Talk, Understand, Listen for In-Patient Settings (TULIPS)

Working in partnership with patients and healthcare professionals

NHS National Institute for Health Research logo

Project background

The National Institute for Health and Care Excellence (NICE) recommend psychological therapies, like cognitive behavioural therapy, for severe mental health problems. People may benefit from psychological therapies on inpatient wards, but they are rarely offered them (Care Quality Commission, 2009).

Between 2014 and 2015, 103,840 people with severe mental health problems spent time as inpatients because they were at risk of harming themselves or others (Health and Social Care Information Centre, 2015).

Mental health trusts prioritise spending money for therapy on outpatient services but ward staff often think that inpatients are ‘too unwell’ to benefit from talking-based treatments like psychological therapy, so don’t refer them.

Therapy needs to be delivered differently in inpatient settings compared to the community due to the different nature of the setting and patients’ mental states.



Project aims

The overall aim of this project is to increase access to psychological therapy on mental health inpatient wards.

In the first part of this project we worked alongside people who accessed inpatient mental health services and other key people, such as staff who work on wards, to adapt existing psychological therapy for inpatient settings. We did this by:

  • reviewing previous research on what helps and prevents access to therapy on inpatient wards and;
  • interviewing patients, their carers/relatives and staff working on wards about how they think we need to deliver therapy in inpatient settings.

As part of this process, we also tested different ways of delivering therapy and asked people’s opinions about what does and does not work.

Finally, we gathered all of this information together and asked experts, including experts by experience (people who have lived experience of having been on an inpatient ward), to use this information to help us design a therapeutic model that will improve access to therapy, management of individual mental health conditions and help inform a personalised recovery.

In the next part of this research project we will now test the model of therapy in up to 34 wards across England.


Timeline and process

Explore our timeline of what we aim to achieve across the next 5 years.

  • Have the review of other research ready so we can use it to help decide what the psychological therapy should be.
  • Start interviewing ten service users, five carers/relatives and ten staff.
  • Review what questions we ask people in the interviews as we go along.
  • Start to look at what people have said during their interviews for important patterns of information.
  • Have a meeting to design the therapy so we can test it in a couple of wards.
  • Start to test the therapy in one-two wards.
  • Interview more service users, carers/relatives and staff (between 5 and 10 of each group).
  • Hold a meeting with 20 experts in psychological therapy for severe mental health problems, including senior clinicians and managers working in inpatient setting, service users and carer/relative representatives. Attendees will look at all the information we have gathered from interviews, the review of other research, and results from the test wards to agree what the therapy should look like and what we need to do to make sure it is implemented correctly.
  • Continue to monitor the test ward(s) to see if the therapy is working and use the findings to finalise the therapy to be used in the main trial.
  • Look to identify suitable inpatient wards for the trial and get NHS agreement.
  • Look to recruit service users from selected inpatient wards in August/September 2019.
  • Start the trial/deliver the therapy.
  • Continue recruiting service users from selected inpatient wards.
  • Deliver the therapy/continue with the trial.
  • Gather information from service users and staff during the trial so we can see if the therapy works.
  • Interview service users and staff about their experience of the therapy.
  • Visit wards and make observation notes about how the therapy is being delivered (ethnographic method).
  • Interview service users and staff about their experience of the therapy.
  • Visit wards and make observation notes about how the therapy is being delivered (ethnographic method).
  • Gather information and data from all of our work across the five years to see if the therapy was a success.
  • If our findings suggest the therapy is successful and is acceptable to service users and staff, look for ways to introduce therapy into the NHS.

Our progress so far…

Year 1 (January 2018 – December 2018)

  • We received NHS approval to start interviewing patients, their carers/relatives and staff working on wards.
  • We received approval to start our literature review.
  • We interviewed 38 people (14 staff members, 12 patients and 12 carers) about their views on what stops and helps people access psychological therapy on acute mental health wards.
  • We had initial findings from our interviews and literature review.
  • We had a mini consensus conference to decide what the therapeutic model should look like based on our findings from the interviews and review.

