SUCCESS STORIES

The Oakley Mental Health Research Foundation takes pride in what ‘our’ researchers have achieved. Since its beginnings in 1967, the Foundation has given out over a million dollars in research funding. Although most of our grants are relatively small in the world of health research funding, they have often had an impact well beyond their size.

We have been pleased to support new researchers, sometimes during their PhD studies, to get a foot in the door of health research. Many have gone on to have productive careers in mental health research.

At other times, we have supported well-established researchers, either with seeding grants or a ‘grant-in-aid’. Often the grant enables a team to conduct the first stage of a larger study or fill a funding gap. Some of these studies have produced ground-breaking results that are continuing to have an impact internationally.

Many of ‘our researchers’ have completed applied clinical studies that have had an immediate impact on how mental health services are delivered here in New Zealand. Their awareness of Māori concerns has often led to Māori-specific aspects of their research. We are proud of their contribution.

At times, we have funded studies that are unlikely to attract money elsewhere. These may be in ‘unfashionable’ areas of mental health or on the edge of new developments. For us the risk has proven worthwhile. The Foundation does not hold a narrow definition of mental health. Rather, it aims to support high quality research in New Zealand that addresses issues with mental health whether it is in epidemiology, aetiology, pathology, clinical presentation, intervention or prevention.

The researcher profiles in this brief report will give you a snapshot of the range of projects that Oakley has recently funded and how the researchers are making a difference to the mental health of New Zealanders, and the understanding of mental health issues both here in New Zealand and overseas.

NEW GENERATION E-THERAPY FOR TEENS

Depression, one of the most common disorders in adolescence, is a serious public health problem. It’s a contributor to New Zealand’s alarming teen suicide rate.* And even when not so severe, can lead to serious psychosocial impairment.

Dr Karolina Stasiak tackled the issue while completing her PhD. Using computerised Cognitive Behaviour Therapy (cCBT), she developed new generation e-therapy for young people with mild to moderate depression.

Traditionally cCBT has taken the form of static self-help texts that centre on reading content off computer screens. Yet Karolina believed a more effective approach would be one that took advantage of teens’ enthusiasm for video games. The result was The Journey, a 2-D animated ‘magical book’. It featured interactive exercises and quizzes, animated characters who talked about problems and solutions and video vignettes with teen actors. A pilot randomised controlled trial showed that adolescents who engaged with The Journey showed greater symptom improvement on the Children’s Depression Rating Scale-Revised (CDRS-R) than those treated with a placebo programme.

Oakley awarded Karolina a grant that allowed her to hire a digital graphic designer to help bring The Journey to life on screen.

“Design was outside my realm of expertise, and it wasn’t possible to fund someone out of my PhD scholarship. Getting the Oakley grant was a god-send. The project couldn’t have gone forward without it.”

The Journey served as a prototype for the next step in cCBT’s evolution: SPARX, a 3D video game that teaches young people cognitive behavioural therapy techniques for dealing with symptoms of depression. The project, funded by the Ministry of Health and led by Professor Sally Merry at the University of Auckland, included Karolina as study manager as well as several research fellows, clinical psychologists, learning technology experts and clinicians. Two PhD and one DClinPsy project resulted, as did numerous conference presentations and publications in peer-reviewed journals, including the British Medical Journal. UNESCO awarded SPARX a 2013 Netexplo Award, given to “the ten most innovative and promising digital initiatives of the year. In April 2014 SPARX was rolled out nationally as part of the Prime Ministers Youth Mental Health Project and is freely available online at www.sparx.org.nz

Karolina continues to work in the e-therapy research area and has been a co-recipient of two other relevant grants. The first grant, with Dr Stephanie Moor (Otago University) is to investigate the effectiveness of BRAVE-ONLINE (Australian cCBT for children with anxiety) in the post-earthquake context in Christchurch. The second is with Hiran Thabrew (University of Auckland) to investigate the feasibility of developing a computer program to help children with chronic illness better cope psychologically.

Karolina is grateful for the support of the Oakley Foundation. “I would like to acknowledge the Foundation’s ongoing support for the line of work our team is dedicated to.”

LINKS

SPARX
http://www.sparx.org.nz

The Werry Centre
http://www.werrycentre.org.nz

*In 2012, New Zealand ranked 1st in the OECD in adolescent male suicide rates and 3rd highest in adolescent female rates.
http://www.sciencemediacentre.co.nz/2012/04/26/nz-ranks-poorly-in-adolescent-mortality-and-suicide-study/

MAKING A DIFFERENCE TO PATIENT EXPERIENCE

Fiona Mathieson’s two Oakley Mental Health Research Foundation-funded research projects are quite different but both involve the practitioner’s ability to make a difference to a patient’s experience.

