An interview with... Professor Richard Emsley

Professor Richard Emsley is the NIHR Maudsley BRC's Theme Lead in Trials, Prediction and Genomics, and was recently appointed the role of Interim Academic Director of the King’s Clinical Trials Unit and lead of a new NIHR Research Services Support hub. He specialises in improving the delivery of clinical trials in mental health, supported by the NIHR and with partners at King's College London's as well as across the country. In this interview he provides some insights into his work in this area.  

Could you introduce yourself and outline your roles at King's and the BRC? 

I am Professor of Medical Statistics and Trials Methodology at the Institute of Psychiatry, Psychology & Neuroscience, and alongside this I hold an NIHR research professorship with the aim of making clinical trials in mental health more efficient.

Clinical trials are an established way to evaluate treatments, but they take time and money. We need to make sure we are using the best method and evaluating the right treatment in the right way and with the right participants. I work with a team to develop methodological ideas to improve clinical trials and then work in partnership with clinical teams from King’s College London and across the country to apply these ideas and investigate ways to improve clinical trials.

I am also a theme lead at the NIHR Maudsley BRC in Trials, Prediction and Genomics. I work with the early stage evaluation of interventions and finding appropriate signs of whether a treatment is working or not. This past few months have been busy for me as I have started as Interim Academic Director of the King’s Clinical Trials Unit and am also heading up one of the new eight NIHR Research Services Support (RSS) hubs delivered by King's College London and partners to provide free and confidential support, advice and expertise for researchers across England, with a particular focus on mental health and neuroscience.

How did you become interested in this area?

During my PhD in medical statistics at University of Manchester I became very interested in the methodology of clinical trials - how we design them, how we analyse them – and particularly applying that theory to mental health. I worked on some datasets around drug treatments for schizophrenia which really sparked my interest in this field and how to research what happens in the brain, and how that influences the effectiveness of different treatments. When an opportunity arose to join the IoPPN as a Professor in the Department of Biostatistics and Health Informatics it seemed like a great opportunity to specialise more in this area.

What is changing in the way clinical trials are conducted?

Traditionally we used to wait until the end of trial before doing any analysis, but it’s now been recognised that this isn’t always an effective approach and that you can use interim data to help adapt the trial for the better before it has reached its end.  

The COVID-19 pandemic really changed the landscape of clinical trials. During this time, we saw successful clinical trials deliver treatments and vaccines at scale, by adopting a more decentralised approach and using novel approaches for analysis and designs. This led to very large trials, comparing lots of treatments simultaneously against a common control to identify quickly what wasn't working. It was only with COVID-19 that we really pushed and accelerated this approach, and now there is much more willingness to adopt it in other areas.  For example, we have these platform trials in dermatology at Guy’s and St Thomas' NHS Foundation Trust, and we're running a couple of mental health trials with this approach. It is a really interesting shift where the trials are larger and considering the bigger picture of disease rather than whether a specific intervention works or not.

Also linked to the pandemic are changes in the type of interventions that we are evaluating. For example, there has been increased use of digital interventions, and greater demand to get an evidence base for those therapies. For this I am working with the Digital Therapies theme in the NIHR Maudsley BRC and other groups researching this space within the IoPPN.

What will the NIHR Research Support Service offer and will it tackle current challenges within clinical research?

It is a new support service that replaces the NIHR Research Design Service (RDS) and support funding for Clinical Trials Units (CTUs). We were successful at King’s in getting funding for an RSS that's focused specifically on mental health and neuroscience research.

A key change in how the RSS hubs are set up is that the support offered will be provided from the conception of an idea all the way through to funding, implementation and delivery of the project. This is central to help provide the most effective support. In addition, we now have a single entry portal for the whole of the country so researchers can find specialised support from any of the hubs rather than being restricted to a local service.

An important remit of the new NIHR RSS hubs is boosting research capacity in social care which involves meeting the challenges of researching in a range of settings, from schools and hospitals to residential care settings, and forensic settings. Linked to this the hubs have also been tasked with identifying where the gaps are in methodology with the aim of providing some pump priming and additional money to conduct that methodology research, which will bring the network closer in terms of shared delivery across different disciplines.

Is there anything about research in mental health and neuroscience that sets it apart from other areas and requires a more ‘specialised’ form of support? 

Where mental health is unique is that the delivery of treatments, particularly psychosocial treatments, is much more intensive so conducting interviews and assessments and collecting data takes more time and resources. At the IoPPN we've been successful in our trial design, and we want to share that expertise with other researchers through the new RSS hub.

There are also methodological challenges as direct observation is very hard and instead, we often rely more on indirect measurements such as questionnaires or on outcomes such as brain scanning which are harder to analyse.

What is being done to make trials and research inclusive and accessible?

There is a strong drive from funders and the NHS to promote wider diversity and inclusion and make sure that research is done in the areas of greatest need and with the people who can benefit the most. This involves the development of new approaches, such as informatic tools that can enable us to search electronic health records across the country to find out how many people have a certain condition and identify their characteristics to help recruit quicker and get a more representative sample. The work of teams like the Informatics theme at the NIHR Maudsley BRC are contributing to this development with tools such as Clinical Record Interactive Search (CRIS) and CogStack which both enable the unlocking of data from electronic health records. 

We are getting better at raising awareness of the benefits of taking part in research and making our studies more accessible.  At South London and Maudsley we have initiatives such as Consent for Contact (C4C) and the new ‘Take part in research’ database. Through these tools and through awareness campaigns we hope to work towards the vision that wherever you are in the country, as soon as you have a contact with services, you're offered the chance to take part in some form of research. And by supporting researchers through the RSS hub we are increasing this choice in the field of mental health and neuroscience.