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Recap: The BEST study

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What we did and why we did it

The BEST (Brief Education Supported Treatment) study explored a new approach to supporting young people who had early symptoms of borderline personality disorder (BPD). Symptoms of BPD include unstable emotions, difficulties getting along with others, risky behaviour and self-harm. The BEST approach involved mental health services working together with schools and colleges to jointly deliver and test a short intervention. This study aimed to find out whether this new joint approach to providing support was practical, liked by staff and young people, and whether it would be possible to run a larger study in the future. Students aged 13-18 years with symptoms of BPD were allocated at random to either receive the BEST intervention or standard care. Information was collected to assess whether it would be possible to run a future larger trial.

Take away points

  • The BEST intervention was delivered successfully within schools and colleges and valued by staff and young people. It represents a promising approach to access timely support for young people who are experiencing BPD symptoms.
  • While the findings of this study provide support for progressing to a larger trial, they also highlighted several changes that would need to be made to make a larger trial successful.

What we found

We found that it is possible to deliver the BEST intervention within schools and colleges. Feedback from staff and young people suggested that the intervention was popular, and was viewed as potentially beneficial for young people, staff involved in co-delivery, and the wider school or college. But most referrals came directly from schools and colleges rather than the NHS, so when schools closed due to COVID-19, the study was cut short. These findings suggest that a larger trial testing whether the BEST intervention leads to improved outcomes and offers value for money would be worthwhile. But the study also identified several practical changes that would be needed in order for a future trial to be successful.

What’s Next?

We plan to use the learning from this study, together with some more work, to design a larger trial of how well the BEST intervention works. We intend to apply for further funding later this year to start this work.

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Research highlights why some bipolar patients don’t take their meds

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People with bipolar disorder may not take their medication because of side effects, fear of addiction and a preference for alternative treatment – according to research from Norfolk and Suffolk NHS Foundation Trust (NSFT) and the University of East Anglia (UEA).

Nearly half of people with bipolar disorder do not take their medication as prescribed leading to relapse, hospitalisation, and increased risk of suicide.

A new study, published today, reveals six key factors that stop people taking their medication as prescribed.

These include whether they are experiencing side effects, difficulties in remembering to take medication and a lack of support from family, friends and healthcare professionals.

A patient’s own beliefs and knowledge about bipolar disorder and its treatment was also found to affect whether or not they take their meds, as well as fear of addiction, and a preference for alternative treatment.

The new study comes from a team of pharmacists, psychiatrists, and experts in behavioural science from NSFT, UEA, Devon Partnership Trust, and the University of Lyon.

Asta Ratna Prajapati, consultant pharmacist at NSFT and a post-graduate researcher at UEA’s School of Pharmacy, led the research. The study was funded by a Health Education England (HEE) / National Institute for Health Research Clinical Doctoral Research Fellowship.

He said: “Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs, known as mania or hypomania, and depressive lows.

“Around half of people with bipolar disorder don’t take their medication which can lead to a relapse of symptoms. And this can have a knock-on impact with problems at work, strained relationships with family and friends, hospitalisation, and an increased risk of suicide.

“We wanted to better understand what stops people from taking their medication.”

The research team looked at the evidence for what hinders people taking their medication for bipolar disorder. The research team carried out a systematic review and included 57 studies, mostly surveys and interviews, involving 32894 patients and healthcare professionals. The majority (79%) of the studies were conducted in the USA and Europe.

“We found six key factors that affect whether people take their medication. The main reason being what the medication is like, whether there are side effects, and whether it works,” said Prajapati.

“Secondly, we found that a patient’s beliefs and knowledge about bipolar disorder and its treatment could stop them taking medication.

“We also found that how patients felt taking their medication had an impact – for example a fear of addiction or worry about negative side effects.

 "Other factors included a lack of support, difficulty remembering taking medication and not wanting to take it for reasons including preferring alternative treatment.

“We recommend that the prescribers talk to patients about their thoughts and experiences of the medications they take, paying particular attention to these issues which may stop patients taking their meds.”

The research team are now developing a tool to identify people who struggle to take their medication and their individual reasons. They hope it will help prescribers and patients work together and offer bespoke support to make medication taking easier.

‘Mapping modifiable determinants of medication adherence in bipolar disorder (BD) to the theoretical domains framework (TDF): a systematic review is published in the Psychological Medicine Journal on May 19, 2021


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Podcast exploring whether exercise can help teens with low mood?

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In this edition of NSFT’s podcast series – Mental Health and You it is the turn of NSFT Research to get behind the microphone.

Kayte Rowe, co-investigator on the READY Trial and Kiersten Wakefield the READY Trial delivery lead come together to talk about why we are researching exercise and low mood in young people for this latest study the READY trial. They chat about how common low mood/depression is in young people, what to look out for if you are a parent, which groups it particularly affects and how activity might help.

Kiersten fills us in on how the trial is run and what is involved and how young people have had an input in the creation of the trial.

Do have a listen to NSFT’s podcast by looking up Mental Health and You wherever you get your podcasts and subscribing (all free) – or download Apple Podcasts or google podcasts if you haven’t listened to one before. It comes out every fortnight from one of four departments within NSFT – Recovery College, School and parent support, Wellbeing and Research.

The research project talked about in this podcast is the READY trial - this study aims to see if physical activity improves the symptoms of low mood in young people aged 13 – 17 years old. Young people that take part will be asked to attend one of three groups twice a week for 12 weeks. The group activities will either be high intensity exercise, low intensity exercise or social non-exercise based activities. If you, or someone you know, is suffering from low mood you may be interested in taking part in this study.

 Any young people interested in finding out more should contact the research team at NSFT by email:

Listen now.

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Understanding mental health needs of young people using the ambulance service

Young people tell us their lived experiences of using the ambulance service due to a mental health crisis in a recent evaluation called SEAMLESS. NSFT Research has launched a new short film about SEAMLESS on how we can better understand the mental health needs of young people using the ambulance service.

Despite the fact the ambulance service is on the front-line of providing mental health care for young people in crisis, there is a lack of evidence to guide best practice in this area. This film made by NSFT Research with East of England Ambulance service explains their evaluation, which will offer important insights to guide service development and future research.    

This project was funded by the National Institute of Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme. To take part in research do go to Be a part of research.

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