Improving access to psychological therapies Catherine Hooper Facilitator

Improving access to psychological therapies Catherine Hooper Facilitator IAPT Project (depression and anxiety) Cognitive Behavioural Therapist, Brynmair Clinic, Llanelli Chris Jones Cognitive Behavioural Psychotherapist Myddfai Psychotherapy Centre Carmarthen Hywel Dda Local Health Board Why improve access? NICE guidelines Government policies and targets Locally- attention and concern within the Trust, establishment of the Psychological therapies group, Modernisation agenda Hywel Dda Local Health Board Modernising the provision of Psychological Therapies Report compiled by Chris Jones, Psychotherapy Dept Aim: - to determine need for psychological therapy within the 3 counties - to determine the current capacity to provide psychological therapy - to develop options to address the gap Hywel Dda Local Health Board What Need and When?

Before assessment and identification a Prevalence of mental health problems in GP registered population. a b PRIMARY CARE CONTINUOUS OR STEPPED CARE PROGRAMME c SECONDARY CARE d e b Attend GP (1st assessment) c Referral to Primary Care Team d Referral to Secondary Care Team e Acceptance onto CPA f f Existing CPA pool Hywel Dda Local Health Board

DIAGNOSTIC CATEGORY INCIDENCE pa/PREVALENCE ESTIMATES per 1000 in Ceredigion (popn 18-65yrs: 63,610) INCIDENCE pa/PREVALENCE ESTIMATES per 1000 in Pembrokeshire (popn 1865yrs: 69,187 INCIDENCE pa/PREVALENCE ESTIMATES per 1000 in Carmarthenshire (popn 1865yrs: 106,190 Anxiety Panic Disorder 89/509 96/553 148/850 Anxiety Generalised Anxiety Disorder 2799 3044 4672 Anxiety All phobias 1145 1245

1911 Bipolar Disorder 3/1209 3/1315 4/2018 Depression (incid. Of Major Depn) 191/1336 208/1453 319/2230 Eating Disorders anorexia No reliable estimate for adult popn (7/1000 girls; 1/1000 boys) 0.5-1% young women c. 477 No reliable estimate for adult popn (7/1000 girls; 1/1000 boys) 0.5-1% young women c.519 No reliable estimate for adult popn (7/1000 girls; 1/1000 boys) 0.5-1% young women c.796 Obsessive Compulsive Disorder 38/670

42/761 64/1168 Body Dysmorphic Disorder 318-445 346-484 531-743 Personality Disorder 2799 3044 4672 Post-traumatic Stress Disorder 1590 1730 2655 Schizophrenia 7/318 8/346 12/531 - bulimea

Hywel Dda Local Health Board Estimated % prevalence of psychiatric diagnoses in Ceredigion, Carmarthenshire and Pembrokeshire Schizophrenia Anxiety Panic Disorder Post-traumatic Stress Disorder Anxiety Gener alsied Anxiety Disorder Anxiety Panic Disorder Anxiety Generalsied Anxiety Disorder Anxiety all Phobias Bipolar Disor der Depression Per sonality Disorder Eating Disorders - Anorexia Ner vosa* Eating Disorders - Bulimia Ner vosa* Anxiety all Phobias Eating Disorders - Binge-eating disor der* Obsessive Compulsive Disor der Body Dysmorphic Disorder* Personality Disorder Post-traumatic Stress Disorder Body Dysmorphic Disorder* Bipolar Disor der Obsessive Compulsive Disorder Schizophr enia

EatingDisor ders - Binge-eatingdisorder * Depression Eating Disorders - Bulimia Ner vosa* EatingDisor ders - Anor exia Nervosa* Hywel Dda Local Health Board Judith Evan-Jones Toolkit assay of caseloads & skills in Trust CMHTs Diagnosis Ceredigion CMHTs Pembrokeshire CMHTs Carmarthen CMHTs projected Total Anxiety 19 3 18 40 Depression 42 34

76 Anxiety & depression 1 112 90 203 Bioplar 30 65 76 171 Eating disorder 4 4 6 14 Anorexia 6 5 11

Psychosis 119 169 230 518 PTSD 3 2 4 9 OCD/BDD 8 4 10 22 PD not specified 1 6 6

13 Borderline PD 23 5 22 50 Totals 256 370 501 1127 Hywel Dda Local Health Board Toolkit: Caseload Composition Pembs. & Ceredigion CMHTs Anxiety Depression Anx & Dep Bipolar Eating Dis Anorexia Psychosis PTSD OCD/BDD Personality Disorder (not specified)

Borderline PD Hywel Dda Local Health Board Casework Projections based on Corporate Data & CMHT Toolkit Responses Carm. Cered. Pembs. Total Anxy & Depn 358 119 173 650 OCD/BDD 25 15 6 46 BPAD 192

58 98 348 Eating Disorders 22 19 6 47 Psychosis 581 229 254 1064 PTSD 10 6 3 19 PD (NOS)

15 2 9 26 Borderline PD 56 44 8 108 Total 1259 492 557 2308 Hywel Dda Local Health Board Summary of Psychological Treatment per Case by Dominant Evidence Modality Hours Duration Anxiety and depression

CBT 8 - 20 4 months OCD/BDD CBT 10+ BPAD CBT 16 6 - 9 months CBT Family Work 16 6 months CBT 20 40 6 12 months CAT 25 + 6+ months