Year 2 (January 2019 – December 2019)

  • We ran a pilot of the therapeutic model on two wards. One ward was in Pennine Care NHS Foundation Trust, one ward was in Greater Manchester Mental Health NHS Foundation Trust. The pilot involved two half time clinical psychologist (one on each ward) who delivered our therapeutic model. We collected information about the number of serious incidents that occurred on the ward during this time, as well as gathering information on patient and staff well-being and conducting interviews with staff and patients.
  • We interviewed 22 more people (12 staff members and 10 patients).
  • We gained ethical approval for the main trial.
  • We started the main trial in October at Greater Manchester Mental Health NHS Foundation Trust and Leeds and York Partnership NHS Foundation Trust.

Year 3 (January 2020 – December 2020)

  • The main research trial continued in Greater Manchester Mental Health NHS Foundation Trust and Leeds and York Partnership NHS Foundation Trust.
  • Due to COVID-19 and the outbreak on various wards, the study was paused for 4 and a half months (from mid-March – August 2020). This included pausing face-to-face research activity.
  • Despite this, we sought ethics approval for several ethical amendments to continue research activity remotely e.g. recruitment and follow ups conducted via the telephone and MS Teams.
  • Despite the challenges in 2020, when we met with our Trial Steering Committee (TSC) in November 2020 for our Stop and Go criteria review we had met all planned targets and the research continued as planned.

Year 4 (January 2021 – June 2022)

  • We have continued to recruit wards despite the challenges posed by COVID-19 and subsequent vaccine studies taking precedent at sites. 
  • We were in discussions with several sites and met our recruitment quota of 34 wards

Year 5 (July 2022 – December 2023)

  • We completed recruitment for our main trial: 490 staff members and 309 service users, which is very close to our targets.
  • We recruited 252 further service users at the 6-months follow up to complete our primary outcome measure.
  • Follow up data collection was also completed.  At the 6 months follow-up: 85% of the recruited staff members completed the measures and 70% of the service users. At the 9-months follow-up 79% of the recruited staff members completed the measures and 70% of the service users.
  • Furthermore, we recruited participants to take part in interviews and observational studies evaluating the intervention in more depth. In total, 112 staff members and 56 service users consented to take part in the observational studies, and we interviewed 32 staff members as well as 31 service users.

  • We also received all serious incidents reports that were made on each of the 34 included wards during the study period of 12 months, approximately 15 000 reports. Our study team classified each of these reports with respect to the harm and intervention level of the reported incident.

  • At the moment, we are extracting the data to our statisticians and health economists. We expect to have the result early next year.

For more updates and information about our project and events, follow us on Twitter at @TULIPS_Project.



Meet the research team

Our research team comprises both academic and clinical specialists. Find out more about them here.

Professor Katherine Berry - Principal investigator (PI) and Professor of Clinical Psychology

Dr Katherine Berry Katherine is a health service researcher and clinical psychologist specialising in the field of psychosis. She has over 15 years of experience in research investigating the psychological mechanisms underlying the development of psychosis and in the development, delivery and evaluation of psychological interventions to improve health outcomes for people with psychosis. She is currently a Professor and a member of staff on the Manchester Clinical Psychology Training Programme.

Professor Gillian Haddock - Co-principal investigator (Co-PI) and Professor of Clinical Psychology
Gillian Haddock Professor Gillian Haddock is Professor of Clinical Psychology at The University of Manchester. Gillian is the Head of Division for the Division of Psychology and Mental Health. Her professional experience is primarily in the field of mental health with particular expertise in psychosis, learning disability, forensic and substance use. She is also an Honorary Consultant Clinical Psychologist in Manchester Mental Health and Social Care NHS Trust. She is Co-Principal Investigator for the MRC funded CARMS research trial which is investigating cognitive approaches to remedying suicide.  She has 20 years’ experience in conducting clinical trials within the NHS.
Fritz Handerer – Trial Manager

Fritz is the project manager of TULIPS and responsible for coordinating data collection, organising analysis, writing reports, and supervising research assistants. Moreover, he is exploring potential future research within the unit.

