Written evidence submitted by the Royal College of Psychiatrists (LEA0282)

Introduction

The Royal College of Psychiatrists (RCPsych) is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and in setting and raising standards of psychiatry in the United Kingdom.

The College aims to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities. In order to achieve this, the College sets standards and promotes excellence in psychiatry; leads, represents and supports psychiatrists; improves the scientific understanding of mental illness; works with and advocates for patients, carers and their organisations. Nationally and internationally, the College has a vital role in representing the expertise of the psychiatric profession to governments and other agencies.

The Faculty of Academic Psychiatry provides a focus within the College for members with a major interest in academic psychiatry, particularly those employed within university and research institutions who undertake psychiatry research and education. The Faculty of Academic Psychiatry aims to promote, facilitate, and stimulate interest in high-quality clinical research and teaching. Our response was prepared by Professor Hugo Critchley with comments from the Academic Faculty.

Summary

• Those working on the Brexit negotiations must develop clear and coherent plans to safeguard scientific research in UK and ensure that the momentum gained in mental health policy in recent years is maintained. If not, the losers will be not only the leading position of the UK in mental health research, but patients themselves.

• In the UK, mental illness accounts for around 23% of the disease burden yet we invest less than 6% of the annual health research budget in mental health which amounts to £115 million. By contrast, cancer receives 25%. In a sector where every penny counts, UK researchers cannot afford to miss out on EU support.

• The EU remains the largest single funder of mental health research in Europe and indeed one of the 10 largest funders globally. FP7, for example, invested €1.92 billon in brain research between 2007 and 2012. 

• The UK undertakes more studies in mental health than any other EU country. UK institutions currently lead on ten mental health related flagship collaborative research programmes (EU funding amounting to over £54M), and participate in at least a further 12 European consortium collaborations (total EU funding £94M).  The EU presently invests over £24M in research funding and support for individual mental health researchers in the UK.

• Membership of the EU has facilitated the movement and retention of leading clinical academics, psychologists and neuroscientists from non-UK EU backgrounds who have contributed to UK’s leadership of research into psychological disorders and mental illness. Any negotiations around free movement of workers need to take into account the value that this movement has added to scientific research.

• Collaboration is important to the future of mental health research. , This was confirmed, both in the UK and across Europe, by the EU project ROAMER (2015: “Road Map for Mental Health Research in Europe”) setting out ‘a comprehensive, coordinated mental health research agenda for Europe’.

• Mental health research is particularly sensitive to the potential negative consequences of a UK exit from EU funding schemes. Negotiations need to ensure the UK’s exit from the EU does not mean an exit from funding for science. This would impoverish funding, compromise collaboration with other people and institutions within other EU countries (and large scale studies across similar populations) and further deplete the mental health researcher workforce, by affecting status and mobility of those working in the UK.

1. The effect of the various models available for the UK’s future relationship with the EU

1.1.            What models are there?

One possible model is ‘associated country status’ as accorded to Norway, Switzerland and Israel. This would allow us to “buy into” the EU science programme and apply for Horizon 2020 (H2020) projects in the same way as we would if we had remained an EU member state.

However, associated country status is not guaranteed, and a pre-condition for participation will almost certainly be continued freedom of movement between EU countries. In Switzerland, in 2014 a vote to limit migration and blocking of free movement led to suspended access to H2020 funding.

The Swiss government has since set up a national programme to replace access to ERC funding and ‘Erasmus’-like funding for students, and has negotiated limited access to H2020 until 2016. They are now relegated to a “partially associated” status and forced to increase national spending to try and match the funds lost. By some estimates this has reduced their participation in EU research projects by 40%.[i]

Continued EU budget contributions would be required if the UK wishes to mirror the Switzerland model and (limited) access may similarly depend on free movement agreements.

In 2012, prior to the initiation of H2020 the Norwegian Government considered four scenarios, choosing strong integration in to EU science funding programmes[ii].

1.2.            Collaboration in mental health 

The FP7 Project ROAMER[iii] set out to map future psychiatry research within the EU.  Its conclusions push for the coordinated investment and strategic use of resources to build upon and highlight the benefits of EU collaborations to UK mental health and psychiatry research.  The following recommendations assume UK commitment to EU mental health projects, which will be compromised if the UK is ineligible to participate fully in European mental health research schemes.  Alternatives would be costly.

ROAMER recommendations include,

1. Data sharing and harmonization of comprehensive mental health studies that avoid research redundancies throughout Europe. Better mental health research studies would arise through sharing of methodologies and measures, and data repositories, as well as the integration of research networks to overcome regional constraints including stigma, organisation, different data protection laws and terminology related to mental health. 

2. Fostering of more intensive collaboration, e.g. a European mental health research network of centres of excellence that can share data at a coordinated level, including access to high throughput genotyping, creation of functional -omics and neuroimaging centres. These centres would also optimise the use of expensive facilities, including equipment (e.g. MRI), databases or infrastructures (e.g. cohorts). These collaborations would facilitate knowledge transfer, limit bias and increase the reproducibility of findings and improve the quality, transparency and credibility of research.

