Mid Essex IAPT. Improving Access to Psychological Therapies for Older People Claire Beechend Senior Psychological Wellbeing Practitioner

Transcription

1 Mid Essex IAPT Improving Access to Psychological Therapies for Older People Claire Beechend Senior Psychological Wellbeing Practitioner Katie Santos Team Manager Jamie Hacker Hughes Clinical Lead Krishna Singh Clinical Director A member of Cambridge University Health Partners

2 Contents Page Improving Access to Psychological Therapies for Older Adults in Mid Essex Executive Summary Background Project Plan Activity Data Service User Comments Learning Points Conclusions 13 Executive Summary This paper reports on a CQUIN-funded project ( ) with NHS Mid Essex and CPFT to raise awareness and to enhance access through outreach work with Older people referred to IAPT, in order to improve the quality, effectiveness and experience of psychological interventions. This was achieved through recruiting a Senior PWP who raised mental health awareness in people aged over 65 years to GPs, primary and secondary care staff across both statutory and non-statutory agencies, as well as the current IAPT staff team. In addition, a range of interventions were planned and delivered to improve Older Peoples experience of IAPT when referred to the service. 2

3 1.0 Background Improving Access to Psychological Therapies for Older Adults in Mid Essex In April 2011 Mid Essex IAPT were asked to develop a service with CQUIN funding from the PCT. The main goals were as follows: 1. To raise awareness and enhance access through outreach work with older people s groups and possibly in-reach groups into care homes 2. To plan and deliver a range of interventions to improve older peoples experience of IAPT Initially a Senior PWP (psychological wellbeing practitioner) worker was appointed to focus on this project. The PWP s work was to provide: Specific training and mental health awareness for primary care and other IAPT therapists to work with older people. To provide increased specialist PWP leadership within the team who could provide supervision and training to HI & LI trainees and to qualified staff as appropriate Within the existing IAPT service. To provide support to partnership working arrangements with local Mid Essex third sector and other stakeholder groups providing support to older people. To develop the provision of appropriate programmes for care home staff to receive training on depression (and other common mental health problems) in older people. This has been a successful element of the project as highlighted in the IAPT national positive practice guideline as a successful intervention strategy. Scoping of any additional administrative support to deal with increased Older Peoples referrals and associated documentation, if required. Mid Essex IAPT was established in April 2009, for patients aged 18 years upwards, i.e. with no upper age limit. It has been noted by the Department of Health IAPT Older People Positive Practice Guide (2009) 1 and Equality Act (20) 2 that access for Older People was still below the national average target. In general only 4% referrals for people aged over 65 were being seen by IAPT services, despite the fact that older people nationally make up 18 % of the population. In Mid-Essex IAPT 5% of referrals were for people aged 65 +, and it was agreed that the CQUIN target would be set at %. 1 Iapt.mmhdu.org.uk/silo/files/older-people-positive-practice-guide.pdf 2 3

4 2.0 Project Plan The aim of the Improving Access to Psychological Therapies for Older Adults in Mid Essex project was to increase the number of service users aged over 65 accessing the service from 5% to %. In order to implement the project, two areas needed to be focused on: firstly, advertising and promoting the service to older people within the community and, secondly, to raise awareness adapting the attitudes of the Service and its staff towards the needs of older people with common mental health problems and to modify processes to in order to enable easier access for them into the service. 2.1 External Work included: Advertising and Promoting the service to older people within the community Psychoeducation and training events with GPs and raising their awareness of the need to enabling older people to access talking therapies in line with NICE guidelines etc Design of a mail shot informing all GPs of this project and distributing leaflets aimed at the Over 65s to be placed in waiting rooms, libraries etc. Meetings with Age Concern s central office in Chelmsford to discuss the project and to gain information regarding older people, facilities within the community that could potentially be targeted, possible collaboration etc. Creating links with CAB in all areas regarding services for older people and distributing leaflets within their premises Targeting specific areas i.e. residential care homes, bowls clubs, community centres and arranging a talk with older people in order to canvass their views and raise awareness of the service and means of access. Adapting the attitudes of the Service and its staff towards older people and modifying processes to enable easier access to the service. These included: o Brainstorming, within the team, ways in which practitioners could adapt working processes to accommodate the needs of older people i.e. offering manuals in larger print, allowing longer session times etc o Using the staff survey in order to ascertain the general attitudes towards older people within the staff group. o Exploring alternative means of referral that might make it easier for older people to access the service, e.g. running community clinics, working out of care homes, accepting referrals from social services/carers/gp s/self-referrals 4

