Maudsley NHS Foundation Trust Research Articles

Cohort profile: working age adults accessing secondary mental health services in South London (UK) and benefits – a data linkage of electronic mental health records and benefits data.

IntroductionIn the UK, mental disorders are one of the most common reasons for claiming a benefit relating to unemployment, income, sickness and disability. Limited information exists regarding the demographic characteristics and psychiatric profiles of working age individuals claiming benefits in London. Until recently, detailed data on both mental disorders and benefit receipt were unavailable. ObjectivesTo establish and describe a cohort of working age adults accessing secondary mental health services and benefits related to unemployment, income, sickness, and disability. MethodsUsing a novel data linkage containing electronic secondary mental health records from the South London and Maudsley (SLaM) NHS Foundation Trust and benefits data from the Department for Work and Pensions (DWP), we present descriptive statistics on sociodemographics, psychiatric diagnoses, and benefits received among a cohort of working age adults. The DWP benefits data window covers the period January 2007-June 2020, the SLaM data window covers the period January 2007-June 2019. ResultsWe identified n = 150,348 patients (18-65 years), who had attended SLaM secondary mental health services, 78.3% of which had received a benefit relating to unemployment, income, sickness and disability. Of this group, 68% had a recorded primary psychiatric diagnosis. We found that a much higher percentage of those with a primary psychiatric diagnosis received more than one benefit (69.4%) compared to those who had not received a primary psychiatric diagnosis (30.6%). Almost 70% of claimants who obtained more than one benefit were identified as living within the two quintiles representing the highest levels of deprivation in the South-east London boroughs served by SLaM. ConclusionsWe showed types of benefits received among working age adults accessing secondary mental health services. This cohort will be further examined to explore trajectories of mental health care and benefit receipt and provide evidence that will help to inform both DWP policies and mental health care delivery.

Lay review of the South London and Maudsley NHS Foundation Trust’s (SLaM) Clinical Records Interactive Search (CRIS) system website to better meet UK Heath Data Research Alliance Transparency Standards.

Lay review of the South London and Maudsley NHS Foundation Trust’s (SLaM) Clinical Records Interactive Search (CRIS) system website to better meet UK Heath Data Research Alliance Transparency Standards.

Impact of inconsistent ethnicity recordings on estimates of inequality in child health and education data: a data linkage study of Child and Adolescent Mental Health Services in South London

ObjectivesEthnicity data are critical for identifying inequalities, but previous studies suggest that ethnicity is not consistently recorded between different administrative datasets. With researchers increasingly leveraging cross-domain data linkages, we investigated...

Improving our understanding of the social determinants of mental health: a data linkage study of mental health records and the 2011 UK census

ObjectivesTo address the lack of individual-level socioeconomic information in electronic healthcare records, we linked the 2011 census of England and Wales to patient records from a large mental healthcare provider....

Identifying features of risk periods for suicide attempts using document frequency and language use in electronic health records.