3. Capacity building of multidisciplinary research in mental health, through coordination of masters and PhD programmes devoted to mental health research and growth of new postgraduate research training programmes to foster coordination of training content across Europe. This would include a minimum requirement of research training for academic posts in mental health, and a parity of funding for mental health research relative to other health fields given the burden of mental health problems.

4. Stakeholders: Service users, their relatives, professionals, the public and decision-makers all need to contribute to the direction of mental health research. The European Commission fosters greater stakeholder involvement in conducting and translating research (European Commission, 2014a) and a Europe-wide view will maximize comparability, strength and usefulness of mental health research and resources. 

The UK may lose out on benefits arising of the strategy put forward by ROAMER to optimise European mental health research if it is not committed or eligible to enable in deep collaboration with centres in other EU countries.  This would diminish the UK’s standing in the field  

1.3.            Free movement of researchers and students in psychiatry and mental health:

UK mental health research, and academic psychiatry in particular, are dependent upon a workforce that draws heavily from non-UK EU member states.  Around 16% of UK academic staff and 10% of specialist doctors in the UK are non-UK European origin.  While there are ongoing initiatives to recruit to psychiatry care, and academic psychiatry, from UK medical students and trainees, the existing through-put is insufficient to fill existing vacancies.

This crisis in academic psychiatry is recognised as a training and recruitment[iv], but it is tightly coupled to funding issues and a need for consensus and parity of mental health research.

1.4.            Access to funding for mental health (psychology, psychiatry and neuroscience) research.

The EU, through FP7 and H2020, has been a major funder of mental health research in the UK - investing in UK centres of excellence to lead major European collaborations with European partners. 

Ongoing EU investment into UK-led consortium projects with a primary focus on mental health amounts to over £54M. 

These European collaborative research programmes encompass psychiatry neuroimaging (PSYSCAN led by KCL total grant €18M; Braintrain Cardiff €6M), child suicide prevention (STOP KCL 3.7M), psychiatric genetics (CRESTAR UCL €6M), international mental health (EMERALD KCL), information technology and monitoring in dementia, depression and autism (VPH DARE@IT Sheffield €13M; RADAR_CNS Kings €22M; MICHELANGELO Ulster €0.5M) and mental health policy and organization (COFI QuMarys €5M; MILESTONE Warwick €6M).  Other UK institutions are partners in many of these programmes.

Individual psychiatry researchers in the UK are directly supported through supported EU funding, notably e.g. Marie Curie scheme and via the e-European Research Council (ERC). The ERC funded more scientists in the UK, between 2007-2015 in Life Sciences (N=182), and Social Science and Humanities (N=190) grants, than elsewhere in the EU (each grant typically in excess of €1M). These include more than thirty-eight grants funding researchers working directly on areas related to psychiatry and mental health. Ongoing funding for UK-based mental health researchers through these schemes amount to well over £24M[v]. 

These awards include programmes to develop European researchers in psychiatric diagnosis and prevention (PSYDPD: €0.9M); postpartum psychosis (POSTPARTUM €0.9M);Translation mental health (TRIP €0.7M); Global mental health (INCAS €0.2M); Cellular neurobiology in psychosis (CODIP €0.2M; IN-SENS €3.9M); Neuropsychiatry (EXTRABRAIN €3.5M);Mental health training (MARATONE €3.7M).  At least eight UK mental health researchers receive primary funding through ERC investigator grants in covering areas including autism (Hamilton 1.38M) child and adolescent vulnerability (Abel €14.9M), anxiety disorder (Critchley €1.9M; Bishop €1.7M), alcohol misuse (Britton €1.M), schizophrenia (Shergill €1.5M) and trauma (Edmonds €1.49M).

The Government and Treasury has given reassurance that multi-year projects funded by the EU will continue to be supported beyond an exit date, and that universities should continue to bid for EU funding while the UK is still a member of the EU[vi].

1.5.            Access to EU-funded research facilities, cohorts and networks

UK institutions are partners in ongoing EU-funded research consortia led by institutions elsewhere in Europe. Funding for these European collaborative research programmes amounts to over £102.4M.

They currently include projects on psychiatry imaging (MET-SY €6.3M; IMAGEMEND €6M; BIOCOG €6M) paediatric mental health (AGRESSOTYPE €6M; PAED RESPRI €5.6M) psychiatric genetics (GENCODYS €11.6M; EUGEI €11.6), information technology (LINKED2SAFETY €3.1M) understanding and treating autism (EU_AIMS, KCL main UK partner €29M), outcomes in psychosis (OPTiMiSE €14.9M; PRONIA €6M), mental health policy ROAMER €2.2M), conduct disorder (MATRICS €4.5M) and Obsessionality (TACTICS €6M).[vii]

1.6.            Intellectual property and commercialization of research

A total of 332 SMEs and 260 other industries have been supported in FP7 brain research projects till now. More than 2/3 of this support was granted through the FP7 collaborative research programme, demonstrating the key role played by this FP7 pillar for the support to SMEs.