5 o Considering the Minimal Dataset (MDS) and the implications for outcome data and exceptions that needed to be considered e.g. employment statistics and other IAPT national objectives that did not necessarily fit with the needs of an older service user o Working with Mid Essex IAPT s Employment Support Partners (Richmond Fellowship) in order to access the support and interventions that they offer e.g. pension guidance, voluntary / paid employment possibilities, social contacts/group activities. o Promotion of the IAPT Older Adults project with external agencies and information gathering was accomplished as follows: Information meetings were arranged with the following: o Age UK o District Nursing Team o Braintree, Chelmsford and Maldon CATs o Older Adult MH Community Teams o Healthy Living Team o Action for Supporting Carers o Village Agents o Citizens Advice Bureaux (CAB) o Richmond Fellowship o Development of promotional IAPT leaflets to be distributed to Older Adults by external supporting agencies Arranging for information presentations to the various older adult groups run by the external agencies Promotion of the IAPT Older Adults project among GP surgeries was achieved by: Developing information presentation for GPs regarding the Older Adults project and visiting, giving them details of referral criteria for this patient group etc Arranging for promotional older adult leaflets to be distributed throughout surgeries within Mid-Essex 2.2 Internal Work included: Conducting staff discussion groups and surveys in order to establish current attitudes towards working with Older Adults Arranging for guest speakers to talk to the staff group about working with older adults (e.g. Age UK, Village Agents). Reviewing the current research on working with Older Adults and IAPT Developing assessment instruments for use with an older age group etc 5

6 The PWP regularly met with IAPT team leaders to review referral criteria and team considerations throughout the project. The referral form was subsequently modified for use with Older People referrals into the service. 3.0 Activity Data 3.1 Referrals Referrals per month Series April May June July August September October November December January February March Fig. 1 Referrals per month Percentage of referrals April May June July Augu st Sept embe r Octo ber Series Fig 2 Older Adult referrals as percentage of total IAPT referrals. Nove mber Dece mber Janu ary Febr uary 6

7 NB Statistics for February and March 2011 not verified at time of writing (therefore underestimated) As can be seen from the above the referral target was attained in January 2012, two months before the conclusion of the project. The trajectory increased over the course over the year to achieving the % target of Older People referrals. This continues to be the trend and future subsequent reports will demonstrate this where the data is inputted and updated into the PC-MIS recording system database. 3.2 Source of Referrals 2 Source of referrals GP Health Visitor Self District nurse/matron OA CMHT OA CAT Village Agents AFFC Falls Prevention Other Fig. 3 Sources of Referral The majority referrers continued to be GP s, with OA CMHT referrals never exceeding % of GP referrals. 7

8 3.3 Analysis of Referrals Referral breakdown In Treatment Completed Treatment Declined Treatment Not Suitable No Contact Awaiting forms 5 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Fig.4 Referral breakdown As at the time of writing, 115 service users had completed treatment (146 had declined treatment, 38 were found, on assessment, to be unsuitable for an IAPT intervention and 2 were listed as deceased). The percentage of referrals that declined treatment declined steadily across the life of the project as can be seen in Fig 4 above, while those in treatment showed a steady rise over the course of the project. 3.4 Analysis by Gender Analysis by Gender Female Male Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Fig 5 Analysis by Gender 8

9 As can be seen from Fig 5 above, the number of referrals of females significantly exceeded referrals of males. 281 (72.8%) females were referred to the project at the time of writing in comparison to 5 males (27.2%). The pattern of referrals across the span of the project is shown in Fig. 5 above 3.5 Analysis by Age Age at referral Fig. 6 Analysis by age The number of year-olds referred showed a steady increase across the life of the project. The ages of those referred to the project ranged from 65 to 93, with the mean age of those referred being 71.9 as shown in Fig. 6. 9

