Minority Health and Health Disparities International Research Training Programme Grant.

Students will be able to work on one of the following projects.

Project 1

EMILIA: Social inclusion through life long learning

EMILIA (contract number 513435) is a European Union funded (€3.4m for 54 months) research project in the thematic area of lifelong learning. It is a large and ambitious project that aims to evaluate a lifelong learning process to facilitate the social inclusion of people with mental illness. The project will specifically address issues regarding health disparities. The research element of the project will evaluate the process and outcome with respect to the application of lifelong learning approaches to achieve social inclusion. A multiple site time series methodology will be used. The key outcomes that will be measured will include employment and quality of life. There are 21 partners from 13 European countries collaborating on this project. Dr Richard Gray and Professor Kevin Gournay from King’s College London are principal investigators responsible for the research element of this project. This is a very large project and a number of students would be able to work on it, each selecting a different element of the project to focus on.   

Students will:

• Assist in the collection of high quality scientific data across 13 EU countries.
• Assist in the cleaning and entry of data from the 13 demonstration sites.
• Ensure that bias is kept to a minimum in data collection.
• Develop an understanding of and critically review the psychometric measures available to determine outcome, quality, cost and use of the intervention in this project.
• Assist in the description of similarities and disparities between health service delivery models in the 13 demonstration sites.
• Assist in the development of a conceptual understanding of the predictors of health disparity across the 13 demonstration sites.
• Actively participate in the qualitative element of the study.
• Participate in the dissemination of findings from the EMELIA project.

Project 2

Mental Health needs of people with Multiple Sclerosis

This project is funded by the UK based MS Society (£120,000 for 36 months). MS is the most common neurological disability in young adults. Cognitive and mental health problems are common in people with MS. There have been no attempts to develop a community-based model to address these needs. We are in the process of developing a flagship model of service provision that we will independently evaluate. The service will be evaluated via the collection of data on physical and mental health, quality of life, service use and cost. We are also particularly interested in exploring the health disparity in the population particularly focusing on cultural differences. Dr Richard Gray, Professor Kevin Gournay and Dr Eli Silber are the joint Principal investigators on this project (all King’s College London).

Students will:

• Assist in establishing and developing an internationally innovative and unique service delivery model for the mental health needs of people with MS to help eliminate an important health disparity (namely that people with MS have unmet mental health needs).
• Assist in setting up and managing a database of the mental health needs of people with MS.
• Assist in collecting evaluation data, using standardised valid measures of quality, outcomes, cost and use.
• Assist in developing an epidemiological understanding of the prevalence of mental disorders (e.g. depression, fatigue, cognitive deficits) in people with MS and examine areas of health disparity.
• To assist in the dissemination (both via publication and conference presentation) of findings from this project nationally and internationally.

Project 3

An evaluation of a specialist smoking cessation service for people with schizophrenia

This project is funded by the NHS research and development money (£81,000 for 18 months). Deaths from respiratory, cardiovascular disease and cancer are more likely to occur in people with schizophrenia compared to the general population.  Reducing rates of smoking in people with schizophrenia and improving the overall physical health in this group is a priority area in mental health. Evidence suggests that people with schizophrenia are able to stop smoking when smoking cessation services are tailored to address the biological, cognitive, affective and social effects of the illness. To date there have been no published studies in the UK evaluating the efficacy of a smoking cessation programme for people with schizophrenia. This project aims to evaluate the efficacy of a nurse led manualised smoking cessation package on the smoking cessation rates of people with schizophrenia. It is a before and after study and patients will receive a specialised smoking cessation package which will consist of 12 individual sessions to be delivered by an experienced mental health nurse trained in smoking cessation. The intervention will comprise fours phases: 1. preparation; 2. supply of NRT, via a patient group direction (PGD); 3. maintenance; 4. relapse prevention, and will include pharmacological, motivational enhancement, psychoeducation, cognitive and behavioural components. The Primary outcome is smoking status. Deborah Robson and Dr Richard Gray (both King’s College London) are the Principal Investigators on this project.

Students will:

• Assist in establishing and developing an internationally innovative and unique service delivery model (the smoking cessation clinic) to help eliminate an important health disparity (namely that people with schizophrenia do not have access to appropriate smoking cessation services).
• Assist in collecting evaluation data, using standardised valid measures of quality, outcomes, cost and use.
• Assist in developing an qualitative understanding of the process of giving up smoking in people with schizophrenia and health disparity issues to be addressed
• To assist in the dissemination (both via publication and conference presentation) of findings from this project nationally and internationally.

Project 4

A pilot study of medication adherence in people with mental illness in prisons

This project is funded by the NHS Prison research network (£50,000 for 12 months). Treatment adherence is a complex health behaviour affected by many factors including the efficacy of medication, side effects, relationship with clinicians, and medication attitudes and beliefs. Poor adherence limits the effectiveness of medications for chronic mental illnesses such as schizophrenia and places patients at high risk of relapse. In prisons settings patients who relapse may exhibit increasingly disturbed and violent behaviour. Medication adherence has not been empirically examined in a prison population who are marginalised and underserved by health services and where there is clear evidence of health disparity. We are undertaking a cross sectional survey to examine the point prevalence of medication adherence and explore predictors of adherence in prisoners with mental health problems. The Principal Investigators on this project are Dr Richard Gray (King’s College London) and Professor Judith Lathlean (University of Southampton).     

Students will:

• Assist in the collection of high quality scientific data across four prisons
• Assist in the cleaning and entry of data from the four prisons
• Ensure that bias is kept to a minimum in data collection
• To develop an understanding of and critically review the psychometric properties of measures available to determine factors predicative of medication adherence in this project.
• To assist in developing a conceptual model for enhancing medication adherence in prisoners that addresses differences among prison populations.
• Assist in developing a qualitative understanding of medication adherence in prisoners.  
• Assist in identifying how health disparities influence medication adherence in prisoners.
• To assist in the dissemination (both via publication and conference presentation) of findings from this project nationally and internationally.

Dr. Richard Gray

16^th January 2006

Health conditions that created mental health impact and health disparities in the mental health population are a significant concern in all areas of the United States, but particularly South Florida. South Florida has the highest national incidence of patients with major mental health diagnoses and the need for treatment. Services are fragmented here and research that provides understanding of the needs of patients’ issues with medication adherence, smoking cessation and other primary care needs of the mentally ill, that examines the psychiatric sequelae of medical illness, and social inclusion issues of disenfranchised members of our society directly addresses health disparity issues of concern.