MRC and the Westminster Foundation the team also worked with the Mental Elf to produce guidance and webinars for parents and people that work with children and young people, and a range of evidence-based resources made with and for young people.

The OxWell school survey had 19,000 pupils participate in 2020 and 31,000 participate in 2021, with findings on subjects including the impact of the first lockdown on mental health in adolescents, as well as young people's willingness to have the COVID-19 vaccination. Findings suggest the importance of improved information for younger children and adolescents as they are the least willing to have the COVID-19 vaccination.

Research papers reporting on the Co-SPACE and OxWell studies have both been amongst the most highly cited in the Association for Child and Adolescent Mental Health (ACAMH) journals in 2021.

©Kensington Palace

The Secondary Education around Early Neurodevelopment (SEEN) project, commissioned and funded by Kindred², involved nearly 4,000 children across the UK in three specially developed science lessons to educate pupils about brain development during early childhood. The work is part of a wider drive to increase public understanding of how early experiences can shape the adults we become.

Dr Elizabeth Rapa, co-investigator of SEEN and Senior Scientist, University of Oxford, said:

'This ground-breaking project could improve the lives of children for generations. We hope that the key principles of early child development into KS3/4 (aged 11-14) will now be taught in more schools.'

The development of a new project, Brainwaves, got under way this year. It is an ambitious project which will bring together education and mental health research through the recruitment of a large cohort of adolescents, as well as work to improve access to existing research findings in this area. Professors Mina Fazel and John Gallacher are leading the team and are drawing from expertise across the Department of Psychiatry. The project will launch in 2022.

The Identifying Child Anxiety Through Schools (ICATS) and Minimising Young Children's Anxiety Through Schools (MY-CATS) programmes, funded by the NIHR and the Kavli Trust respectively, are working with over 100 primary schools across England to evaluate the provision of providing early online support to parents and carers to prevent or treat anxiety problems in children.

UKRI Emerging Minds is a research network that aims to reduce the prevalence of mental health problems experienced by children and young people. The network team has worked with families and people that work with families to co-create a set of priorities for the research into child and adolescent mental health which is most important to them. The network has supported nine research projects, three cross-sector placements and 20 special interest research groups.

Adult Mental Health

© Amber Anderson www.amberanderson.co.uk

Professor Daniel Freeman launched the new Feeling Safe – treatment programme for persecutory delusions, which promises a step change in the treatment of severe mental health problems. The clinical trial results showed that the Feeling Safe programme is the most effective psychological treatment for persecutory delusions, with 50 percent of patients achieving recovery.

Professor Daniel Freeman, the developer of the Feeling Safe programme, University of Oxford, said:

'Feeling Safe is the result of more than ten years of research and clinical practice. Its success has been built on listening carefully to patients, to really understand the causes of the problems they are facing. Over 20 sessions, the programme helps people to develop new memories of safety and addresses the factors that often maintain persecutory thoughts, such as worry, poor sleep, and low self-confidence. The challenge now is to reach the many thousands of people whose lives have been disrupted by severe paranoia.'

Professor Alan Stein's team led the first national UK survey focused on those bereaved during the COVID-19 pandemic. The survey findings informed important recommendations for service delivery of individualised, compassionate end-of-life care during a pandemic.

Lead author Dr Jeff Hanna said:

'Health and social care professionals have a pivotal role in facilitating vital interactions between relatives and their loved ones. Although numbers of COVID patients have decreased, all NHS staff now face the enduring legacy of the pandemic on the wider healthcare system.'

Dementias Platform UK (DPUK), based in the Department of Psychiatry, supported the launch of a data-driven sister project, Dementias Platform Australia (DPAU). Run by UNSW Sydney's Centre for Healthy Brain Ageing, DPAU will work alongside DPUK towards the collective aim of accelerating discoveries in the understanding and diagnosis of dementia. The DPAU platform, which uses secure technology deployed at Monash University, will house data on physical and brain health from dozens of cohort studies conducted in Australia, the Asia-Pacific region and beyond. The ability to combine data across many studies has a potential not yet fully realised: DPAU's platform will complement DPUK's existing Data Portal, which gives researchers access to dementia-optimised data from more than 50 UK-based cohort studies.

Professor John Gallacher, Director of DPUK, said:

'It's hugely exciting to see how the dementia research community in Australia is thriving. The close partnership between DPUK and DPAU will enable us to share technical assets and best practice, and to facilitate international data analysis. Science is data-driven, and we can help accelerate progress in dementia research by working together at a global level to improve data access.'

Professor Alan Stein and his team led the cognitive and mental health components of a large multi-country collaborative study, known as the Child Development and Adult Social and Human Capital study. It involves three of the largest and longest-running birth cohorts in low-and-middle-income countries (LMICs): the Institute of Nutrition of Central America and Panama (INCAP) study, Cebu Longitudinal Health & Nutrition survey, and a cohort collected in Soweto, Johannesburg, South Africa. The study tested the reliability and validity of a set of measures of executive function and cognitive processes which are critical to mental health, academic achievement, and job success. They also examined the relationship of these measures with key aspects of human capital such as school attainment and processing speed. The study results provide evidence for a set of robust measures of executive function that could be used across different cultural, language and socio-economic backgrounds in future LMIC research, something which has only previously been evidenced from Western, educated, industrialised, rich and democratic (WEIRD) countries.

The National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre (BRC) is a nationally and internationally important hub for translational mental health and dementia research. The BRC aim is to improve the lives of patients through discovery science, the development of personalised new treatments and innovative research, which helps to solve the complex problems of mental health disorders and dementia.