10 3.6 Analysis by Diagnosis The following figure, Fig 7, represents the breakdown of referrals by diagnosis following assessment. ICD Diagnosis Major Depressive Disorder 42% Specific Phobia 2% Panic Disorder 9% Generalised Anxiety Disorder 28% Mixed Anxiety and Depression 12% Obsessive Compulsive Disorder 1% Post Traumatic Stress Disorder 1% Somatoform Disorder 1% Mental Disorder Not Otherwise Specified 2% Bereavement Reaction 2% Fig 7 Diagnosis As can be seen from the above, the majority (42%) of referrals were for Major Depressive with the next three most frequent referral problems being Generalised Anxiety Disorder (28%) and Mixed Anxiety and Depression (24%) and Panic Disorder (9%). The remaining diagnoses (Specific Phobia, Obsessive Compulsive Disorder (OCD), Somatoform Disorder, Bereavement Reaction and various unspecified problems totalled less than 7% of referrals. 3.7 Effectiveness of intervention From the data collected from those who completed treatment, there were significant improvements in both measures of anxiety (GAD-7) and depression (PHQ-9) as can be seen in Fig. 8. below. The average number of treatment sessions was 2.4 (Range 1-12).

11 GAD and PHQ Scores Series GAD Pre GAD Post PHQ Pre PHQ Post Fig. 8 Pre and Post Scores 4.0 Service User Comments. I m feeling much brighter. CBT has enabled me to make changes to my life and I am feeling much better in mood. I m feeling great. This therapy really helped me put things into perspective. Before I was really worried about my health but now I have the techniques to manage it. Thank you very much! It's been wonderful, very helpful. I am very thankful. I was very happy with the service and I hope it continues as so many people need it. It's been very helpful talking things through and I really appreciate it. A lot of good advice. 11

12 I'm extremely impressed; I have felt helped and supported. "It s been a great help". As a community matron performing holistic assessments, mainly on older patients, I have found this referral process a valuable tool in fast-tracking to your service. The patients appreciate being able to discuss some of their issues prior to a referral, and we are ideally placed to triage their needs for psychological therapies It's been marvellous. Everything was done right. My wife has noticed that I ve changed and we are pleased. I realise that things are better now and I can see how I have improved. "I would recommend the service to anybody 5.0 Learning points from project Over the course of the CQUIN we established a number of reasons why older people may be unrepresented in being referred to the service. The reasons are listed as follows: Low numbers of older adults referred by GP s. The Age Concern depression campaign (2008) 3 suggested that Older Adults could be more reluctant to seek advice and support for mental health needs, This emphasized the importance of psycho-education and mental health awareness training for GP s and primary care practice staff to make referrals to IAPT, and not to just refer straight into secondary care services. Review of care pathway, and referral procedures to enable external agencies to directly refer to IAPT. 3 report 12

13 Mental health awareness training and education for various groups including the Healthy Living Team, Action for Supporting Carers, the Older Adult Community Mental Health Team (CMHT), the Older Adult Community Assessment Team (CAT) and the District Nursing Team. Understanding of systems in secondary care CMHT Older people. Liaison to ensure effective communication retained during treatment with the CMHT. 6.0 Conclusions The Mid Essex IAPT Service Older Adults project has been a success over the one-year period of its duration with referrals meeting the target of %. The visibility of the service has been increased through general awareness-raising and training of, community groups, primary care and secondary care services. This work will now be continued by the MID Essex IAPT team and all learning points will be fully integrated fully into the core service. Report produced by: Claire Beechend Senior Psychological Wellbeing Practitioner Mid Essex IAPT Katie Santos Team Manager Mid Essex IAPT Jamie Hacker Hughes Clinical Lead Mid Essex IAPT Krishna Singh Clinical Director March 2012 HQ Elizabeth House, Fulbourn Hospital, Cambridge CB21 5EF. T F