Time to Talk Health. Dr Remy Marckus (Clinical Psychologist North Team)

Transcription

1 Time to Talk Health Dr Remy Marckus (Clinical Psychologist North Team)

2 Setting the Scene Underpinned by Government Policy: The Five Year Forward Plan 2014 Integrating the care of people s physical and Mental Health Objectives New psychological therapy provision will see physical and mental health care co-located and integrated into existing medical pathways April 2017 West Sussex - First Wave NHS England Early Implementer Site

3 Why focus on Long Term Conditions? Over 16.5 million people in England around 30% of the population will be diagnosed with one or more long term conditions Of these people 30% will experience a mental health problem People with long term conditions are 2 to 3 times more likely to experience anxiety and depression than the general population Depression and anxiety impair active self-management of physical health conditions

4 Aims and Objectives Breaking down the hard wired separation of physical and mental health care Supporting patients to self-manage Joint Care Planning Integrated in Physical health Teams Embedded in GP Surgeries

5 Challenges The Legacy of Descartes Mind / Body Dualism The Medical Model treats mental disorders in the same way as a broken arm, i.e. there is thought to be a physical cause How do we create a new language?

6 Benefits Shared Understanding of the problem The burden of living with an LTC is acknowledged from both a physical and psychological standpoint Joined up care planning Improved communication Improved well-being

7 Developing a Service - The first 235 days Recruited 49 new staff (15 WTE clinical staff and 25 trainees with restricted capacity for the service) Undertook NHS England commissioned training on Long Term conditions and attended Desmond Courses Found new clinical space across North west Sussex Formed partnerships with health care services across three main health conditions diabetes/copd/cardiac

8 How did we meet the challenge? Our language allowed us to translate our complex clinical work so that this was accessible to all. From Post traumatic stress disorder interventions following a cardiac event or emergency hospital admission with diabetes complications TO interventions for obsessive compulsive disorder where the ritualistic management of the condition has taken over every day life TO panic work for those who believe that their breathlessness is the last breath they will ever take TO a needle phobia that is preventing someone from accessing treatment

9 What did we achieve? The 2 graphs on the right show the gender and age split of people treated in our Core Time To Talk service over the last year. There are low levels of access from males and older members of the West Sussex population. Time To Talk Health are seeing a very different gender and age split to our Core service. The 2 graphs to the left display this. The gender split is identical to that of the wider West Sussex population and there is a bias towards older members of the population in the age split (as you would expect given the higher chance of long term conditions in older patients). For reference this is the actual age split of the adult population in West Sussex. The gender split is 48% male, 52% female.

10 Feedback from Patients In March and April % of patients reported being satisfied with their treatment The volume of people accessing psychological therapies with one of the long term conditions served by the pilot phase (Diabetes/CHD/COPD) has almost doubled since Time To Talk Health started, meaning this group of people have their psychological needs much better served.

11 Where are we now? Recommissioning and Expansion of the Service Asthma Irritable Bowel Syndrome (IBS) Musculoskeletal Difficulties (Arthritis, Fibromyalgia, Bone fractures, Pain )

12 LTC NORTH Clinical Lead Debbie Barnett (Full Time) Service Manager Vicky Fenwick (Full Time) Senior Therapists Remy Marckus (4 days) Colin Watkins (5 days) Senior Administrator Paul Earl (Full Time) Administrators Edore Sambo Senior Wellbeing Therapist (PWP) Kim White (Full Time) Wellbeing Therapists (PWP) Dennis Benniman (Full Time) Philip Thrasher (Full Time) Kesha Wheeler (Full Time) CBT Therapists Claire Dunlop (Full Time) Michal Ann Abott (3 days) Katherine Travis (Full Time) Louise Harper (Full Time) Junaid Khan (Full Time) Jacky Adams (Part Time) Emma Rand (Part Time)

13 When to Refer Inclusion Criteria: Low mood and depression Anxiety disorders (Panic/ GAD/Phobias/OCD/PTSD) which are exacerbating and/or complicating the management of the underlying physical health condition Difficulties with adjusting to a diagnosis Difficulties with burn out or managing the physical health condition Difficulties suitable to be treated in a time limited way Willingness to engage in therapy and capacity to establish therapeutic alliance Clients aged 18 years and over (no upper limit).

14 When to refer on Exclusion Criteria: Psychosis Bipolar Affective Disorder (though we may consider if stable for at least 2 years+) Personality Disorders Eating Disorders Significant current risk to self or others Clients who have recently attempted suicide or active self-harm with likelihood/possibility of escalation. People with active alcohol and substance misuse issues that require treatment. Clients who are receiving treatment from secondary care services (unless treatment completed, or in receipt of medication review only).

15 Step 2 What can be offered Via telephone, face to face, in workshops Recent onset mild to moderate anxiety or depression with minimal risk May be a useful start even for more complex patients Would not work therapeutically with OCD, PTSD, or specific phobias such as needle phobia

16 Treatment Step 2 Step 2 (i.e. least intrusive ) low intensity interventions: Guided Self-Help: Behavioural activation e.g. goal setting, increasing motivation to manage their physical health condition better and supporting patients to increase exercise levels, psychoeducation about anxiety and stress management e.g. supporting someone newly diagnosed to manage multiple demands and new information Workshops: Living Well with Diabetes, Stress management workshops for Cardiac Rehabilitation, Anxiety management Enhanced signposting

17 Step 3 What can be offered Face to face or in groups Moderate to severe anxiety or depression Work with complex presentations for up to 20 sessions Would work therapeutically with OCD, PTSD, or specific phobias such as needle phobia

18 Treatment Step 3 Step 3 High intensity interventions: 1:1 CBT and Counselling Mindfulness-Based Cognitive Therapy (MBCT) for depression and long term conditions. An 8 week course of 2 hours per week Consultation with physical health teams

19 Measuring Success? For all TTT Health patients who, at assessment presented with clinical symptoms of anxiety and depression (as measured on the PHQ9 and GAD7), 56.4% of these patients met recovery indicating that they no longer had any clinical symptoms of anxiety or depression The National target for IAPT is 50% and the national figure for 2017 was 50.6%

20 Any Questions? How to contact us: Our offices are at Horsham Hospital, 1 st Floor, Rose Wing, Hurst Road, RH12 2DR You can call us on You can us at sc-tr.ltcreferrals@nhs.net