The first project involved adapting for Māori a brief mental health intervention, which clinicians can offer patients in primary health care.

Fiona, Clinical Psychologist and Senior Lecturer at the University of Otago’s Department of Psychological Medicine, says there is disparity in contact with mental health services between Māori and non-Māori, and when contact does occur it is often with primary care services, such as GPs.

‘Near threshold’ anxiety, depression, and substance use are common presentations in primary care settings and while not meeting the threshold for diagnosis, the symptoms can carry a significant burden and could develop into a diagnosable disorder.

With input from patients, clinicians and researchers, including Dr Kara Mihaere (Rangitāne, Ngāti Kahungunu ki Wairoa, Ngati Rakaipaaka) an innovative ultra-brief intervention (UBI) was designed for people aged 18-65 with ‘near threshold’ mental health symptoms.

The UBI consists of three brief sessions of guided cognitive behaviour therapy-based self-management, with a focus on problem-solving and behaviour change, and delivered by the primary care physician in a primary care setting.

The sessions comprise one hour total and are supported by a treatment manual and self-help booklets on the topics of relationships, stress, and breaking habits.

The clinician works as a coach and change facilitator rather than therapist, as patients develop a specific plan for change, which is printed out as a prescription and integrated into computerised patient management systems. There is one follow-up email or phone call to see how the plan is working.

Clinicians were trained in a two-hour session and satisfaction ratings from patients and clinicians were very positive.

“What was significant with the UBI (Ultra Brief Intervention) Māori study is we were able to find a way to adapt the intervention for Māori and it hasn’t really been that difficult. We found that we were able to adapt it in a way that had a high level of acceptability with the Māori clients who participated in this study and also with the clinicians, most of who weren’t Māori.

It was only a small study but using the intervention with patients may have helped with the clinician’s cultural competence. Hopefully this study will encourage other researchers to go ahead and adapt tools even if they aren’t Māori – there are still ways you can do that.

Fiona and her co-researchers have presented their research at local and international conferences and had their findings published in the Journal of Primary Health Care.

Fiona’s latest research, also funded by the Oakley Mental Health Research Foundation, is looking at the impact on patients when mental health staff undergo postgraduate cognitive behavioural therapy training. It examines whether as well as students developing knowledge and skills, were their patients getting better with regards to reduced stress and improved functioning.

Fiona says the funding for both projects has enabled the research to be completed, and the funding for the second study on patient outcomes allowed her to employ a research assistant to collect the data in a timely and efficient way.

“Because I am trying to do this research on top of teaching, it is great to get that kind of support. I am fairly new to research and getting those grants has helped me find my feet and gain confidence.

“It’s been a positive experience and I felt supported, especially with the patient outcome study where you have to report back annually about how the study is going. Recruitment has been quite difficult for that study but I didn’t feel criticised. I felt supported to try and work it through, which was helpful.”

Fiona says her research deals with issues that have everyday benefits for clinicians and patients.

“We want to know for staff going on intensive training courses, is that benefiting patients in a real way? And being able to have intervention at primary care level fits really well with meeting people’s needs in the community, many who wouldn’t go and see a counsellor or be eligible for secondary care services. It is real-world applicability which benefits end users.”

PROTEOMICS AND ALZHEIMER’S DISEASE

Oakley Grant Recipient

‘The little snowball that rolled off the top of the mountain and kept on growing’ is how Garth Cooper describes his group’s research into links between Alzheimer’s Disease and protein levels in the brain.

Funded by the Oakley Foundation, the research looked at the new methods of proteomics, which analyses the protein content of the brain, and compared results from those with Alzheimer’s disease, schizophrenia, and control subjects.

Working with Richard Faull at the Brain Bank in Auckland, Garth and his team developed the methodologies for applying proteomic to both diseases.

The research had a major international impact as the first significant application of proteomics to the origins of chronic mental disease in patients.

Their work was taken up by the National Institutes of Health (The National Institute of Neurological Diseases and Stroke) – one of the world’s leading medical research facilities – in the United States. The study, which was published in 2001, was one of the pivotal studies used by the Institute as evidence to set up their global neuroproteomics platform.

