Exeter Collaboration for Academic Primary Care (APEx)

Mental health

The mental health primary care theme focuses on closing mental health treatment gaps in primary care (including the interface with secondary care) that mean many people at risk of developing or who are currently experiencing mental health challenges  are left without access to effective, timely or integrated biopsychosocial support that meets their mental health, wellbeing, and physical health needs. Bringing together primary care facing expertise in Children and Young People’s Mental Health Research (ChYMe) and adult mental health research (Mood Disorders Centre) with primary care researchers (APEx), our work takes a multidisciplinary perspective to innovate care across the lifespan, with a focus on prevention, management and acute treatment using psychologically informed approaches (including psychological therapies, psychoeducation, social prescribing, and innovations in digital technology).

Our aims are:

  • To better understand biopsychosocial factors linked to prevention, onset and maintenance of mental health and wellbeing, and how these interact with physical health, in primary care settings
  • To work with people with lived experience to develop, evaluate, and implement enhanced psychologically informed interventions and approaches for primary care settings (and the interface with secondary care) that aim to foster positive mental health, wellbeing, and physical health.
  • To disseminate and implement best practice in integrated biopsychosocial support for wellbeing, mental health and physical health in primary care, focusing both on workforce training and on system innovation
  • To refine ways to support primary care staff wellbeing and mental health to ensure a sustainable workforce that can deliver compassionate care
  • To harness the power of digital technologies (e.g. mobile apps, systems and data innovation, and integration of AI), to improve integrated mental health, wellbeing, and physical health support within primary care

Theme Leadership

  • Prof. Barney Dunn (co-lead, adult mental health)
  • Associate Prof. Anna Price (co-lead, CHYME)
  • Dr Jane Smith (co-lead, APEX)

 

 

Projects

Title

 

Funder

Amount £

Project/ Programme/ Fellowship

Exeter lead investigator and APEX collaborators

Web link

Contributors to suicide in men and an evaluation of current interventions and support services in the South West region

NIHR Three Schools Mental Health Research Programme

 

Project

Hunt D

None

Site in depression theme of MH-TRC mental health, building a network of clinics across the country that recruit from primary care and that can support commercial and non-commercial research to innovate depression treatments. 

 

 

NIHR MH-TRC

£54 million nationally, £750K to Exeter

Programme

Dunn B

Watkins E

 

Mental Health TRC | NIHR

EYE-D: Site in definitive trial evaluating EMDR as a psychological therapy for depression in primary care

MRC EME

£2.4 million, £310K to Exeter

Project

Dunn B

Payne R

None (one will be developed)

ADepT: Evaluating a novel wellbeing and recovery oriented therapy called Augmented Depression Therapy for clients with complex depression who fall in the gap between primary and secondary care services

NIHR DRF

 

Fellowship

Warbrick L

Dunn B

ADepT+ | Mood Disorders Centre | University of Exeter

Calming Minds: Improving interventions for worry and rumination

Wellcome Trust

 

Programme

Watkins E

None

STABILISE: Development and evaluation of a novel therapy to support clients with inter-episode symptoms in bipolar disorder

NIHR Advanced Fellowship

 

Fellowship

Wright K

STABILISE | Mood Disorders Centre | University of Exeter

Partner on Bath Mental Health Research Group Bid, setting up a mental health research centre for 14-24 age group

 

NIHR

£11.2 mill overall, £800K to Exeter

Programme

Dunn B, Delgado T,

Price A

https://www.bath.ac.uk/projects/bath-mental-health-research-group/

SPOCC programme grant: workstream promoting cancer detection in primary care with patients with depression and anxiety

NIHR Programme Grant

?

Programme

Abel G

Hunt D

Price S

About > Spotting Cancer Among Comordobidities

CHOICES: Exploring how social prescribing pathways, including via primary care, can assist CYP to access, connect with, and participate in community activities

NIHR Three Schools Mental Health Programme

 

 

Berry V, Husk K

https://arc-swp.nihr.ac.uk/research/projects/cyp-choices/

 

MAP: Managing young people with ADHD in Primary Care (MAP) study: mapping current practice and co-producing guidance on pathways to improve healthcare for an underserved population.

