Innovative Training Post at The King’s Fund: Bringing together physical and mental health – A new frontier for integrated care

Preety Das
Preety Das – Specialist Trainee in General Practice

Preety Das is a Specialist Trainee in General Practice in the
Department of Primary Care & Public Health. She joined the King’s Fund as part of an innovative training post at Imperial College Healthcare NHS Trust.

Here she discusses the King’s Fund report she coauthored – Bringing together physical and mental health.


Integrated care initiatives in England and elsewhere have paid insufficient attention to the relationship between physical and mental health. Our report draws on a review of published research evidence, qualitative interviews and focus groups with service users and carers, and case studies of 10 services in England. We conclude by arguing that overcoming the longstanding barriers to integration of mental and physical health should be a central component of efforts to develop new models of care that bring together resources from across local health systems.

The case for seeking to support physical and mental health in a more integrated way is compelling, and is based on four related challenges: 1) high rates of mental health conditions among people with long-term physical health problems, 2) poor management of ‘medically unexplained symptoms’, which lack an identifiable organic cause, 3) reduced life expectancy among people with the most severe forms of mental illness, largely attributable to poor physical health and 4) limited support for the wider psychological aspects of physical health and illness. Collectively, these issues increase the cost of providing services, perpetuate inequalities in health outcomes, and mean that care is less effective than it could be. The first two issues alone cost the NHS in England more than £11 billion annually.

Examples of innovative service models described in the report demonstrate that there are opportunities to redesign care in ways that could improve outcomes and may also be highly cost effective. These include various forms of enhanced support in primary care, integrated community or neighbourhood teams, comprehensive liaison mental health services, physical health liaison within mental health services, and integrated perinatal mental health care.

All health and care professionals have a part to play in delivering closer integration. Our research with service users and carers highlights the importance of professionals being willing and able to take a ‘whole person’ perspective, and having the necessary skills to do so. Integrated service models can support this by facilitating skills transfer and shifting notions of who is responsible for what. Equally, a great deal of improvement is possible within existing service structures. New approaches to training and development are needed to create a workforce able to support integration of mental and physical health. This has significant implications for professional education; all educational curricula need to have a sufficient common foundation in both physical and mental health.

My involvement in this project provided a unique opportunity to relate everyday clinical practice to the range of barriers that have prevented wider adoption of integrated approaches. These include: separate budgets and payment systems for physical and mental health; the challenge of measuring outcomes and demonstrating value; and cultural barriers between organisations or groups of professionals. The report describes several enabling factors and practical lessons, including the value of having a board-level champion for physical health in mental health trusts, and vice versa. New payment systems and contracting approaches offer commissioners various options for overcoming some of the financial barriers.

In recent years there has been a welcome focus in national policy on achieving ‘parity of esteem’ for mental health. Colloquially, this phrase has often been interpreted to mean that mental health services should be ‘as good as’ services for physical health. We argue that there is a greater prize beyond this, in which mental health care is not only ‘as good as’ but is delivered ‘as part of ’ an integrated approach to health.

Preety Das
Specialist Trainee in General Practice
Department of Primary Care & Public Health

Clinical Sciences Centre – Institute of Clinical Sciences – January update

The CSC’s Suffrage Science film night

The CSC’s Suffrage Science film night

It was an evening designed to inspire. This was a chance to celebrate the first five years of the CSC’s Suffrage Science scheme, which aims to encourage women into science, and to stay there. With Helen Pankhurst involved, it was also a chance to explore the role of activism today, and the changing nature of women’s activism since her great grandmother’s time as a Suffragette.

The evening, hosted by the Tricycle theatre in North London, began with a screening of Suffragette the film – to remember those who gave the Suffrage Science scheme its name. The film features Carey Mulligan, Helena Bonham Carter, Meryl Streep and others in a frank portrayal of the fight for Votes for Women. It was an uncomfortable watch. Historical details, such as the Cat and Mouse Act, rendered so much more powerful when portrayed in unflinching detail on the big screen.