Individualising mental healthcare at times when a patient is most at risk of suicide involves shifting research emphasis from static risk factors to those that may be modifiable with interventions. Currently, risk assessment is based on a range of extensively reported stable risk factors, but critical to dynamic suicide risk assessment is an understanding of each individual patient's health trajectory over time. The use of electronic health records (EHRs) and analysis using machine learning has the potential to accelerate progress in developing early warning indicators. EHR data from the South London and Maudsley NHS Foundation Trust (SLaM) which provides secondary mental healthcare for 1.8 million people living in four South London boroughs. To determine whether the time window proximal to a hospitalised suicide attempt can be discriminated from a distal period of lower risk by analysing the documentation and mental health clinical free text data from EHRs and (i) investigate whether the rate at which EHR documents are recorded per patient is associated with a suicide attempt; (ii) compare document-level word usage between documents proximal and distal to a suicide attempt; and (iii) compare n-gram frequency related to third-person pronoun use proximal and distal to a suicide attempt using machine learning. The Clinical Record Interactive Search (CRIS) system allowed access to de-identified information from the EHRs. CRIS has been linked with Hospital Episode Statistics (HES) data for Admitted Patient Care. We analysed document and event data for patients who had at some point between 1 April 2006 and 31 March 2013 been hospitalised with a HES ICD-10 code related to attempted suicide (X60-X84; Y10-Y34; Y87.0/Y87.2). n = 8,247 patients were identified to have made a hospitalised suicide attempt. Of these, n = 3,167 (39.8%) of patients had at least one document available in their EHR prior to their first suicide attempt. N = 1,424 (45.0%) of these patients had been "monitored" by mental healthcare services in the past 30 days. From 60 days prior to a first suicide attempt, there was a rapid increase in the monitoring level (document recording of the past 30 days) increasing from 35.1 to 45.0%. Documents containing words related to prescribed medications/drugs/overdose/poisoning/addiction had the highest odds of being a risk indicator used proximal to a suicide attempt (OR 1.88; precision 0.91 and recall 0.93), and documents with words citing a care plan were associated with the lowest risk for a suicide attempt (OR 0.22; precision 1.00 and recall 1.00). Function words, word sequence, and pronouns were most common in all three representations (uni-, bi-, and tri-gram). EHR documentation frequency and language use can be used to distinguish periods distal from and proximal to a suicide attempt. However, in our study 55.0% of patients with documentation, prior to their first suicide attempt, did not have a record in the preceding 30 days, meaning that there are a high number who are not seen by services at their most vulnerable point.

How is city living associated with psychosis? Findings from a novel data linkage of 612,988 people from an urban and ethnically diverse area

ObjectivesUK cities show higher incidence of psychotic disorders, but the reasons remain unclear. This case-control study uses data from one of the first and largest person-level data linkages between mental health records and the UK census to explore associations previously only assessed using ecological or smaller studies in England.
 MethodsThe SocioEconomic Predictors of Mental Disorders (SEP-MD) project dataset comprises of data extracted from electronic health records (EHR) from the South London and Maudsley NHS Foundation trust (SLaM). These EHRs were linked to the 2011 UK census as a collaboration between SLaM, the ONS and King’s College London.
 Cases with clinical diagnoses of non-affective (schizophrenia-spectrum) and affective psychoses (bipolar disorder, depression with psychosis) were identified. Population controls were sampled from the locality.
 Logistic regression models were used to calculate weighted adjusted (age and sex) odds ratios (waOR) to assess associations. Robust standard errors were used to account for clustering.
 Results16,863 linked cases with psychosis (affective n=5,694; non-affective n=11,169) were identified alongside 596,125 population controls.
 Cases with psychosis were more likely to live in areas with the highest population density (waOR 1.17 (1.05, 1.30)) when comparing the lowest quintile to the highest. Non-affective disorders showed the highest association with population density.
 Being born within the UK was associated with a higher risk of psychosis, and migrants living in the country for longer were at a significantly higher risk than those living in the UK for less time. Socioeconomic predictors, including education, occupation and tenure, were all associated with higher psychosis risk. Racialised minorities were at higher risk of specifically non-affective psychoses. Indicators of isolation (marital status and living alone) were highly associated with psychosis risk.
 ConclusionsOur findings regarding urbanicity, ethnicity, migration socioeconomic position and social circumstances both confirm and provide further depth to previously identified associations. Novel findings relating to migration and interactions with ethnicity will require further investigation.
 These insights will provide valuable information for future public health and policy development.

