Reducing relapse and suicide in bipolar disorder: Practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care

Aims and objectivesWe will extend our teams’ successful work into the clinical understanding and treatment of bipolar disorder (BD) to a programme to address questions that are of highest relevance to NHS priorities (suicide risk and dissemination of evidence based interventions) and that can deliver significant benefit to service users within a 3-5 year timescale (group psychoeducation, CBT for comorbid anxiety and substance use and appropriate application of the Mental Capacity Act). BackgroundDespite evidence that psychological approaches to BD improve clinical outcomes, levels of implementation remain low. One possible reason for this is the lack of a service delivery model for such interventions. Pilot work in Newcastle, indicates the feasibility of delivering group psychoeducation embedded within services by training nurses and expert patients in its delivery. Few individuals with BD receive integrated psychological care for either distressing anxiety symptoms or substance misuse despite both increasing relapse risk. A key challenge in both areas is that although evidence based interventions exist they have not been adapted and evaluated for individuals with this diagnosis. Key risk factors in bipolar disorder include self harm and suicide. However, little research has focused on trying to understand the key factors in suicide risk and resilience or their interconnections in this group. A final gap in the clinical literature is legislative. The new Mental Capacity Act (MCA) has the potential to make a positive difference to the lives of many individuals with BD. However there is an urgent need for research to understand the intended and unintended effects of its implementation in this group. Research plansThe programme contains a series of linked studies to help reduce harm and risk associated with bipolar disorder. Components of the programme will: 1) develop an appropriate service model for effective delivery of evidence-based psychoeducation; 2) evaluate the feasibility of individual psychological interventions to address comorbid anxiety and substance misuse to enhance recovery and reduce relapse and morbidity; 3) identify clinical factors associated with risk of suicide and recurrence of illness; 4) test the application and impact of the MCA on clinical practice. These linked studies will use shared approaches where appropriate. For instance the two therapy development and feasibility studies will employ comparable phases to facilitate comparison of the promise of each intervention for further definitive evaluation. We will use mixed method approaches across the programme to aid our understanding of the complex processes involved in risk and its amelioration. Studies will be timed to maximise efficiency, recruitment, retention and impact. Clinically relevant recommendations will be generated by each of the programme elements. Research team and environmentWe have an impressive track record of applied research into severe mental illness and particularly bipolar disorder including evaluation of psychological approaches for BD and investigations of suicide and associated risks at a national level. Our team encompasses applicants of international standing across academic and clinical fields from disciplines including psychology, psychiatry, statistics, health economics and law. We have the benefit of a service user applicant with prior expertise of externally funded research. Manchester Mental Health and Social Care Trust has longstanding highly effective links with the University of Manchester including a track record of funding linked clinical academic positions. Nottinghamshire Healthcare Trust and the University of Nottingham have jointly formed the Institute of Mental Health to create cross-Faculty and NHS multidisciplinary research into mental health. We are fortunate to have the University-NHS partnerships, collaborations and infrastructure to successfully carry out this research eviden