Before the film head of Communications and Public Engagement at the CSC Susan Watts, sat down with Helen, and talked about how her famous Pankhurst predecessors might view today’s activists; about who inspires her and about whether she sees signs of activism in science and medicine today.

“I think the whole of science is about activism. It’s about looking at a particular discipline and pushing the boundaries of what that discipline can deliver – and often it’s about the relationship between science and humanity and what science can do in terms of changing the world that we humans live in. So to the extent that it enables society to benefit in a hundred ways, that is activism.

Read the full write up and watch the interview.

CSC research

CSC scientists have also published their findings in several high profile papers this month.

A study in Nature Cell Biology shows that we do not yet have the whole story about how fertilised eggs produce the many different types of cell that make up our adult bodies. It is widely accepted that an enzyme called Tet plays an important role, but something else seems to be at play, according to the study.

Scientists including the CSC’s James Ware have found that women who suffer unexplained heart failure towards the ends of pregnancy or shortly after giving birth share certain genetic changes. The finding provides some explanation for this mysterious condition, and suggests that by testing relatives, other women who carry the same genes, and who might face similar risks, could be identified early. They could then be monitored closely and treated more swiftly if needed. In the future preventative treatment might be developed too.

And a study published in Nature Communications is the first to show that an enzyme crucial to keeping our immune system healthy “surfs” along the strands of DNA inside our cells.

Deborah Oakley
Science Communications Officer
MRC Clinical Sciences Centre

Poppy Lamberton shortlisted for The Women of the Future Awards

poppylamberton-profilepicPoppy Lamberton was recently shortlisted for The Women of the Future Awards – the largest national search for exceptionally talented women, which unearths the next generation of high-flying women across nine industries, including technology, media, business, arts and science. Poppy, a Junior Research Fellow in the Department of Infectious Disease Epidemiology, was shortlisted for the 2014 Science category. Poppy works on neglected tropical diseases, which are often endemic in the world’s poorest rural and urban communities. Her research currently focuses on parasitic infections such as Bilharzia and River Blindness, with the aim to maximize the success of treating populations in Africa. Poppy’s research utilizes field epidemiological data, laboratory experiments and population genetics to understand parasite population structure, transmission dynamics and the effects of long term mass drug administration programmes. Poppy is also passionate about public engagement with science, talking at a range of schools and working closely with STEM and the Natural History Museum on events such as Science Uncovered and Nature Live.

Dr Poppy Lamberton
Junior Research Fellow
School of Public Health
Faculty of Medicine

Professor Ten Feizi receives the prestigious 2014 Rosalind Kornfeld Award

The Department of Medicine is delighted that Professor Ten Feizi is the recipient of the prestigious 2014 Rosalind Kornfeld Award from The Society for Glycobiology. The Rosalind Kornfeld Award for Lifetime Achievement in Glycobiology was established in 2008 to honour the distinguished scientific career and service to the Society by Dr Rosalind Kornfeld. The award is given by the Society to scientists who have, over their professional lifetimes, made significant contributions with important impact on the field.  In Professor Feizi’s case this award is in recognition of her many achievements in the fields of structure analysis, immunology and function of glycans over nearly 50 years.

Imperial successfully recruited Professor Ten Feizi in 1994 when the Northwick Park Campus became affiliated with the College. Her research group was already a leading world centre in glycobiology, notably having established the specificity of human monoclonal antibodies for specific oligosaccharide sequences and the observed programmed changes in expression of blood group-related sequences during embryogenesis, cell differentiation and oncogenesis, research published in Nature that became a seminal publication in the field. The group then went on to introduce neoglycolipid (NGL) technology for lipid-linked oligosaccharide probes and in 2002 this became the first glycoarray system intended to encompass entire glycomes. This is currently the most diverse glycoarray system in the world, revolutionizing the molecular dissection of pathogen-host interactions as well as endogenous recognition systems. Recent highlights are assignments of the host cell receptors for the oncogenic simian virus 40 (SV40) and the pandemic A(H1N1) 2009 influenza virus. In recognition of the importance of this ground-breaking work, Prof Ten Feizi received recognition with membership to the Fellowship of the Academy of Medical Sciences.