As part of this Garth was invited to go the NIH and gave a lecture on the approach, which is now being used all over the world.

“The study also provided substantive evidence for understanding the pathological mechanism of Alzheimer’s disease.

It has been cited more than 190 times and has had an important impact on the whole development of the literature in the field. It was really successful.”

With further support from the Oakley Foundation, Garth and his team are again working with Richard Faull looking at the blood vessels in the brain and links between Type 2 Diabetes and Alzheimer’s disease.

“We are starting to follow up now on strong potential links to the mechanisms of Alzheimer disease and Type Two Diabetes.”

“It is now increasingly recognised that the two diseases have a lot in common. The work is leading to conclusions that I believe will probably drive clinical interventions quite soon.”

Garth says the major international impacts can be traced back to the initial funding support from the Oakley Foundation.

“We wouldn’t have been able to do the work without them – it was completely enabling. The Oakley Foundation has funded important studies that would not otherwise get done and it does that by focussing on its areas of interest. These are very important areas that would otherwise be neglected. If the Oakley Foundation wasn’t there this research wouldn’t have happened.”

PROTEOMICS AND ALZHEIMER’S DISEASE

Oakley Grant Recipient

Funding for addiction-related research is hard to obtain. Bruce Russell is particularly grateful for the support Oakley has given for his team for studies on pharmacological approaches to methamphetamine treatment.

Bruce explained, “I think mental health – in particular addictions – tends to get overlooked in New Zealand unless it is something to do with smoking or alcohol. With methamphetamine addiction it is treated as a law and order problem rather than mental illness.

“There are a lot of clinicians that view people with methamphetamine and alcohol in the same way. They think it is just a social problem. ‘Just harden up and stop taking the stuff’. It isn’t that easy because addiction does cause long term changes in the brain and those changes don’t go away.

Funded by the Oakley Mental Health Research Foundation, the research by Russell and his team at The University of Auckland’s School of Pharmacy, looked at whether methylphenidate could be used in replacement therapy for people with methamphetamine or P addiction, in a similar way to which methadone is used as a replacement for opiate addiction.

“The Oakley Foundation made a huge difference. Oakley gave us nearly $20,000 and helped us recruit a research nurse for six to eight months. We completed the trial and got some useful result.” The study’s findings were published in Addiction in July 2013.

Bruce says that there are currently no pharmaceutical treatments for addiction, which is a big problem in New Zealand. With Oakley funding the research team was able to release statistical results demonstrating that methylphenidate showed potential as a methamphetamine substitute, although probably at higher doses than those used in the trial.

“International researchers have since picked up on the research and have recently shown that methylphenidate is actually quite a useful substitute therapy in the way that methadone is for opiates. In terms of assisting with mental health, that is one very good example of trying to treat addictions when there are no currently available treatments.”

Bruce is the recipient of another Oakley Foundation grant for a related study looking at damage done to the brains of methamphetamine addicts, using magnetic residence imagining (MRI).

The second study came about when his team recruited active methamphetamine users for the first study. When he performed MRI scans on their brains, he didn’t find the damage he was expecting and that other researchers said occurred.

They realised that the main difference was that other research had been done with abstinent methamphetamine users, while theirs involved active users and they are currently working with the idea that some of the brain damage occurs post-withdrawal.

“Most of the community support and treatment programmes involve sudden or rapid withdrawal. Usually you go to a centre for two or four weeks and you stay there and abstain. I think the rapid withdrawal might be causing some of the damage that other people are finding.”

Oakley Foundation funding is supporting a study with active users to test whether a treatment programme, rather than rapid withdrawal, may lessen some of the damage that occurs.

Bruce appreciates the on-going support of the Oakley Foundation, which helped establish his reputation as a researcher.

“When I started work with the University of Auckland at the start of 2005 I had some research experience but most of my working life since finishing my PhD had been as a pharmacist in a completely different field overseas. I was an unknown quantity as far as the funding in New Zealand was concerned. The Oakley Foundation kindly gave me that money, which helped raise my profile as a successful researcher, which is useful to other funders and the public in general.”

SUCCESS STORIES

NEW GENERATION E-THERAPY FOR TEENS

LINKS

MAKING A DIFFERENCE TO PATIENT EXPERIENCE

FURTHER READING

PROTEOMICS AND ALZHEIMER’S DISEASE

PROTEOMICS AND ALZHEIMER’S DISEASE

FURTHER READING