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Reflection & Action Needed to Strengthen Mental Health Research During COVID-19 and Beyond

A Q&A with Dr Demkowicz and Dr Panayiotou

Dr Ola Demkowicz and Dr Margarita Panayiotou are Lecturers at the Manchester Institute of Education, where they specialise in adolescent mental health. This year, they teamed up with other leading members of the UK mental health research community to discuss how to strengthen research on mental health and the pandemic.

In their article, “Looking Back to Move Forward” published in April in Frontiers in Psychiatry, they commend the swift reaction of the research community to examine the pandemic’s effects on mental health, but also raise the question of whether this speed may have compromised the quality of the response.

Future research, they said, could be strengthened through greater collaboration and more efficient resource allocation across the field, as well as increased co-production with lived experience experts, mixed methods research, efforts to ensure robust and open research, and by addressing inequalities within academia to sustain the research workforce.

Dr Demkowicz and Dr Panayiotou told the COVID-Minds Network why they felt it was time to bring these reflections to the mental health research community.

1. How was your research impacted by the pandemic and what prompted you to write the article?

Like many mental health researchers worldwide, we wanted to understand how the pandemic would affect mental health and, hopefully, offer insights that could inform ongoing responses. We both became involved in projects to this effect, and watched keenly as the rest of our community also sprang into action to prioritise and guide mental health research, such as Holmes and O’Connor and their colleagues who wrote a piece in The Lancet Psychiatry.

At the same time, though, we were beginning to have some reservations about aspects of the research response. We kept seeing dozens of new studies, many focusing on similar research questions and recruiting the same people. While so much of the work was important and commendable, we started asking ourselves whether we were we doing the best we could, and how the community ended up with so many different studies? We noticed others were also raising these questions, and so we decided that it would be helpful to bring these conversations to the wider community and encourage explicit reflection on our work. We know many of our colleagues have had similar thoughts to those our team raised; we just put these thoughts on paper.

2. How did you and your team of co-authors come together?

While working on this idea, we contemplated how to bring mental health experts together. As early career researchers (ECRs) we found this to be a difficult task, which speaks to some of the issues within our infrastructure: it is easier to work within research silos, as bridging communication chasms that can exist in our community can be intimidating, especially for ECRs. We wanted to challenge that and therefore reached out to individuals across the UK with a range of different perspectives and expertise. Our team is made up of thirteen members of the UK mental health research community, comprising researchers, experts by experience, and academics overseeing relevant networks and journals. These people, like us, had been involved in the COVID-19 research response, and/or had been voicing concerns already about the research practices of our community before and during COVID-19.

3. How did you decide on the four key reflections?

We wanted to start out by getting a sense of different perspectives and reflections across the team. So during the UK summer of 2020, we asked all authors to independently write down their thoughts on the mental health research response to COVID-19. We asked them to reflect on its strengths and challenges, facilitators and barriers, how well research was meeting key priorities, whether “good research practice” was being incorporated, and what lessons had been learnt. We then looked across these comments to identify central points and their associated nuances. These four key reflections therefore capture the thoughts of all thirteen members.

4. Do you feel that these were pre-existing issues that the pandemic exacerbated, or do you think the pandemic is changing the landscape of mental health research?

So many of these issues and challenges are not at all new. But the past year has shone new light on them or even exacerbated them. For instance, co-production and PPIE is frequently overlooked, but this seems to have especially been the case with our rapid response to the pandemic. Similarly, inequality in our workforce is a longstanding issue, and the pandemic has brought even greater threat. It has impaired the productivity of academic staff, which is so prized within academic incentive systems, and increased the uncertainty of precarious employment contracts.

There seems to have been the expectation that there was room, in an emergency like this, for some of these pre-existing issues to be set aside. Or we assumed that they would be resolved somehow through, for instance, joining forces or sharing data and material. But we are now seeing that this was not the case, at least for the majority of the work.

5. How do you think groups could come together to implement changes to improve the evidence base regarding mental health and COVID-19?

Research regarding the pandemic and its aftermath will continue for some time. As we move forward, considerable responsibility lies with those at the stern of our infrastructure – including field leaders, research network/group coordinators, and funders – to carefully consider next steps and develop a coordinated and strategic research approach. Research networks and organisations need to work consciously to minimize duplication and waste and to facilitate collaborative interdisciplinary work. This could include continued revisiting of key priorities, scoping exercises to identify emergent trends, and ongoing consultation with stakeholders.

6. Do you know of any groups already working on research strengthening initiatives?

In the UK, the COVID-MINDS Network and the NIHR’s COVID-19 and Mental Health Studies Register both provide a platform for support and collaboration among researchers. This is in fact one of the strengths of the response. We hope that these initiatives, aimed at solving some of these problems, become the core of our infrastructure, which will allow for stronger collaborative interdisciplinary projects and avoid future duplication and waste.

More widely there are a number of initiatives and networks that have been in place for some time that seek to encourage or facilitate good research practice. For example, ReproducibiliTea is a grassroots journal club initiative that focuses on improving open science practices, or the Public Involvement Fund from NIHR Research Design Services, offers researchers small-scale funding to support PPIE and coproduction. Initiatives such as these are a vital part of developing our field and facilitating good practice. Coordinators and leaders can consider how we can continually support (and learn from) these kinds of activities for the betterment of the field.

7. In your opinion, has the pandemic led to any positive changes regarding mental health research?

Thinking critically about our work is second nature to many of us. But we should not overlook some of the positives. The pandemic has put mental health in the spotlight and has brought renewed attention from the public and policymakers. Whether this will result in greater funding in this area overall remains to be seen. The pandemic has also given us the opportunity to break down barriers in collaboration and dissemination. Online communication means greater cross-cultural collaboration, more flexible co-production and PPIE, and more opportunities for free or affordable learning. These are some of the things we can learn from and adopt as common practices.

8. What would you like to see change in the next year regarding the mental health research community and its work on COVID-19?

We realise that many of the changes our discipline needs are structural and rely on available funding, which is why mental health must be a higher funding priority within the UK Government and worldwide. This will allow us to build stronger multidisciplinary collaborations, reduce inequality and support our workforce.

Moving forward, we call on research groups to reach out and connect with others, exploring opportunities for collaboration across institutes and disciplines. We encourage them to draw on the views of experts by experience, and to embrace qualitative methods. We encourage them to plan their research in a transparent and open way, including asking permission from research participants for the sharing and depositing of their data.

These are small steps that can bring enormous benefits to our research. Ultimately, they will increase the quality, meaningfulness, and transparency of our work.


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