Joanna Thompson
Divisional Manager, Division of Immunology & Inflammation
Department of Medicine

PhD student awarded Ruth Bowden Scholarship

Dr Naomi Walker, a PhD student from the Department of Medicine, has been awarded the Ruth Bowden Scholarship (£5000) for her work on “Defining mechanisms of tissue destruction in TB and TB immune reconstitution inflammatory syndrome (TB-IRIS)”. The scholarship is part of the  British Federation of Women Graduates Scholarship Awards 2013,  which provides prizes for academic excellence to female PhD students in their final year.

Naomi’s success follows last year’s, where two Imperial students; Stephanie Walton and Lucy Thorne, also won awards.

Dr Alexandra Blakemore
Faculty of Medicine Ambassador for Women

The Faculty of Medicine’s winners at the first Student Academic Choice Awards

SACASInnovation and tutoring in the Faculty of Medicine were recognised in the first annual Student Academic Choice Awards (SACAs).

Faculty winners

Congratulations go to:

These awards are a first for academics and support staff, nominated and chosen entirely by students. The awards are designed to celebrate and reward good teaching and emphasise teaching as a skill of equal worth and value as research.

The long term aim of these annual awards is to build a community and ownership of the courses being delivered. It is also a chance for students to say ‘thank you’ to teaching staff.

Our congratulations are extended to all of the nominees. The full list can be seen at https://www.imperialcollegeunion.org/academicchoice

Update from the WHO Collaborating Centre

MedHealth Cairo 2013 conference

Professor Salman Rawaf and Marion Chaix both recently attended the Medhealth Cairo 2013 Conference to support the healthcare sector in the Middle East. It featured workshops and lectures on various topics from leadership to quality, safety risk management & IT.

The Arab Hospitals Federation hosted the event, gathering 9 Ministers of Health on the AHF panel and discussing the “Investment in the adolescent health is the future of healthcare”. It was held simultaneously with the Arab Health Ministers Council. With participants from 16 different countries, 25 local and regional respected speakers, key decision makers and policy makers  sharing expertise and experience with the attendees, the conference was a success allowing some of the biggest buyers and users to share experiences.

The conference included workshops and interactive panel discussion in addition to keynote speeches delivered by regional and international experts. Professor Salman Rawaf delivered two workshops on situational leadership and on hospital management which were highly successful.

During Medhealth Cairo 2013, the Arab Hospitals Federation has granted awards to several personalities who have contributed in developing the healthcare sector and implemented efficient strategies aiming to raise awareness and provide the Arab citizens with high quality healthcare services.

A closing ceremony followed.

Imperial College London and WHOCC welcomes King Saud University (KSU) delegation visit, 21-22 March 2013

On the 21-22 March, the WHO Collaborating Centre for Public Health Education and Training at Imperial College London had the pleasure of hosting His Excellency Dr. Badran Al-Omar, the King Saud University (KSU) Rector and his accompanying senior delegation: Prof. Dr. Ahmed Bin Salem AlAmeri – Rector for Graduate Studies and Scientific Research; Dr. Abdurrehman Al-Moammar – Vice Rector for Health Specializations; Prof. Dr. Moaddi M. Almethhib – Dean of College of Business Administration; Prof. Dr. Khalid Ibrahem Alhumaizi – Dean of College of Engineering; Prof. Dr. Suleiman Alshammari – Deputy Chairman of Scientific Council of Family Medicine, Examination Committee and Health Education Center as well as Consultant of Family and Community Medicine; and Dr. Mezyad M. Alterkawi – Director of International Relations and Twinning Program at KSU, CEO of Riyadh Technology Incubation Centre as well as Associate Professor, College of Architecture and Planning.

