Mental Health Futures event. Dr Stuart Adams, Consultant Psychiatrist and Clinical Director for Merton and Sutton Gill Moore, Operational Manager, Sutton and Merton Adult Services Dr Hendrik Hinrichsen, Consultant Clinical Psychologist and Clinical Lead for IAPT Dr Nicola Omu, Consultant Psychiatrist, Morden Recovery Support Team
Our Vision We aspire to be a Centre of Excellence Effective, responsive, collaborative, accessible, achieving excellence A place where patients want to come Where clinicians want to train and work Our stakeholders want to work with us
Services: National o Eating disorders, BCPU, Deaf services Regional o Forensic Trust wide o CAMHS (inpatient), PTSD, Liaison Psychiatry, Neuropsychiatry, Perinatal, OCD Local
Secondary Mental Health Services: RANGE OF SERVICES o CHILD AND ADOLESCENT SERVICES (CAMHS) (Birches Close, Mitcham) o ADULT SERVICES (Wilson Hospital, Mitcham / Amity Grove, Raynes Park) o OLDER PEOPLES SERVICES o (Springfield Hospital)
Access to services: Direct Self Referral GP Referral Others Concerned Carers Other agencies e.g. Housing /Probation / Children and Families
Access to Adult Services: 17 to 75 years Single Point of Access Assessment Team Triage and Assess Signpost Direct transfer into appropriate team
Range of Teams: Early Intervention Services- first onset psychosis Recovery and Support Teams ( Mitcham, Morden and Wimbledon) Psychosis and Mood disorders Personality Disorder Services SUN Project Complex Needs Personality Disorder Service Mental Health /Learning Disability Team
Adult Teams: Multidisciplinary Recovery Focussed Health and Social Care Referral to Tertiary Service Interfaces managed by Care Pathway
Specialist Adult Teams: Crisis and Home Treatment Team intensive support up to 6 weeks / can be up to three times daily. Support pre-inpatient admission and post-discharge Liaison Psychiatry Emergency Department (A&E) and support to wards. St Helier Hospital work with Home Treatment Team. ON Call Psychiatrist St George s Hospital 24 hours / 7 days service Inpatient Units- Springfield Hospital Jupiter Ward / Psychiatric Intensive Care
Other Services / Teams Employment Specialists- support to return to work Recovery College educational approach / self management. Welfare Benefits Team- support with benefits advice/ appeals
New Services Autism Spectrum Disorders/ Attention Hyperactivity Disorders Service. Assessment and CBT based interventions Complex Depression and Anxiety Disorders Service. CBT based psychological interventions and practical Recovery based social support.
Older Peoples Service 75 years and above functional disorders Dementia related illnesses Memory clinic Dementia Hub Home Treatment Team Challenging Behaviours
Merton IAPT Improving Access to Psychological Services Primary care mental health services: IAPT and beyond Dr Hendrik Hinrichsen Consultant Clinical Psychologist and Clinical Lead, Merton IAPT Merton Healthwatch 01-15 14
What is IAPT? It s been known for a number of years that psychological treatments such as CBT are highly effective for common mental health problems, such as depression and anxiety. The National Improving Access to Psychological Therapies (or IAPT) initiative aims to make these evidence-based psychological treatments available to everyone in our communities who needs them. IAPT now includes children and SMI (via the transformation of CAMHS and 2ndary care). Merton Healthwatch 01-15
IAPT services These are specialist psychological treatment services, offering NICE-supported psychological treatments for everyone in the community suffering from a primary depression or anxiety disorder (DSM-V): Low mood / depression Generalised anxiety disorder (GAD) Panic (with or without agoraphobia) Health anxiety disorder (hypochondriasis) Social anxiety disorder (social phobia) Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Additional: Bulimia nervosa / atypical bulimia Merton Healthwatch 01-15
NICE-supported interventions Medication and CBT Pros Practical Goal-focused Future focused Learning life skills Good relapse prevention Cons Time Effort Work outside the therapy sessions Not suitable for everyone Merton Healthwatch 01-15
What makes IAPT different? 1. Short waiting times patients get the help they need when they need it (not six months later). 2. A number of different treatments are offered to the patient wherever possible (e.g., Beh Act, IPT, EMDR). 3. Feedback on the progress made in treatment is collected at every session (via the IAPT question res). This allows both patient and therapist to determine whether the therapy is working for the patient or not. 4. A dedicated IT system (called IAPTus) allows clinicians to enter questionnaire results, track client progress, enter clinical notes, and send out letters. 5. Employment support is available as needed to help people get back into work. Merton Healthwatch 01-15 18
IAPTus: A dedicated IT system Merton Healthwatch 01-15
How can people access the IAPT service? 1. Patients are typically referred by their GP or a partner organisation, or they can self-refer via our website or by calling our telephone hotline. 2. They are then called to be booked in for a structured ½-hour telephone assessment. 3. Once the assessment has been completed, assessor and supervisor discuss what might be the most appropriate intervention to meet their needs. 4. Wherever possible, patients can choose from a menu of interventions. However, NICE recommends that some form of CBT should be the first-line treatment. Merton Healthwatch 01-15
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4. What happens next? We consider for each patient what will be the most appropriate intervention for them: Step 2 = mild-moderate severity (60%), max. 6-8 sessions Guided CBT (mostly depression / anxiety, but also simple phobias / health anxiety / low self-esteem) Group CBT (anxiety / depression) Step 3 = high severity (30%), 12-20 sessions - One-to-one CBT for PTSD / social anxiety / OCD / bulimia and atypical presentations - Other one-to-one therapies, such as IPT, CAT, BCT, and DIT Merton Healthwatch 01-15
What happens next? Signposting to a non-statutory service (9%) Referral to a specialist Trust service (e.g., CMHT, Eating Disorder Service, Trauma Service) (1%) Merton Healthwatch 01-15
The future of primary care MH 1. Expansion of Step 2 / low intensity options 2. Extended working hours and option of home visits 3. More involvement of service users in the shaping and delivery of services 4. Expansion of community engagement work (incl. training of others) 5. More counselling provision and a new bereavement service Merton Healthwatch 01-15
Skype therapy Merton Healthwatch 01-15