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CBE, DSc, FRCPsych
Chair of Social Psychiatry
My research focuses on the relationships and interactions of people with mental illnesses, both with their friends and families, but also, with our increasingly complex care systems. Whatever the biology is of mental illnesses is, they are experienced and expressed in relationships, they are assessed in relationships, and they are treated in relationships. Understanding these relationships and the social contexts in which they are embedded is central to our patients' well-being. We do this by a mixture of very structured and rigorous trials informed by detailed examination of the patient experience using direct interviews and sophisticated qualitative interviews (where the patient tells their own story and gives their own views).
In our three current major studies we are focused on the sensitive issue of compulsion in psychiatry. We are examining how patients with psychotic illnesses can be helped to accept treatment that all around them believe they need but which they may doubt because of impaired insight. In one study (in conjunction with Queen Mary College London) we are testing whether paying psychosis patients a small sum of money will improve the regularity of their taking preventative anti-psychotic medication (£15 for each injection). In our largest trial (OCTET) we are testing the effect of a recent change in the law that allows patients to be treated against their will outside hospital ('Community Treatment Orders' CTOs). We have recruited over 300 patients with severe and unstable psychotic illnesses (so-called 'revolving door patients') and randomly allocated them to CTO or not CTO. This is a ground-breaking study because it involves random allocation to a legal status, not to a tablet. We hope to know soon whether or not CTOs achieve their stated purpose of keeping these patients well and out of hospital longer. We are also examining which patients who are assessed for compulsory admission are admitted and which are not. This study (AMEND) is being carried out with the University of Warwick and has already provided us with important, if controversial, evidence that race is not itself a major independent factor in this decision although many people have thought so in the past.
Our work tends to feed directly into mental health services policy and hopefully shape services. As with our earlier work on the variety of mental health teams we strive to follow an Oxford tradition of being as scientifically rigorous as possible while trying to answer questions that have a direct impact on patients' experiences of health care.