British Federation of Women Graduates

The British Federation of Women Graduates (BFWG) holds a ‘Research Presentations Day’ each year where women postgraduate students are invited to give short presentations of their research work.  Doctoral Researcher, Elizabeth Dubois, from the Department of Primary Care and Public Health, was one of eight women selected to present on her PhD thesis “Health Checks in Primary Care: Steps to Improve Population Health”.

Society for Academic Primary Care

Elizabeth was also chosen to present a poster of her PhD thesis to this year’s 42nd Annual Conference Society for Academic Primary Care (SAPC) to be held at the University of Nottingham, July 2013.   The SAPC, a medical teaching society, supports high quality primary care research studies undertaken in the UK.

Advanced Iraqi  Academia Training programme

Dr Elizabeth Muir with delegates

On the 22 April 2013 the WHO Collaborating Centre for Public Health Education and Training, Department of Primary Care and Public Health, welcomed a group of senior academics from across Iraq to Imperial College London.

Ranging from medicine, pharmacy, nursing and veterinary science, 14 university staff were invited, in conjunction with the Iraqi Cultural Attaché and Ministry of Higher Education for Science and Research (MoHERS), to undertake an intensive four-week training programme.  The aim of the programme was to strengthen current skills and teaching methods at an international level.  The important visit also establishes opportunity for greater collaboration between MoHERS Iraq and Imperial College.

Sourced in a rich history of medical education, Iraq was once described by the UN and the World Bank as having “first class medical facilities including well-established public health services, hospitals, primary care facilities and ample production and supply of medicine and medical equipment” (2003).  Medical education in turn, was well developed with 12 established medical schools.  Today there are now 20.

With planned visits to NICE, the BMJ/BMA, the Faculty of Public Health, PBL Learning, the Centre for Clinical Practice, St George’s Hospital and Chelsea Westminster Hospital NHS Foundation Trust, this specially tailored training programme was designed to meet their needs and offered the visiting academics a useful insight into standards of good practice to share with academic colleagues back home in Iraq.

The 1st Arab World Conference on Public Health “Towards Excellence in Public Health: Opportunities and Challenges in the Arab World”, 4-6 April 2013 Dubai, United Arab Emirates

Doctoral Researcher, Elizabeth Dubois, and Research Assistant, Dr Sondus Hassounah from the Department of Primary Care and Public Health, WHO Collaborating Centre were chosen to present their posters at the 1st Arab World Conference on Public Health held in Dubai this past April. Their topics were: ‘Health Checks in Primary Care: Steps to Improve Population Health’ and ‘Challenges & Solutions: The Case of Egypt’s Health System Performance’ respectively.

 

This update was prepared by Ela Augustyniak, WHO Collaborating Centre.

In response to the College Maternity Survey from the FoM Ambassador for Women

As we are all aware, there is a serious problem in retention and career progression for women in science – leading to the current situation where only 15% of Imperial professorial staff are female. This “leaky pipeline” of female staff represents an enormous loss of talent and creativity and there is a strong business case for the College to take effective measures to retain and support the best talent, of whatever gender.

One of the main time-periods where female researchers  are lost to academia is when they start a family. This often happens during the postdoctoral period or first academic post for pure scientists, and during the PhD period for medically-qualified staff. These are key career transition points for women and support at this time is critical for retention and progression.

In order to try to address this particular part of the “leaky pipeline” and to ensure that expectant mothers and new parents are provided with the optimal conditions in which to flourish, the College is exploring how to provide better support to staff members at this time.