The Proof of Concept Grants through ERC programme represent initiatives directed at fostering commercialization of research outputs.  This scheme addresses the call for higher-risk potentially transformative research within mental health. For example, ROAMER[viii] call for strategies to stimulate innovation and creativity, including more proof- of-concept pilot studies with lower probability of success, via Horizon 2020 and future funding calls. Withdrawal from the levels of EU research funding that the UK can currently access would compromise such initiatives and impair the development of commercialization potential and innovation of UK funded-research. This would impact areas where advances are much needed.

2. What the science and research priorities for the UK Government should be in negotiating a new relationship with the EU.

2.1.            Parity for mental health research:

There is low investment versus clinical need. The charity MQ state that for every £1 the government spends on cancer research, the UK general public invests £2.75. For heart and circulatory problems it’s £1.35. For mental health research the investment is 0.3p, or a 1/3 of a penny. There is no dedicated funding stream for mental health. The UK should propose this as a priority for support with EU funding in acknowledgement of the leading mental health research within the UK[ix].

2.2.            Access to EU facilities and centres of excellence. 

Future success and advances in psychiatry research are likely to arise from networks and collaborations, including sharing of resources.  Access to centres of excellence and collaborative projects including joint projects and transnational initiatives will foster UK psychiatric science in an appropriate sociocultural context (e.g. universal access to healthcare) for the benefit of enhance UK nationals and residents.[x]

3. What science and technology-related legislation, regulations and projects will need to be reviewed in the run up to the UK leaving the EU?

3.1.            Consideration will need to be given to regulations relating to pharmaceutical research, the sharing of databases and cohorts equipment.

3.2.            Legislation regarding the movement and employment of researchers and students from different (EU and non-EU) countries with respect to how these might affect the mental health research workforce in academic and clinical settings.

4. The status of mental health and psychiatry researchers, scientists and students working and studying in the UK when the UK leaves the EU, and what protections should be put in place for them.

4.1.            The status of mental health researchers 

The status of existing mental health researchers from EU countries outside the UK has not changed overnight. However, there is as yet no guarantee that a final settlement between the UK and the EU will include their right to continue to live and work here. This creates an immediate insecurity for non-UK EU academics working in mental health research, where there are already significant challenges related to critical mass, including recruitment to an overstretched workforce and access to funding, outside of key centres.

Scientists are beginning to look elsewhere in the EU or beyond to avoid finding themselves in the position of having to apply for the right to continue working for the UK as clinical academics. But it is also a problem for the University, where in many places such as Imperial College,  ‘immigration offices’  are being set up to manage concerns around Brexit.

A flight of non-UK academics would have a particularly detrimental effect on UK academic psychiatry and leading mental health research. This reflects the existing pressures on academic psychiatry and mental health[xi], where security is enhanced by a critical mass. We ask that the government confirms a commitment made by the official Leave campaigns that EU citizens already living and working in the UK would retain their right to do so on a permanent basis.

4.2.            Mental health workforce from the EU

The NHS depends to a large extent on a workforce that includes non-UK EU nationals (approx. 55,000 10% doctors and 5% nurses)[xii].  The proportion of non-UK EU professionals working in mental health is greater, reflecting the number of unfilled consultant and nursing posts in this sector. Recruitment into the sector remains difficult and workforce is overstretched and under increasing pressures to manage workload.

As noted above, even if the UK becomes an associate country, the free movement of researchers is fundamental to the capacity for the UK to access EU funding streams for mental health and related research.

The existing workforce within mental health research and academic psychiatry need reassurance that their jobs are protected, and that access to research funds, students, postdocturals  and research colleagues and collaborations internationally are not compromised in the changes that follow the EU Referendum vote.   

5. The opportunities that the UK’s exit presents for mental health and psychiatry research and market access with non-EU countries, and how these might compare with existing EU arrangements.

5.1.            How EU research impacts on international research

The EU and European Research Area research activity provides a powerful platform for large-scale collaborative research networks.  Across the EU, science funding teams from 170 other countries are engaged as secondary participants. Within mental health and brain research, examples within FP7 (up to 2012) include programme level cooperative agreements with Canada and the USA in traumatic brain injury research (InTBIR).

The Government needs to look at ways that we can maintain this global advantage through access to EU funding or alternatively negotiations between UK and non-EU countries individually.

The participation of Associated Countries and of Third Countries include 141 and 91 institutions taking part to FP7 brain-related projects. 105 FP7-supported brain research projects have involved 28 Third Countries supported with EUR 17.9 million. The USA is the most supported Third Country with more than EUR 7.7 million for 36 participant research institutions.

Given growing emphasis on large scale studies within mental health, opportunities to develop fresh collaborations with non-EU countries may permit new access to cohorts and equipment necessary to support big-data and -omics or neuroimaging investigations. It is may also be harder to carry out these large scale projects outside of Europe because of logistical issues, including geographical proximity and cultural differences in healthcare provision.

September 2016

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