Mental health, welfare and state support: Findings from a novel data linkage

ObjectivesTo describe the process and outcomes of establishing a unique data linkage between mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions.
 Methods448,404 IDs of patients who accessed secondary mental healthcare services at SLaM were sent to the DWP, including personal identifiers. Data from SLaM covered years 2007-2019, whereas data from DWP covered years 2005-2020. A deterministic data linkage approach was used.
 ResultsA linkage rate of 93% was achieved. Patient groups who were less likely to be linked were women, those from a racial and ethnic minority background and younger patients. Benefit receipt was high among patients, with 83% of patients having received benefits during the 15-year follow-up period. Benefits most frequently received included unemployment related or income replacing disability benefits.
 ConclusionThis data linkage is the first of its kind in the UK to demonstrate the use of routinely collected mental health and benefits data. It provides opportunities to generate much needed high-quality evidence that can be used to achieve change, investment in services and translation into policy and practice.

Cohort profile: Working age adults accessing secondary mental healthcare services in South London (UK) and benefits – A data linkage of electronic mental healthcare records and benefits data

ObjectivesTo present an overview of a cohort of working age adults accessing secondary mental healthcare services and benefits related to unemployment, sickness, disability, or income support and describe the different benefit types received across diagnostic and sociodemographic groups.
 MethodsUsing a novel data linkage containing electronic secondary mental health care records from the South London and Maudsley (SLaM) NHS Foundation Trust and benefits data from the Department for Work and Pensions (DWP), we present descriptive statistics on a cohort of working age adults. The data window covers the period January 2007-June 2020.
 ResultsWe identified n=150,348 patients of working age (18-65 years), who had attended SLaM secondary mental health care services, 78.3% of which had received a benefit relating to unemployment, sickness, disability, or income support. Of this group, 68% had a recorded primary psychiatric diagnosis. We found that a much higher percentage of those with a primary psychiatric diagnosis received more than one benefit (69.4%) compared to those who had not received a primary psychiatric diagnosis (30.6%).
 ConclusionsWe showed types of benefits received among working age adults accessing secondary mental health care services. This cohort will be further examined to explore trajectories of mental health care and benefit receipt and provide evidence that will help to inform both DWP policies and mental health care delivery.

Antidepressant drug prescription and incidence of COVID-19 in mental health outpatients: a retrospective cohort study

BackgroundCurrently, the main pharmaceutical intervention for COVID-19 is vaccination. While antidepressant (AD) drugs have shown some efficacy in treatment of symptomatic COVID-19, their preventative potential remains largely unexplored. Analysis of association between prescription of ADs and COVID-19 incidence in the population would be beneficial for assessing the utility of ADs in COVID-19 prevention.MethodsRetrospective study of association between AD prescription and COVID-19 diagnosis was performed in a cohort of community-dwelling adult mental health outpatients during the 1st wave of COVID-19 pandemic in the UK. Clinical record interactive search (CRIS) was performed for mentions of ADs within 3 months preceding admission to inpatient care of the South London and Maudsley (SLaM) NHS Foundation Trust. Incidence of positive COVID-19 tests upon admission and during inpatient treatment was the primary outcome measure.ResultsAD mention was associated with approximately 40% lower incidence of positive COVID-19 test results when adjusted for socioeconomic parameters and physical health. This association was also observed for prescription of ADs of the selective serotonin reuptake inhibitor (SSRI) class.ConclusionsThis preliminary study suggests that ADs, and SSRIs in particular, may be of benefit for preventing COVID-19 infection spread in the community. The key limitations of the study are its retrospective nature and the focus on a mental health patient cohort. A more definitive assessment of AD and SSRI preventative potential warrants prospective studies in the wider demographic.