Her own recent experience of returning to work after maternity leave, led Su Nandy (Deputy Head of Faculty Operations, Engineering) to start thinking about what could be done to support staff members who are expecting, or new parents. In October 2012, Su devised a questionnaire to explore this and invited all staff members who had taken maternity leave in the previous four years and were still employed in the College to take part. An article was published in BMJ Careers, “Supporting mothers to become clinician scientists” by Victoria Salem (Clinical Research Fellow, Department of Medicine), Su Nandy, Stephen Bloom.

At a meeting today (21 March 2013), Su presented the results of her work. The first surprise was that of the 553 women who had taken maternity leave between July 2008 and July 2012, nearly 60% had since left the College. Currently, exit data is not collected in a way that allows analysis of the factors operating here (how many were had been on fixed-term contracts, for example), highlighting the need to collect data in this area.

There was a magnificent response to Su’s survey – of the 226 eligible staff, 192 (85%) responded. Of these, 78% described experiencing difficulties in balancing work and home responsibilities, 70% reported exhaustion and 50% were suffering from sleep deprivation. These data might be useful in training line managers dealing with new parents.

Recommended measures:

As a result of the detailed responses to the survey (Maternity Survey Presentation), Su has proposed 10 measures the College could take to support expectant women and new parents:

1. Staff education

  • Pre/Post maternity leave courses dealing with transition
  • Paternity courses  to support new fathers
  • Line management/academic supervisor guidance/ training

2. Support through visible/approachable female role models

  • Maternity buddy scheme set up last year- recommendation to extend to include pre-maternity leave. 42% requested this
  • Mentoring/career coaching programmes to be offered more proactively on return from maternity leave. 31% requested this

3. Widely publicised designated room for expressing milk/place for pregnant staff members to rest in each campus

4. Provision of a dedicated parents webpage/ forum

5. Baby changing facilities in each large building across all College campuses and sign posted/ publicised.

6.  Increase maternity pay to match or better other Russell Group universities.

7. Provision of affordable childcare with flexible / longer nursery hours to encompass the scientific working day (8am-6pm)

8. One – off emergency child care provisions for parents to access.

9. Dedicated member of HR/Equalities to cover maternity/family friendly/gender issues.

10. College to sponsor further study in relation to women taking maternity leave who are funded on research grants

These recommendations were presented and discussion was invited from the audience.  The proposals were warmly welcomed and we were pleased to hear that full consideration was being given to them by the College’s Management Board. Some of the proposals are relatively easy to implement and cost-free or very inexpensive, while others may require more resource or planning. We look forward to hearing the Management Boards views.

A number of additional issues were raised including nursery hours, eligibility employment periods for both maternity and paternity leave and the excellent Elsie Widdowson Scheme, which provides funding for replacement teaching, admin, research staff or consumables to support women returning from maternity leave. The money is provided centrally by HR, so Departments and individuals can only gain from the scheme.

At the moment Elsie Widdowson funding is being offered to all eligible staff, so if you are pregnant or just back from maternity leave, don’t lose out!

It is really commendable that Su and the College senior HR team are engaged in this initiative and that there are plans to build on the information gained – the maternity survey will be repeated in 3 years time to see whether there have been any improvements and a paternity survey is planned for later this year. The HR team would welcome any ideas, comments or suggestions that you might have on these issues. If you would like to contribute to the discussion please contact: Su Nandy – Ext 41628 s.nandy@imperial.ac.uk

Dr Alexandra Blakemore
Faculty of Medicine Ambassador for Women

Professor Jenny Higham wins Mentor of the Year award at Women of the Future Awards 2011

Professor Jenny Higham (Deputy Principal and Director of Education) was awarded the ‘Mentor of the Year’ award at the Women of the Future Awards, held at the London Marriott Grosvenor Square on Wednesday 16 November.

Held in association with Shell, the glittering awards ceremony and dinner were attended by HRH The Princess Royal, HRH Princess Badiya bint El Hassan, Cherie Blair and wife of the Deputy Prime Minister, Miriam Gonzalez Durantez, amongst other well known faces.