by Howard Ryland, Oxford University, and Daniel Whiting, Nottingham University
Have you ever encountered an issue in secure or community forensic mental health services that you thought would benefit from more research evidence?
Have you ever wondered what research in forensic psychiatry should be focusing on?
The James Lind Alliance (JLA) Priority Setting Partnership for Adult Secure and Community Forensic Mental Health Services aims to identify the ‘Top 10’ most important research questions (find out more here: https://www.jla.nihr.ac.uk/priority-setting-partnerships/adult-secure-inpatient-and-community-forensic-mental-health-services). The partnership is generously supported by Crime in Mind.
James Lind was a Scottish physician who lived in 18th Century and is credited with conducting one of the first ever recorded controlled experiments. In his work as a Royal Navy doctor, Lind gave sailors suffering from scurvy different treatments. He noted that those receiving citrus fruits improved, while the others did not. The charity established in his name now facilitates so called ‘Priority Setting Partnerships’ (PSPs) to conduct research prioritization exercises in different health and care settings. Over 100 of these PSPs have been completed to date.
The JLA has established a rigorous approach to priority setting which emphasises the involvement of people with lived experience and frontline practitioners. The JLA methodology can be applied across different settings and sets out a series of stages, guided by an expert JLA Advisor. Find out more by visiting the JLA website: https://www.jla.nihr.ac.uk/about-priority-setting-partnerships
We have set up a JLA PSP in forensic psychiatry to help increase the strategic direction and advocate for more investment in academic endeavour in the field. Forensic mental health services require considerable resources and yet research activity is out of keeping with nature and scale of clinical services. With the help of Crime in Mind, and other funders and partner organisations, we have established a steering group bringing together people with lived experience, clinicians from a range of backgrounds and policymakers. We are guided by our excellent JLA advisor, Suzannah Kinsella, who is an expert on the JLA process and provides even-handed, independent chairing to the steering group.
The scope agreed by the steering group focuses on adult forensic services within the mental health system, either inpatient units at all levels of security or specialized community teams. We agreed to limit the exercise to Scotland, England and Wales, while recognizing that international evidence could be relevant. Coincidentally, a parallel process in Northern Ireland was already underway (see https://www.jla.nihr.ac.uk/priority-setting-partnerships/forensic-mental-health-and-neurodiversity-northern-ireland)! The aim is for the two PSPs to work together closely and share our learning with each other.
We have developed and published our first survey, designed to gather potential ‘research uncertainties’ (i.e. unanswered questions) from patients, carers and professionals. This survey is available online here. A paper version is also available by contacting Dr Daniel Whiting on Daniel.whiting@nottingham.ac.uk, who can arrange to send out a pack that includes paper copies and prepaid envelopes. We are particularly keen to hear from patients and their carers/family members.
The next step will be to sort through the responses, matching them to any existing research (such as systematic reviews), before formulating a long list of research questions. These will then be further whittled down through an interim prioritization survey before a shortlist will be taken forward to a final prioritization workshop to agree the top ten questions.
Then the hard work begins…
We hope to disseminate the PSPs final list widely through the JLA, Crime in Mind and other partner organisations. The hope is that researchers will come forward with proposals to address the questions we identify. The National Institute for Health and Care Research (NIHR) have a rolling call for funding to act on priorities from these James Lind Priority Setting Partnerships, and we hope other funders will be similarly supportive!
Research can transform lives. We want to support discoveries about what helps people with mental disorder who have been victims of criminal behaviour, or perpetrators of criminal behaviour, and their families, and the clinicians and others who treat them and, indeed, the wider community when its members are in contact with these problems. More effective prevention is the ideal, when this is not possible, we need more effective, evidenced interventions for recovery and restoration of safety.
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