Case Study: Professor David Gunnell

Prof David GunnellProfessor of Epidemiology, School of Social and Community Medicine, University of Bristol

“We involve patients to understand what they want, to understand their needs, to ensure that what we research is directly relevant and will make a difference. We’re doing it to make a difference to the patient and to population health.”

NIHR Senior Investigator David Gunnell was the co-Principal Investigator on an NIHR Programme Grant for Applied Research (PGfAR) in support of the National Suicide Prevention Strategy for England. His research focuses on strategies for improving mental health and preventing suicide.

To plan and agree priorities for this suicide research programme Professor Gunnell and his team convened a workshop that included patients, representatives from the Samaritans (the national suicide prevention charity) and policy makers. Their views and input were key to ensuring this very challenging programme of work was designed appropriately and sensitively with the needs and concerns of service users and population health policy at its heart. One service user became a co-applicant, advising the research team and assisting with the recruitment of patients who self-harm to the study.

In previous research, Professor Gunnell and colleagues tested a contact-based intervention – a letter and the provision of sources of information and help – aimed at reducing the incidence of self-harm in the period after psychiatric hospital discharge. Every aspect of this was shaped by patient and public involvement (PPI). There were two service users and a Samaritans’ representative on the steering group. One of the service users became a co-author of a resultant paper.

The design of the intervention was determined through research interviews with service users. This enabled the team to assess how patients preferred to be contacted, how useful they might find the letter, how to word it, how often to contact them and any other issues they felt were relevant. The letters and protocols for patient contact following psychiatric hospital discharge were co-produced with a service user member of the research group and had input from a number of patients who had recently been discharged from a psychiatric inpatient unit. Service users commented on the design of the study and provided ideas that were incorporated into the final letters to patients and the interview guide to follow up on the intervention.

A similar approach was adopted in the development of the second intervention within the research programme: a contact-based intervention aimed at reducing the risk of repeat self-harm among people presenting to hospital following self-harm.

Professor Gunnell and his team worked closely with their Service User Adviser to ensure people were adequately briefed and supported before, during and after the process of being involved. As well as the adviser, there were always at least two service users involved, to encourage peer support and to minimise the pressure a lone individual could feel.

Professor Gunnell believes that a key determinant of successful PPI in research is collaboration. Research is enhanced through the sharing of knowledge, insights and experience. In particular he credits the Service User Adviser, Rosie Davies, with playing a key role in terms of contacting patients to be involved, helping the research team to communicate with them and supporting them to remain involved.

For Professor Gunnell, patient and public involvement is not an optional extra: it is part of the research process, ensuring that the evidence discovered is meaningful, relevant and useful to a particularly vulnerable group of patients.

“Patient and public involvement is about collaboration. It is not about the work of one individual but rather groups of patients and researchers coming together and contributing to a wider body of work.”

Gunnell D et al (2013) A multicentre programme of clinical and public health research in support of the National Suicide prevention Strategy for England, Programme Grants Appl Res 2013:1(1)

INVOLVE (2013) Examples of public involvement in research funding applications: Example 9  – a multi-centre programme of clinical and public health research to guide health service priorities for preventing suicide in England.

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