Mental health research – it is still underfunded

Vanessa Pinfold

The second mental health research funding landscape review from MQ: Transforming Mental Health is finally out! This second analysis looks at the mental health-related research grants awarded by major funders in the UK between 2014 and 2017, and builds on their initial funding landscape review which considered funding between 2008 and 2013. We know it has been a tricky project for the charity, as their paper in Lancet Psychiatry documents.

Has mental health research received more investment between 2008 and 2017? In a word, no, not in real terms when inflation is taken into account. The headline figures are:

  • Between 2008 and 2014, £115 million per year on average was spent, or £9.75 per person affected by mental health problems. This compares to between 2014 and 2017, £124 million per year, or £9.25 per person.
  • This is significantly lower than spending on physical conditions such as cancer. Between 2014 to 2017, comparator figures were £612 million per year spent on cancer research which equates to £228 per person. 
  • Investment dedicated to research focusing on children and young people accounted for 26% grants.
  • Funding is allocated to 250 universities and organisations including NHS Trusts, but the majority (59%) is awarded to just 10 institutions, and actually 37% goes to just 4 institutions – 3 in London and the University of Oxford.
  • Charity fundraising accounted for 2.7% of mental health research funding. This compares to 68% for cancer research, 41% for cardiovascular disease and 28% for dementia.
  • Very little funding is going on prevention or development of new treatments. Most is spent on underpinning research and aetiology (looking at causes).

At McPin, the report speaks to us in several ways.

Firstly, as so few resources are allocated per head of the population we need to be even more coordinated in our approach to research to reduce duplication and to prioritise studies that will make the biggest impact on people’s lives. It is not uncommon to find several research teams all working on the same topic and none of them knowing (much) about the other! We hope our Right People, Right Questions project (which provides a list of 10 top priorities for young people’s mental health research) can assist here. This study is based upon the views of multiple stakeholders including children and parents. It is good to see a greater interest in child mental health among funders, including the Wolfson Institute, and more focus on the link between mental and physical health, which calls for more research crossing the traditional discipline boundaries in medicine and social science.

Secondly, we welcome a call for a multi-disciplinary approach, and encourage the inclusion of lived experience expertise in every mental health research project. This is both using peer research methods as well as developing strategies for Patient and Public Involvement (PPI).  We would like funders to require more of mental health research teams in terms of co-production and leadership with experts by experience. This is in line with recommendations within the recent Framework for Mental Health Research produced by the UK Department of Health.

Thirdly, the concentration of mental health investment in a small number of institutions is a concern (the majority of funding, 59%, being awarded to 10 institutions and 37% of this going to just 4 institutions), as we need diversification in the sector to ensure fresh thinking and leadership. The report is UK wide but it looks like spending is concentrated in England, and in particular London and Oxford. We need to encourage more people into mental health research as researchers, research advisors and research participants from across the UK. This means maintaining these centres of excellence but investing elsewhere as well. It also requires strategies to address the lack of diversity and intersectionality in the mental health research workforce.

There are not that many funding organisations in the mental health research sector, with most grants being awarded by government funders. This limits the pool of money available but also restricts innovation and diversification into new areas of study. Each funder has its own priorities, but the sector needs different types of organisations to cover the breadth of mental health research and differences in conceptual models and support approaches. There are significant gaps in terms of types of research being prioritised, the topics invested in, and the health areas targeted. For example, very little work supports research around the diagnosis of personality disorders, itself a very problematic label, which is something we are trying to address with Words That Carry On. Eating Disorders is also poorly supported by funding. The 2018 survivor research network manifesto  calls for a greater focus on experiential knowledge in mental health research; future landscape reports could look at what methodologies are employed in research studies to track the use of recommended multi-disciplinary approaches.

Many people get involved in mental health research to provide ‘hope’ that better support and understanding will be available to future generations. This is why we need a broad base of scientific discovery, listening carefully to experts by experience and those working with them, including carers and practitioners. However, there have also been over 200 user-led organisations that have closed in the past two years making it harder for grassroots priorities, ideas and teams to get involved and develop their own research. The eight new RCUK research networks look like they will attempt do more of this, connecting with community groups and allocating grants beyond university research teams, but each of these networks has only a very small budget. All of this is important because we want the best quality mental health research produced – research that can have a practical and beneficial impact on people’s lives.

Research is only useful if it leads somewhere – to greater understanding and to practical actions that change systems, practices and approaches for the better. McPin supports the call for increased funding for research but that resource has to be well spent to achieve maximum impact. We believe there needs to be a greater tie between research produced and the impact on society. We will be discussing the MQ report and the importance of better research impact assessments with the Alliance of Mental Health Research Funders when we meet in March. And we welcome feedback from you on the current mental health research funding landscape.