Elizabeth England’s research interests are focussed on the development and implementation of primary care mental health and mental health policy. She has been involved in several Department of Health funded evaluations of Primary Care mental health services and models of working, including an evaluation of the Primary Care Mental Heath Workers in the Heart of Birmingham PCT and an evaluation of the development and implementation of early intervention services for first episode psychosis. She is currently involved in an evaluation of mental health services for people with learning disabilities in Wolverhampton and is the lead researcher for the West Midlands Mental Health, Substance Misuse and Learning Disabilities Commissioning Modelling Group.
Clinical Lecturer in Primary Care
2011 PhD Medicine
2004 MSc. Primary Care
2003 MRCGP (Member of the Royal College of General Practitioners)
1998 MBBS Kings College School of Medicine and Dentistry, London
1995Intercalated BSc. In Nutrition, Dietetics and Biomedical
Elizabeth England's research interests are focussed on the policy implementation and development in mental health services. She has been involved in a project generating outcome indicators of patient satisfaction with care received, for people with serious and enduring mental illness and has participated in a review of the published literature between January 1997 and February 2002 concerning adult primary care mental health service delivery and policy. She undertook an evaluation of Primary Care Mental Health Workers in the Heart of Birmingham PCT, which formed the basis of her Masters degree in Primary Care. The Department of Health and Heart of Birmingham PCT funded this (£180, 000).
Following on from this, she lead on an evaluation of the development and implementation of early intervention services for first episode psychosis, which explored policy implementation and the interface between primary care and other statutory agencies and health services with the new specialist mental health service. This was funded by a Department of Health Researcher Development Award and formed the basis of her PhD (£307,000).
She is one of the key researchers involved in the Birmingham and Black Country NIHR CLAHRC Theme 3: Early detection and interventions in psychosis; alongside Professor Max Birchwood (theme leader), Professor Swaran Singh, Professor Helen Lester and Professor Nick Freemantle. Her role within this program of research is to explore DUP (Duration of Untreated Psychosis) in primary care. This will be through a combination of interviews with GPs, carers and patients and analysis of GP records. The CLARHC program has been funded by the National Institute of Health Research NIHR £2, 500,000.
She is currently developing further studies which aim to explore the impact of the ‘youth focused early intervention service model’ in England on health service development and policy. In addition, she is research lead for the evaluation of the West Midlands Mental Health, Substance Misuse and Learning Disabilities Commissioning Modelling Group, which aims to describe current best practice commissioning and models of care in mental health across the region and generate evidence to support Values Based Practice and Commissioning Frameworks.
She is also lead researcher for a study which is exploring best practice in mental health services for people with learning disabilities and behaviour that challenges in Wolverhampton and an evaluation of the management of mental health issues in people with learning disabilities in primary care settings in Wolverhampton (funded by Wolverhampton Council £60 000).
Undergraduate teaching of medical students (years 1-5) communication skills, behavioural sciences and medical ethics. Intercalated BMedSci.
Mental health policy, early intervention services for first episode psychosis and mental health services for young people; mental health and learning disabilities
Mental Health Policy
Between September 2003 and March 2004, 37 semi-structured interviews and 11 focus groups involving 53 people were undertaken with the aim of exploring the views of GPs, primary health care teams (PHCTs), Primary Care Mental Health Workers (PCMHWs) and patients on the value and development of the role of PCMHWs in practice.This qualitative study was set in the Heart of Birmingham tPrimary Care Trust (PCT) in the West Midlands. Six senior PCT executives, seven PCMHWs, three voluntary sector service leads and 21 patients were interviewed. Focus groups were held with three voluntary sector services, six PHCTs with a worker and two PHCTs who asked for the worker to be removed.A number of different approaches were used to implement this new role. Strategies that took into account PCT senior management, PHCT and workers’ views appeared most successful. The ability to be listened to without time rationing and in a non-medical manner was highly prized by patients. For patients with common mental health problems, PCMHWs appeared to increase satisfaction with care through providing an intermediate level of care including facilitating use of the voluntary sector, and support while on secondary care waiting lists.PCMHWs might provide a new range of skills valued by patients and the PHCT, which may be important when trying to offer patients a collaborative model of care. In addition, successful implementation strategies for PCMHWs may be generalisable to other new roles in primary care.