NIHR Three Schools Mental Health Fellowship

£264k

Fellowship

Price A

https://sites.exeter.ac.uk/mapadhd/

 

CHANGES: Understanding trends in child and adolescent mental health over time, and the need for services

NIHR Advanced Fellowship

 

Fellowship

Newlove-Delgado T

https://sites.exeter.ac.uk/changes/

 

SPaCE: Exploring and understanding support for parent carers of children with special educational needs or disabilities in England, including understanding access via primary care

NIHR Three Schools Mental Health Programme

£399k

Project

Bjornstad G

https://sites.exeter.ac.uk/space/

 

SmartADHD: Supported Management of ADHD with evidence-based Resources and Tools

NIHR Advanced Fellowship

£1.2 million

Fellowship

A.     Price

https://sites.exeter.ac.uk/smartadhd/

IAM-ADHD: Interdisciplinary Approach to Multimorbidity and Multiple Long Term Conditions in Young People with ADHD

NIHR Team Science Award

£113k

Project

Newlove-Delgado, T (Chair)

Price, A. (Deputy Chair)

https://sites.exeter.ac.uk/iamadhd/

Primary Care Under Pressure: mapping the provision of staff wellbeing strategies and interventions for the primary care workforce in England

SPCR

£30k

Project

Smith, J

Carriere, D

https://sites.exeter.ac.uk/careunderpressure/primary-care-under-pressure-mapping-the-provision-of-staff-wellbeing-strategies-and-interventions-for-the-primary-care-workforce-in-england/

Other current active projects

Title

 

Funder

Amount £

Project/ Programme/ Fellowship

Exeter lead investigator and APEX collaborators

Project web link (if none, please state)

Establishing a practice research network in the South West to innovate best practice in the mental health space in the gap that currently exists between primary and secondary care

Mental Health Mission

£160K

Fellowship

Ladwa A

Dunn B

 

ACORN II trial: Evaluating a remotely delivered group psychological therapy for treating perinatal anxiety

NIHR HTA

?

 

O’Mahen H

Davey A

 

Tools for Schools: designing a toolkit to help children with ADHD cope better in primary school

NIHR Advanced Fellowship

 

Fellowship

Russell A

DunnB

 

https://sites.exeter.ac.uk/toolsforschools/

 

KAILO: test and co-design evidence-based responses to the root causes of young people’s mental health

UK Prevention Research Partnership

 

 

Berry V

https://kailo.community/about/

 

ATTEND: The Adolescents and carers using mindfulness Therapy To END depression and anxiety project

UK Prevention Research Partnership

 

Project

Berry V, Hayes, R

https://fundingawards.nihr.ac.uk/award/NIHR204413

 

Digital Health ADHD: Identifying evidence-based digital solutions to improve healthcare and support for young people (aged 16 to 25) with ADHD in primary care.

NIHR SPCR

£53k

Project

Price A

https://sites.exeter.ac.uk/mapadhd/

SmartADHD Chatbot: Co-developing a multilingual AI-powered virtual assistant, to increase engagement with the CareADHD app for young people aged 16-25 with ADHD: reducing health inequalities during transition

UKRI EPSRC Leap Digital Health Hub

£98k

Project

Price, A

https://sites.exeter.ac.uk/smartadhd/

Improving identification and management of binge eating disorder and bulimia nervosa in primary care

SPCR

£70k

PhD

Kozmer, S

https://experts.exeter.ac.uk/40053-stella-kozm%C3%A9r

Understanding and addressing health inequalities in accessing digital healthcare for minoritized young people with ADHD: A mixed methods study

ESCR South West Doctoral Training Partnership Studentship Award

£140k

PhD

Gudka, R.

https://sites.exeter.ac.uk/adhdresearch/

Other recently completed projects

 

End date

Funder

Amount £

Project/ Programme/ Fellowship

Exeter lead investigator

Project web link (if none, please state)

