Past project

Understanding remote access to services (ETHOS)

A qualitative study exploring stakeholder experiences of secondary mental health services during the first 6 months of the Covid-19 pandemic

Project overview

We have a long-term partnership with The Healthcare Improvement Studies (THIS) Institute in Cambridge, supporting the application for funding from the Health foundation in 2018. We are also involved in specific project activity including ETHOS a study carried out in the first few months of the Covid-19 pandemic from April 2020.

We explored experiences of accessing and providing secondary mental healthcare as services moved to mostly remote access provision, using in-depth interviews with mental health service users, carers and frontline practitioners.

We wanted to understand how the pandemic affected the provision of secondary mental health support, and to identify principles for good practice going forwards. 

A consultation with an expert panel of service users and carers refined the project aims and approach. It was decided interviews would be conducted with service users and carers to examine their perspectives on deciding to seek NHS mental health support, and with NHS staff to understand the ethical dilemmas and challenges in provision of care that staff faced during Covid-19. The study was known as ETHOS.  

It was led by Professor Peter Jones and co-ordinated by Dr Elisa Liberati both from the Department of Psychiatry (University of Cambridge).  

Project details

Secondary mental healthcare typically offers continued access to treatment and support.

Changes following the introduction of lockdown measures meant services had to adapt quickly.  

Difficult decisions about prioritisation of care and changes to the way inpatient and community services could operate had to be balanced with multiple priorities, including individual needs and attempts to contain Covid-19 infections.   

As we move forward, attention is turning to what we can learn from these experiences.

This research sought to offer useful insights drawing on views of mental health service users, carers and practitioners.   

We helped recruit both study advisers and participants to ETHOS, and a peer researcher with McPin joined the study team to carry out all the service user interviews using a peer research approach.  

Ten people with lived experience of using mental health services or caring for someone with mental health difficulties were advisers on the project, including young people.

By attending meetings with researchers, they helped shape the project from the start, ensuring the research questions were relevant to service users and carers, and the methods proposed were appropriate. 

ETHOS was conducted using peer research methods: all the service user interviews were conducted by a McPin researcher drawing on their own experiences of accessing mental health services.

The peer researcher also worked with the THIS Institute team on the analysis and write-up of the findings for the service user data, as well as inputting for the carer and practitioner analysis.

This study is now complete and three peer review papers have been published.

We are currently working on a second study with the team called PHILM. This is looking at physical health among people with ongoing mental health needs. 

You can find more information on our findings in the study papers: 

  • Our first peer reviewed paper explores service users, carers and practitioners of remote access mental healthcare during the first months of Covid-19. 
  • Our second peer reviewed paper explores mental health practitioner experiences of providing support during first months of Covid-19. 
  • Our third paper looks at access and candidacy for secondary mental healthcare services. 

You can also read a peer researcher’s perspective in our mental healthcare and Covid blog:

“At a time when services were needed most, the onus was on us to find other ways to access support” 

For further queries about service user involvement, please email [email protected] 

Work with us

We are always excited to hear from others who want to collaborate on mental health research. From delivering peer research to helping you with public involvement strategies and providing training, get in touch to chat.