Early intervention services for first episode psychosis and mental health services for young people
This qualitative study, set in three strategic health authorities across England explored the experiences of stakeholders involved in implementing the guidance for new early intervention services (EIS) for first episode psychosis (FEP), which encourages teams to develop integrated patterns of partnership working across a number of diverse organisational boundaries, particularly CAMHS. Between September 2004 and March 2007, 142 semi-structuredinterviews were held with senior executives in 3 Strategic Health Authorities, commissioners and managers responsible for adult mental health services and children’s services across 31 Primary Care Trusts (PCTs) and EIS and CAMHS Leads. 4 focus groups were held with PCT executives and 2 with EIS and CAMHS team leads. Successful strategies by EIS in developing collaborative working practices with CAMHS were those championed by more senior executives or key organisational figure and which addressed ‘cross boundary’ service issues such as transition from youth to adult services. One of the main findings was that a large proportion of respondents at both management and operational levels had little understanding or active involvement in transitions between child and adolescent mental health service and adult mental health services. Elements that led to more successful transition working development included senior level champions and an organisational commitment which facilitated joint working and joint training between child and adolescent services and early intervention services.
Mental health and learning disabilities
While people with learning disabilities have greater mental health needs than the general population, they receive inequitable mental health care from primary care services. This work in progress aims to explore the views and experiences of GPs and practice nurses in providing mental health care for individuals with learning disabilities. Set in Wolverhampton PCT in West Midlands, semi-structured interviews were conducted with 14 GPs and 5 practice nurses from nineteen general practices. The findings so far suggest that primary care practitioners regard delivering mental health care to people with learning disabilities as challenging. Reasons given included individuals’ poor recognition of their need to consult, difficulty providing accessible services and complexities associated with diagnosing mental illness in the learning disability population. Although wide-ranging levels of joint working practice between practitioners and the Community Learning Disability Team (CLDT) were described, many practitioners reported that they liaise with the community team, and highlighted the benefits of adopting a collaborative approach to care.
2008 Primary Care Lead, Mental Health Research Network Heart of England Hub
2009 GP Appraisal Lead for the Heart of Birmingham teaching PCT in 2009
2010 RCGP Clinical Commissioning Champion
2011 RCGP Midlands Faculty Birmingham University Rep
Lester H, Tait L, England E, Tritter J. Patient involvement in primary care mental health: a focus group study. British Journal of General Practice 2006; 56: 415-22
H Lester, N Freemantle, S Wilson, H Sorohan, E England, C Griffin, and A Shankar. Cluster randomized controlled trial of the effectiveness of graduate primary care mental health workers. British Journal of General Practice 2007; 57: 196-204
England E and H Lester. Implementing the role of the graduate primary care mental health worker: a qualitative study. British Journal of General Practice 2007; 57: 536:204-211
Lester H, Birchwood M, Tait L, Shah S, England E, Smith J.Barriers and facilitators to partnership working between Early Intervention Services and the voluntary and community sector. Health Soc Care Community. 2008 Sep; 16(5):493-500.
Lester H, Birchwood M, Stirling B, England E, Rogers H and Sirvastava N. Development and implementation of early intervention services for young people with psychosis: a case study. British Journal of Psychiatry 2009 May; 194(5):446-50.
England E. Alzheimer’s disease. ‘Just in Time’ On-line Learning Module. BMJ On-line 2009.
England E, Lester H, Birchwood M. Collaborating to provide early intervention services for persons in England with first episode psychosis. Psychiatr Serv. 2009 Nov; 60(11):1484-8.
England E. Survival in primary care after a diagnosis of dementia.British Medical Journal 2010 341: c3530.