Throughout the year BRC researchers have continued to respond to the COVID-19 pandemic with high-impact studies, as well as developing and publishing internationally acclaimed evidence-based guidance for patients and clinicians managing mental health conditions during the pandemic. Earlier this year Professor Andrea Cipriani helped to formalise an important partnership between the University of Oxford and the Oxford Health NHS Foundation Trust, through the NIHR Oxford Health BRC, with the University of Toronto and the Centre for Addiction and Mental Health in Toronto. This partnership will enhance existing relationships and help support global research cooperation and work to attract greater international recognition for mental health research.

Between the creation of the NIHR Oxford Health BRC in 2017 and October 2021 there have been 402 studies, 199 investigators supported by the BRC, 597 peer-reviewed articles published, 120 partnerships with UK small and medium-sized enterprises, 63 new or continued strategic partnerships and £72.5m funding.

Having come to the end of the initial funding period, an ambitious application has been submitted to the NIHR and a decision about renewal is expected in the middle of 2022.

The NIHR Oxford and Oxford Health BRCs established a new Patient and Public Involvement (PPI) group in May 2021, comprising 17 members from diverse backgrounds. Known as the Diversity in Research Group, a name chosen by its members, it aims to advise and support the BRCs to increase involvement of under-represented communities in health research and to work with researchers to include PPI into the design, implementation and dissemination of their research. The group has been working on a variety of projects including the 'Tell us about you' demographics survey, guidance for researchers on barriers and solutions to involvement and a literature review on outreach methods (conducted by PPI contributors). The group will continue to meet monthly, working through a variety of activities and importantly continue supporting researchers in their projects.

The Oxford Medical School continues to be ranked as one of the best medical schools both nationally and internationally. The department supports approximately 160 Year 5 Clinical Students a year, as well as countless special study modules and student research projects. In 2020 the Brain and Behaviour module was launched in collaboration with colleagues at the Nuffield Department of Clinical Neurosciences, in which psychiatry and neurology are taught in the context of an integrated curriculum. The course has continued to develop and has led to a number of new teaching sessions being introduced, which are co-led by members of both departments and highlight the biological aspects of psychiatry and the psychosocial factors in neurology. The course has been complemented by the development of a humanities and medical professionalism curriculum in 2021, which has been funded by a Wellcome Institutional Strategic Support Fund (ISSF) grant and is being delivered with colleagues across the Humanities, Gardens, Libraries and Museums (GLAM) and Medical Sciences Divisions. This year we have adapted the highly rated communications skills session for both online and in-person delivery in collaboration with the Nuffield Department of Primary Care Health Sciences.

We welcome Dr Katy Smith who has taken over as examiner for Psychology for Medicine, Dr Philip Wilkinson who is an internal examiner for the Year 5 synoptic exams, Dr Chris Kowalski who has been appointed as the Oxford Health NHS Foundation Trust simulation lead, Dr Caz Nahman who will lead the provision of children and adolescent mental health services (CAMHS) teaching, and Dr Alastair Reid who has been appointed as the new Director of Medical Education for Oxford Health NHS Foundation Trust and Professor Kate Saunders who has been appointed the new Associate Director of Preclinical Studies (Welfare & Curriculum).

Students

The Department of Psychiatry has also taken an active role in supporting the wellbeing of undergraduate medical students and a new web resource created by Dr Joe Butler, Dr Emma Brookes, Dr Lois Bran and Professor Kate Saunders has now been launched. This was co-created with medical students and funded by a grant from the Nuffield Oxford Hospitals Fund.

Professor Saunders, said:

'The impact of an ongoing pandemic continues to be felt by all involved in undergraduate education, but we are hopeful for a return to more in-person teaching in 2022.'

The Department currently has 63 DPhil and 7 MSc (Res) research degree students including graduates in psychological and biological science and psychiatric trainees. In 2021, six candidates successfully completed their course, and have either moved onto postdoctoral positions or enrolled on Graduate Research or Medicine programmes.

MSc Clinical and Therapeutic Neuroscience

The MSc course in Clinical and Therapeutic Neuroscience is now in its third year. The class of 2020/21 successfully completed the course and five class prizes were awarded. All lectures were live-streamed, with small group face-to-face journal clubs meeting in large teaching rooms in the department, and chaired by the Course Director, Associate Professor Phil Burnet and Deputy Course Director, Professor Zameel Cader, Nuffield Department of Clinical Neuroscience. PIs from all departments involved in the course provided both lectures and excellent data analysis projects that substituted some of the practical experiments.

Associate Professor Burnet said:

'We'd like to praise all of our students for their hard work and adaptability to on-line teaching, and for achieving an exceptionally high standard of work.'

Training

Professor Morten Kringelbach, Director of the new Centre for Eudaimonia and Human Flourishing, is also directing the Carlsberg Foundation-Oxford Visiting Fellows Programme, supported by the Carlsberg Foundation. This competitive programme supports up to 12 excellent postdoctoral scholars per year who will become Junior Research Fellows at Linacre College and work for two years with an Oxford academic in a University department.

The NIHR Incubator for Mental Health Research is hosted by the Department of Psychiatry. It provides career development support for aspiring and established mental health researchers across sectors and professional backgrounds. A number of our department members have contributed to its activities this year and are featured as career case examples.

Several team members in the department began NIHR fellowships this year, Dr Rebecca Murphy and Dr Rowan Diamond began a Clinical Doctoral Research Fellowship, Dr Sinéad Lambe began a Doctoral Fellowship and Ariane Petit started a Pre-doctoral Fellowship.

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