RESPOND trial:  Can Mindfulness Based Cognitive Therapy (MBCT) help individuals recover from depression who have not fully benefitted from existing primary care NHS Talking Therapies provision

2024

NIHR RfPB

£230K

Project

Dunn B

Past research | AccEPT Clinic | University of Exeter

Development and evaluation of brief GP and NHS-TT clinician training to improve the care of patients with underlying personality difficulties in primary care

2025

NIHR Three Schools Mental Health Programme

£171K

Fellowship

Warbrick L

Dunn B

None

 

Development and Preliminary Evaluation of a Novel Psychotherapy for Depression for Clients with a Complex Trauma Background (ADepT-CT)

 

2024

NIHR Three Schools Mental Health Programme (Individual Research Career Development Award)

£25K

Career Development Award

Pione R

Dunn B

None

Relational Approach to Treating Self-Harm (RelATe) - A Feasibility Study of Cognitive Analytic Therapy for People who Self-Harm

2024

NIHR RfPB

£230K

Project

Dunn B

None

Publications

1

The RESPOND trial shows that MBCT is an effective next stage psychotherapy for hard to treat depression in primary care, with superior clinical and cost-effectiveness relative to usual care (Barnhofer, Dunn et al., 2025, Lancet Psychiatry) Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high-intensity psychological therapy for depression: a UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial - The Lancet Psychiatry

2

The ADepT pilot trial suggests a that a novel wellbeing recovery oriented therapy for depression has potential to be clinically superior and health economically dominant over CBT in primary care (Dunn, Wright et al., 2023; Lancet EClinical Medicine) Preliminary clinical and cost effectiveness of augmented depression therapy versus cognitive behavioural therapy for the treatment of anhedonic depression (ADepT): a single-centre, open-label, parallel-group, pilot, randomised, controlled trial - eClinicalMedicine

3

A randomized optimisation trial established key effective intervention ingredients in internet delivered CBT for depression (Watkins et al, 2023, JAMA Psychiatry)

4

A system wide approach was proposed to enhance personality disorder care in Oxfordshire (Morgan, Hunt et al, 2022, BMJ Open Quality) Improving personality disorder care across mental health services: a system-wide approach | BMJ Open Quality

5

The ACORN pilot trial showed a group intervention could support women with maternal anxiety during pregnancy (O’Mahen et al., 2022, BMC Psychiatry), which supported this project moving to definitive trial evaluation (ongoing).

6

Child mental health in England before and during the COVID-19 lockdown (Newlove-Delgado, McManus et al., 2021, Lancet Psychiatry)

7

Mental Health of Children and Young People in England, 2022-wave 3 follow up to the 2017 survey, (Newlove-Delgado, Marcheselli et al., 2022, NHS Digital)

8

Support for primary care prescribing for adult ADHD in England: national survey (Price, Becker et al., 2024, British Journal of General Practice)

9

Primary care provision for young people with ADHD: a multi-perspective qualitative study. (Gudka, Becker et al., 2024, British Journal of General Practice)

10

Children and young people's reported contact with professional services for mental health concerns: a secondary data analysis (Mathews, Ford et al., 2024, European Child and Adolescent Psychiatry)

Recent publications

 

1 McDonagh S, Makukha N, Reburn C, Smith JR, Clark C. Group-delivered interventions for lowering blood pressure in hypertension: a systematic review and meta-analysis. Br J Gen Pract, 2025; 75(753): e266-e276. DOI: https://doi.org/10.3399/BJGP.2023.0585 
2 Cockcroft E, Clarke R, Dias RP, Lloyd J, Mann RH, Narendran P, Reburn C, Smith B, Smith JR, Andrews RC. Do we need to go back to the drawing board? Effectiveness of educational and psychoeducational self-management interventions in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. Pediatric Diabetes, 2024. DOI: https://doi.org/10.1155/2024/2921845
3

Van Beurden S, Greaves CJ, Abraham C, Lawrence N, Smith JR*. ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping. Digital Health, 2021; 7: 1-17.