Developing and user testing iSWITCHED (implementing SWITCHing EDucational intervention) to support switching antipsychotics to improve physical health outcomes in people with severe mental illness.

Chief Investigator: Professor Saeed Farooq
Co-Investigators: Professor Carolyn Chew-Graham, Professor Krysia Dziedzic, Dr Tom Kingstone, Prachi Kaistha, Gabby Andrews (Keele University and Midlands Partnership NHS Foundation Trust), Dr Martyn Lewis and Dr Krysia Canvin (Keele University), Professor Ian Maidment (Aston University), Dr Ian Kellar (University of Leeds), Professor Peter Haddad and Professor Nusrat Hussain (University of Manchester). David Shiers (Service user and caregiver co-investigator).
Funder: National Institute for Health Research (NIHR): Health Services and Delivery Research (HS&DR)
Year: 2022 – 2025


Severe mental illness (SMI) includes schizophrenia, bipolar disorder and other non-organic psychotic conditions. In England, there are over 490,000 people with SMI. People with SMI are likely to die 15-20 years earlier than people without SMI. For many of whom, mortality may be linked to a potentially preventable physical illness, mainly cardiovascular disease. Some antipsychotic medications used to treat SMI, may inadvertently cause physical health side-effects (e.g. weight gain). Physical side-effects increase the risk of a physical health problem developing.

Switching antipsychotics could help improve physical health for people with SMI; however, a lack of knowledge and confidence prevents switching for reasons related to physical health.

Aim of the research

The study aims to develop and user-test an intervention (to include a medication review tool, training package, information resources) to support decision-making around switching antipsychotic medication for people with SMI to improve physical health outcomes. To achieve this aim, the following objectives have been set:

  1. To develop a medication review tool that will support clinicians to review and consider switching high metabolic risk APs to lower metabolic risk APs in people living with SMI
  2. To develop educational guidance linked with the medication review tool for clinicians to switch APs using a shared decision-making approach
  3. To co-produce educational materials for people living with SMI to understand the metabolic side-effects of APs, risks and benefits of switching
  4. To develop and refine the intervention components in a mixed-methods study


We have designed a set of mixed methods across three work packages. Work package 1 will include a review of guidelines, stakeholder engagement workshop and qualitative interviews with patients and caregivers to explore attitudes and beliefs about switching. Work package 2 will include prototype development of the medication review tool, training, information resources and the IT interface (e.g. pop-up tool on local NHS systems). Work package 3 will include quantitative and qualitative methods to evaluate end-user implementation experiences of all resources and processes.


Research findings will have implications for service users and caregivers, clinicians and researchers. Research outputs will include a novel multi-component intervention to be refined and appropriately tested in a future trial, new knowledge to extend the evidence base around switching antipsychotics, and new information resources for service users and caregivers.


The team will develop various research outputs to enable key messages from the research to be shared with a wide range of people. A link to key research outputs will be provided here.

Patient and public involvement

People with lived experience of SMI and caregivers contributed to the design of this research. A service user and caregiver advisory group has been established to support this research. The research team are working closely with the advisory group to conduct key research activities, such as, ethical review processes, participant recruitment, writing up results.

Could you help? We are currently recruiting caregivers to take part in a research interview

If you are an informal caregiver (e.g. family member, friend) providing support for a person living with SMI, you may be eligible to take part in an interview. For further information, please follow this link to our Research Participant study information sheet.