Severity and symptoms of depression in older adults presenting to mental health services during COVID‐19 lockdown – an experience from south London region

AbstractBackgroundSocial restrictive measures during COVID‐19 pandemic has influenced people’s mental health conditions across different countries. Global studies indicated an increased prevalence of anxiety disorder and depression with varied impacts among different age groups. Most studies in the elderly have been done via surveys or internet medias missing out on people with no access to digital technology tools. We aimed to investigate the prevalence of depression among elderly people aged 65 years and above who attended mental health service for older adults (MHOA).MethodsRetrospective data was collected from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register for MHOA. Using this large mental health care database in South London, United Kingdom, we identified referrals to MHOA during the first UK lockdown (March ‐ July 2020) and compared those to a corresponding pre‐COVID period (February ‐ July 2019). Logistic regression analysis adjusted for age, gender, ethnicity, diagnosis and living conditions were done to examine association between COVID‐19 lockdown and severity and symptoms of depression.Results536 patients were referred and seen within the MHOA during the first UK COVID‐19 lockdown period compared to 1,455 patients during the pre‐COVID‐19 corresponding period. We found presence of COVID‐19 lockdown had no effect on overall severity of depression but significantly associated with depressive symptoms such as anhedonia (1.64, 95% CI 1.14‐2.37, p = 0.008), lack of energy (1.65. 95% CI 1.65 (1.25‐2.16), p<0.001), tearfulness (1.43, CI% 1.15‐1.78, p = 0.001), agitation (1.32, CI% 1.07‐1.63, p = 0.009), disturbed sleep (1.37, CI% 1.11‐1.70, p = 0.003) and guilt feelings (1.45, CI% 1.04‐2.03, p = 0.030)ConclusionsThere was an increased prevalence of certain depressive symptoms among older adults within MHOA during first COVID‐19 lockdown which implies impact of isolation and possibly physical ill‐health on mental well‐being. This needs to be explored further for potential prevention and managements.

The patient journeys of children and adolescents with depression: a study of electronic health records.

In England, children and adolescents with depression can seek treatment from specialist mental health services. We know little about how they journey through these services, or whether healthcare providers collect sufficient data to accurately appraise this. We aimed to summarise the child and adolescent depression pathway for two healthcare providers. This cohort study used de-identified electronic health records extracted from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and South London and Maudsley NHS Foundation Trust (SLaM). We identified referrals between 2015 and 2019 during which the referred patient received their first depression diagnosis aged < 18years. We described patient demographic and clinical characteristics, and features of the referral. In total, n = 296 (CPFT) and n = 2502 (SLaM) patients had a referral which met eligibility criteria. In both sites, patients were more frequently female (CPFT 79.3%; SLaM 69.3%) and White ethnicity (CPFT 88.9%; SLaM 57.9%) as compared to respective population estimates for the Trusts' catchment areas. Patients typically received their first depression diagnosis during adolescence (median ages 16 in CPFT and 15 in SLaM). The most common comorbidity was anxiety disorder. Referrals were usually routine, to community teams specialising in the child age group. Commonly mentioned interventions included antidepressant medication, cognitive behavioural therapy, and dialectical behaviour therapy. However, pathways varied within and between sites, and the quality and consistency of some data was poor. These findings provide an overview of service pathways experienced by children and adolescents with depression, but also highlight that pathways can vary according to individual need and healthcare provider. More systematic collection of some data, and standardisation in record systems used by different providers, would be beneficial.

Participating in a virtual Gaining Experience programme during the COVID-19 pandemic and wartime-a Ukrainian's experience at King's College London.

Journal Article Participating in a virtual Gaining Experience programme during the COVID-19 pandemic and wartime—a Ukrainian’s experience at King’s College London Get access Khrystyna Shalak, Khrystyna Shalak Ukrainian Catholic University Lviv, Lviv, UkraineLviv Regional Clinical Psychiatric Hospital Search for other works by this author on: Oxford Academic Google Scholar Mariana Pinto da Costa Mariana Pinto da Costa Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomSouth London and Maudsley NHS Foundation Trust, London, United Kingdom Corresponding author. 16 De Crespigny Park, London SE58AB. E-mail: mariana.pintodacosta@kcl.ac.uk Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, qgad034, https://doi.org/10.1093/postmj/qgad034 Published: 02 May 2023 Article history Received: 19 March 2023 Accepted: 02 April 2023 Published: 02 May 2023

Investigating online activity in UK adolescent mental health patients: a feasibility study using a natural language processing approach for electronic health records

ObjectivesTo assess the feasibility of using a natural language processing (NLP) application for extraction of free-text online activity mentions in adolescent mental health patient electronic health records (EHRs).SettingThe Clinical Records...

Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study.

To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust. To investigate the impact of this temporary policy change on clinical and safety outcomes. All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined. Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection. There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.

Consistency of Violence: Implications for Effective Inpatient Psychiatric Care

Instances of violence and aggression in acute psychiatric settings are common and highly distressing for service users and staff. They also incur financial costs. This study aimed to identify the proportion of service users at risk of consistent violence/aggression enactment. It also aimed to analyse associated service use to explore the potential need for specialised, targeted approaches. Five years’ worth of data were extracted from 2016 to 2020 on inpatient stays across South London and Maudsley NHS Foundation Trust (SLaM) acute adult wards and Psychiatric Intensive Care Units (PICUs). Service users were divided into cohorts based on relative number of violent/agressive incidents enacted. Differences in frequency of acute service use during the period 1st January-31st December 2020 were analysed. In total, 2524 service users had at least one inpatient stay during 2020. 679 were recorded as having enacted at least one incident of violence or aggression. Just 4% of all service users accounted for 50% of all violence/aggression enactment. Results further showed strong evidence of group differences between violence cohorts in the following domains: internal transfers, occupied bed days, admissions and Place of Safety (PoS) referrals. There was weaker evidence for group differences in referrals to Home Treatment teams (HTTs) and Psychiatric Liaison Teams. A small proportion of service users disproportionately account for the majority of violent and aggressive incidents and higher levels of violence and aggression are associated with more acute service use. The provision of targeted, personalised interventions for this cohort may reduce the enactment of violence and aggression, leading to improved quality life and a reduction in financial expenditure.

Evaluation of service-user and clinician feedback of ‘Beth’: a new digital tool in South London and Maudsley NHS Foundation Trust

Introduction Conventional healthcare records are generally inaccessible to service-users. ‘Beth’ is a digital tool in South London and Maudsley NHS Foundation Trust which allows service-users to self-monitor symptoms, set therapeutic goals, access aspects of clinical records and communicate with care teams. Objectives To explore service-user and clinician perspectives of Beth, and to understand how Beth might impact clinical care. Methods Service-user and clinician users completed an online questionnaire. Likert-scale and free-text response questions covered user experience, impact on clinical care and suggested improvements. N=26 service-users and 43 clinicians completed the questionnaire. Quantitative and qualitative analyses are presented. Results Service-users reported the most useful features were tracking sleep and mood, messaging their care team, logging coping strategies and viewing care plans, goals and upcoming appointments. A majority reported Beth improved clinical assessments and they would recommend it to others. Barriers to using Beth included navigational difficulties, lack of access to internet or hardware, needing to register for an account and forgetting to use it. Clinicians reported booking appointments, messaging service-users, sharing care plans and accessing mood diaries were the most useful features. However, many clinicians did not use Beth regularly. Barriers included difficulties using Beth, finding it time-consuming and reportedly poor service-user adherence. Conclusions Our findings highlight potential benefits of digital tools in mental health care, alongside numerous barriers and suggested improvements. Limitations include a small sample size and lack of objective user data. Future work may involve qualitative interviews, analysis of objective usage data and trialing improvements in service design. Disclosure of Interest None Declared

The impact of severe mental illness (SMI) on the rate of COVID-19 vaccine uptake and hesitancy

