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Research and Projects

Care Under Pressure

Theme: CLAHRC - Mental Health & Dementia
Status: Live

“We are delighted to start work on our NIHR-funded project called Care Under Pressure.  The NHS needs healthy, motivated doctors to provide high quality care for patients but being a doctor is a challenging job and mental ill-health can often result.  Our project will look across the continuum from medical student to senior doctor, and across medical specialties, in order to understand when and why doctors develop mental ill-health.  In doing this we will seek to understand which strategies are effective in reducing mental ill-health, and in what circumstances, so that we can make practical recommendations that can benefit the NHS, doctors and patients”.  

- Professor Karen Mattick, Principal Investigator for Care Under Pressure. 


 In recent years, increasing workload due to societal demand for healthcare services, combined with increasing external scrutiny, has been associated with a high prevalence of mental ill- health amongst doctors. In November 2015, the Head of Thought Leadership at the King’s Fund said stress levels among NHS staff are “astonishingly high”. 

Our focus on doctors working in the NHS reflects the pressing recruitment and retention issues in this profession (e.g. doctors-in-training, general practice, emergency medicine), the significant potential for sick doctors to cause harm to patients and the financial implications of doctors’ mental ill-health and loss from the profession. 

Changing the work environment to prevent the development of mental ill -health would be preferable to a focus on alleviating the ‘symptoms’, such as presenteeism, absenteeism and workforce retention. However, prevention strategies may be challenging and take time to implement.  A multi -pronged approach of prevention, support and treatment is likely to be needed for the foreseeable future.

Project Aims

This research aims to improve understanding of how, why and in what contexts mental health services and support interventions can be designed in order to minimise the negative impacts of providing care on UK doctors’ mental ill-health.

Project Objectives

1. To conduct a synthesis of the literature (realist review) on interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care. We draw on diverse literature sources, and engage iteratively with diverse stakeholder perspectives to produce actionable theory.
2. To produce recommendations that support the tailoring, implementation, monitoring and evaluation of contextually-sensitive strategies to tackle mental ill-health and its impacts.


The project has produced a range of outputs, tailored to intended audiences, including: academic publications, conference presentations and reports; more innovative outputs such as comics, animations and/or information graphics and measures/indicators that can be used in existing healthcare systems to monitor and evaluate the impact of changes made as a result of our research:


Academic Outputs


Read Daniele Carrieri's BMJ Opinion article here

Further Information 

The Care Under Pressure project is funded by the NIHR's Health Services and Delivery Research Programme.

PROSPERO Project Record


Care Under Pressure

Related Publications 

Carrieri D, Briscoe S, Jackson M, Mattick K, Papoutsi C, Pearson M, Wong G. ‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care. BMJ Open (2018).


University of Exeter Care Under Pressure Webpages




​Dr Geoff Wong, Dr Chrysanthi Papoutsi
Nuffield Department of Primary Care Health Sciences, University of Oxford.
Professor Mark Jackson
Director, Wellcome Centre for Cultures and Environments of Health, University of Exeter.

Who is Involved? 
Principal Investigator: Dr Mark Pearson 
Principal Investigator: Professor Karen Mattick
Information Specialist: Simon Briscoe 
Research Fellow: Dr Daniele Carrieri