Before Fritz joined this team, he completed his PhD in Clinical Psychology, analysing the importance of documenting social contextual factors in mental health care to facilitate a whole person approach. Fritz is interested in research that contributes to addressing social inequalities in mental health, that puts individuals at the centre rather than diagnoses, and research that looks at the philosophical ideas underpinning current understandings of mental health.

Professor Sandra Bucci - Professor of Clinical Psychology

Sandra BucciSandra is a Professor in Clinical Psychology at The University of Manchester and is actively involved in research and training of Clinical Psychologists and psychological researchers. Sandra’s research is centred around examining psychological processes involved in the development and maintenance of psychosis, as well as developing interventions for psychosis. Her recent programme of research has focused on evaluating innovative methods to facilitate access to, and delivery of, interventions for severe mental health problems. In addition to research and teaching, Sandra is the Division of Psychology and Mental Health Lead for Social Responsibility (a key University strategy). Alongside her University role, Sandra is an Honorary Consultant Clinical Psychologist with Greater Manchester Mental Health NHS Foundation Trust where she is involved in supervising and training NHS clinicians.

Professor Karina Lovell - Professor of Mental Health
Karina LovellKarina is Professor of Mental Health and Director of Research (School of Health Sciences) at The University of Manchester. She is a NIHR Senior Investigator; her main research areas are developing and evaluating complex psychological interventions for anxiety and depression in primary care mental health. More recently Karina has been involved in leading programmes of research which aim to improve user and carer involvement in care planning and physical health of individuals with enduring mental health problems in secondary care mental health settings.
Professor Dawn Edge - Professor of Mental Health & Inclusivity

Dawn EdgeDawn is a Professor in the Division of Psychology & Mental Health at The University of Manchester. She is also The University of Manchester’s Academic Lead for Equality Diversity & Inclusion. Reflecting her strong commitment to integrating research, policy and practice and to public service, Dawn actively engages in working with communities to improve health and well-being – especially among those who are marginalised, socially excluded, and experience inferior access to health and care. Formerly, a Non-Executive Director of two NHS Mental Health Trusts in the North West of England, she has also held secondments to the national Care Standards Improvement Partnership (CSIP) and its precursor, the National Institute for Mental Health in England (NIMHE). Dawn is currently a member of the national Independent Review of the Mental Health Act and the Greater Manchester Student Mental Health Working. Group.

Owen Price - Lecturer
Dr Owen PriceOwen is a registered mental health nurse and lecturer at The University of Manchester. His clinical background is in forensic mental health inpatient services and Owen continues to work clinically on an honorary basis at Greater Manchester West Mental Health NHS Foundation Trust. He has led or co-applied on several funded projects developing, implementing and evaluating complex interventions to reduce staff-patient conflict and rates of restrictive practices in mental health settings. He has established a consistent track-record of high quality patient and public involvement in research, including the co-design and delivery of an award-winning service user and carer research methods course, cited as best practice by NICE and recognised by the MHRN as ‘exemplary carer involvement’.
Richard Drake - Clinical Lead, Senior Lecturer & Honorary Consultant
Richard DrakeRichard is currently Manchester Academic Health Science Centre Clinical Lead for Mental Health in Adults of Working Age; he is also a Senior Lecturer in CENTRUM, an Honorary Consultant at Manchester Mental Health & Social Care NHS Trust and Chair of MMHSCT Medication Management Committee. He became a member of the Royal College of Psychiatrists in 1996 and won the Laughlin prize and Gaskell Medal. He started his research career working on the SOCRATES trial of cognitive-behavioural therapy in early psychosis. He became a Senior Lecturer at the end of 2002 and completed his Ph.D. part-time in 2003. As an Honorary Consultant Psychiatrist at Manchester Mental Health & Social Care NHS Trust and then Greater Manchester Mental Health NHS Foundation Trust he has been involved in developing rehabilitation services across Manchester over the past decade and in 2015 took over as Responsible Clinician for Anson Road rehabilitation unit.
Suzy Bourke - Service User Consultant
Suzy BourkeSuzy’s journey into involvement research began nine years ago. She is a member of many lived experience panels, including primary care and various mental health projects. She has experience in undertaking interviews and focus groups and providing support and training for researchers on engagement and involvement. Previous roles include working as a vocational guidance advice worker for a Community Mental Health team. Suzy also has experience working in the voluntary sector, providing guidance on involvement.  She is passionate about improving support for people experiencing mental health crisis and has been involved with advising health and social care professionals and third sector providers on mental health topics.  Suzy is currently involved with quality improvement projects and with various research studies in both mental health and primary care.
Professor Richard Emsley - Statistician
Professor Richard EmsleyRichard is Professor of Medical Statistics and Trials Methodology at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. Prior to this, he was Professor of Medical Statistics at The University of Manchester and Deputy Director of the Manchester Clinical Trials Unit. His research aims to answer four key questions:

1. Are treatments effective?
2. How do they work?
3. What factors make them work more effectively?
4. Which patients are they most effective for?

This involves the development of statistical methods for causal inference, and efficacy and mechanisms evaluation. Current applications of these methods include randomised trials of complex interventions in mental health, and trial designs and associated analysis methods in precision medicine. Other research interests include the application of causal inference methods in pharmacoepidemiology and routinely collected datasets (eHealth).  He is a co-investigator and theme lead on the MRC North West Hub for Trials Methodology Research, and currently trial statistician on 15 NIHR and MRC funded randomised trials. He is the founder of the European Causal Inference Meeting (Euro-CIM).

Professor Matthew Sutton - Health Economist

Professor Matthew SuttonMatt is the Centre Lead for the Manchester Centre for Health Economics at The University of Manchester. Matt obtained a first class honours degree in Economics with Econometrics from the University of Leeds in 1990 and an MSc in Health Economics from the University of York in 1991. Matt joined the Centre for Health Economics at the University of York as a Research Fellow in 1991 and worked on a series of projects for government agencies on the economics of addiction. He was appointed Professor of Health Economics by the University of Aberdeen in 2004 and was Director of the Behaviour, Performance and Organisation of Care Programme in the Health Economics Research Unit. He joined The University of Manchester as Professor of Health Economics in April 2008.

Bola Odebiyi - Health Economist

Bola is a Health Economist working as a Research Associate for the TULIPS Trial. Bola graduated with a Bachelor of Pharmacy degree from the University of Lagos (Nigeria) in 2010, after which she worked as a pharmacist in different settings before embarking on postgraduate studies. She holds a Master of Science in Health Economics and Health Policy from the University of Birmingham, UK. Bola is responsible for developing a health economic measure for the trial and economic evaluation which will be conducted as part of the TULIPS trial.

Bola is also involved in the National General Practitioner Worklife Survey in England. This survey which is now in its 11th iteration examines the impacts of recent changes (including COVID-19) in primary care on GPs’ work-related satisfaction and stress.

Isobel Johnston - Qualitative Researcher

Isobel a research assistant on the TULIPS project and is responsible for the Qualitative data collection and analysis. She has previously worked as a Healthcare Assistant across a variety of inpatient wards and is passionate about research aiming to enhance therapeutic relationships and improve services.


Mica Samji - Research Assistant

Mica is a Research Assistant currently working on the TULIPS Project. Her role consists of handling the day-to-day quantitative data collection as well as supporting with the projects qualitative work. Mica has an undergraduate degree in Psychology awarded by The University of Manchester and has prior experience working in research through her placement year. Mica has a particular interest in early interventions and promoting recovery as she is passionate about making a difference in the lives of others.                                                                                                          

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