IntroductionThe COVID-19 pandemic has disproportionately affected patients with severe mental illness (SMI), a vulnerable population with high morbidity and mortality. A UK-based study found reduced vaccination rates in patients with SMI; they therefore need to be prioritised for prevention and disease management.ObjectivesThe objectives were to determine risk factors for vaccine hesitancy, and how best to manage those in patients with SMI, as well as whether our intervention of calling patients for their vaccines had a positive outcome.MethodsFollowing approval from the Lambeth Directorate of South London and Maudsley (SLaM) NHS Foundation Trust, we investigated COVID-19 vaccination rates inpatients with SMI from a psychosis community service in South London (n=236). Dates of first and second doses were recorded through audit; reasons for refusal of vaccination were noted. Patients were encouraged to take the vaccine. A re-audit was performed after allowing three months. Chi-squared statistical analysis was performed to determine the value of our intervention.ResultsBefore the intervention, 143 patients (60.6%) received at least one vaccine. 24 patients (10.2%) received one dose, and 77 (32.8%) were yet to receive any. There was no statistical significance (p=0.1509) between the number of patients who received a vaccine before and after intervention, with 33.1% of patients still remaining unvaccinated.Image:Image 2:Image 3:ConclusionsThere is limited research on perceptions of receiving vaccines in patients with SMI, despite their cost-effectiveness in disease prevention. Even after intervention, 33.1% of patients remained unvaccinated, compared to 6.6% nationally. A lack of knowledge and recommendations from care teams are reasons for hesitancy. Misinformation, conspiracy theories and propaganda can drive people towards refusal. Patients with SMI typically have disadvantages of healthcare inequality, lower levels of education and access to inaccurate information. Patients and their healthcare team should be knowledgeable about vaccine efficacy and side effects. Studies have shown low uptake in the Black/African/Caribbean ethnic group (49.3%, table 3). Reasons include general mistrust in institutions and access barriers. For minority communities, vaccination sites in community centres or places of worship have proven to be effective, providing familiarity.Patients taking clozapine may have a weaker immune system due to myelosuppression. 24.3% of our patients take this, with many unsure of interactions or side effects. Poorer prognosis means a focussed approach is needed.Vaccine hesitancy is complex and requires targeted, tailor-made strategies, with consideration for patients who may lack capacity. It is evident from our results that calling patients alone may not be effective. A future multi-modal approach may be necessary to address poor vaccine uptake and opens up avenues to further explore vaccine hesitancy.Disclosure of InterestNone Declared

Observational prospective study of social media, smartphone use and self-harm in a clinical sample of young people: study protocol

IntroductionYoung people are the most frequent users of social media and smartphones and there has been an increasing speculation about the potential negative impacts of their use on mental health....

Linking electronic mental healthcare and benefits records in South London: design, procedure and descriptive outcomes

ObjectivesTo describe the process and outcomes of a data linkage between electronic secondary mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from...

Physical Health in Clinical High Risk for Psychosis Individuals: A Cross-Sectional Study.

The clinical high risk for psychosis (CHR-P) phase represents an opportunity for prevention and early intervention in young adults, which also could focus on improving physical health trajectories. We conducted a RECORD-compliant clinical register-based cohort study. The primary outcome was to describe the physical health of assessed CHR-P individuals, obtained via Electronic Health Records at the South London and Maudsley (SLaM) NHS Foundation Trust, UK (January 2013-October 2020). The final database included 194 CHR-P subjects (46% female). Mean age was 23.70 ± 5.12 years. Percentage of tobacco smokers was 41% (significantly higher than in the age-matched general population [24%]). We found that 49% of subjects who consumed alcohol had an AUDIT-C (Alcohol Use Disorder Identification Test) score above 5 (hazardous drinking), with an average score of 4.94 (significantly higher than in the general population [2.75]). Investigating diet revealed low fiber intake in most subjects and high saturated fat intake in 10% of the individuals. We found that 47% of CHR-P subjects met the UK recommended physical activity guidelines (significantly lower than in the general population [66%]). Physical parameters (e.g., weight, heart rate, blood pressure) were not significantly different from the general population. This evidence corroborates the need for monitoring physical health parameters in CHR-P subjects, to implement tailored interventions that target daily habits.