Psychodynamic 25 + 6 + months CBT 10 6 + months CBT Family Work 10+ 6 + months CBT 8 12 3 months EMDR 8 12 3 months DBT c. 160 12 months + SFT c. 276

36 months Eating Disorders Psychosis PTSD PD inc Borderline CAT Psychodynamic (TFP) Long c. 276 36 months Hywel Dda Local Health Board All P & D Adult CMHTs Formal Skills Skill level Skill A A-B B B-C C Total CAT CBT

5 Counselling 1 3 8 1 9 3 12 DBT 9 9 EMDR 2 2 10 13 Personal Construct Psychotherapy Psychodynamic Therapy Psychosocial Interventions for Psychosis

3 Schema Focused Therapy Systemic Therapy Transactional Analysis Total 1 6 11 25 3 1 2 2 47 Hywel Dda Local Health Board Psychological Treatment Hours Estimated per annum by Modality (for all cases to have minimum treatment within one year) CMHT caseloads only Level B and Above Disorder CBT Psychod. CAT

EMDR DBT SFT 21440 12328 Anx & dep 520013000 OCD/BDD 460 BPAD 1136 Eating dis. 940-1880 1175 Psychosis 21280 PTSD 152-228 PD inc Bor 1175 152-228 Long

Long (assume 1/3 take-up) Total 2916837984 1175+ 1175+ 152-228 21440 12328 Hywel Dda Local Health Board Therapy Capacity Deficit Hours per annum; Level B and Above CBT Psychod CAT EMDR DBT SFT Therapy needed

(h) 2916837984 1175+ 1175+ 152-228 21440 12328 CMHT # 4 0 0 2 9 0 CMHT Cap. (h) 4600 0 0 2300

10350 0 Deficit range 2456833384 1175+ 1175+ 21482372 11090 12328 Addnl WTE range (25h/wk 46wk/yr) 21.4-29.0 1.0 1.0 -1.9 to1.8 9.6 10.7 Hywel Dda Local Health Board Mind the Gap

Evidence base largely supports and recommends CBT for many common disorders Effective, accessible, speedy, economic, variety of methods Not for all, however Clinical experience and a less prolific evidence base also suggest the utility of other therapies (dynamic work, CAT, SFT, art) Provides choice of approach highly meaningful to clients Indicated for specific disorders for some may need to be intense and lengthy Practice evidence indicates use for long-term and sometimes ill-defined (and profound) distress Applications for team and organisational development Basic, psychologically informed engagement skills also necessary for majority of work force e.g. basic listening and other counselling skills Hywel Dda Local Health Board Results Huge gap between need and provision On CMHT caseloads: estimated deficits29,168 37,984 of treatment hours per annum for CBT alone, 5,200-13,000 deficit of treatment hours for people with anxiety\ depression, 21,280 deficit of treatment hours for people with psychosis Hywel Dda Local Health Board How can we address the gap? Improving access to Psychological Therapies Project launched in 2009 Stage one will be concerned with improving access for people with

anxiety and depression Hywel Dda Local Health Board Aim of the IAPT (depression and anxiety) Project For patients entering our service to receive evidence based psychological therapies delivered by mental health professionals who are competent in their use For our service to be NICE compliant NICE guidelines (2004) Depression and Anxiety( panic disorder with or without agoraphobia and generalised anxiety disorder) To train a sustainable psychologically skilled workforce to provide interventions now and in the future Hywel Dda Local Health Board Progress so far 8-day CBT training programme designed Curriculum based on the DOH(2007) Report The competencies required to deliver CBT to people with depression and anxiety Aim to train mental health professionals up to Level B status Hywel Dda Local Health Board Level B definition A practitioner who is able to deliver formulation based or manualised evidence based interventions for specific problems, through regular

structured sessions for an agreed time. Requires training in the particular interventions appropriate to the particular diagnosed problem, but will only work under close consultative supervision Hywel Dda Local Health Board Why CBT? Evidence base largely supports and recommends CBT for most mental health problems Therefore in most cases CBT should be the first psychological intervention that is offered However recognised that it certainly does not work for everyone and other psychological models should continue to be provided and developed Hywel Dda Local Health Board Who are we training? We are providing the training course in all 3 counties and in all CMHTS both adult and older adult In some areas ward staff and CRT members have been trained So far 18 mental health professionals have been trained in Llanelli and Pembrokeshire With a further 30 in training in Ceridigion Updates are also being offered to staff who have already done their basic training All professions have been represented amongst the trainees Hywel Dda Local Health Board

Training is not enough! Past experience nationally and locally tells us that training without appropriate support and supervision is not enough to change practice To address this we have set up supervision groups across the counties. Supervision starts in training and continues thereafter The psychological therapies group has formed a subgroup which manages and monitors the project Hywel Dda Local Health Board Measuring competencies For trainees we are using the Cognitive Therapy Scale- Revised, which is a validated scale used nationally by all respected Cognitive Therapy training courses Practically trainees submit tape recordings for scrutiny and have to reach a certain standard before being awarded Level B status After initial training continuous professional development is provided and trainees are expected to attend, this programme has started in Llanelli and Pembrokeshire Hywel Dda Local Health Board Competencies for supervisors All IAPT supervisors have attended training in CBT supervision Supervision group for the supervisors set up About to introduce validated scale to assess competencies of the supervisors- Supervision:adherance& guidance evaluation (SAGE)

instrument. Hywel Dda Local Health Board Will it work? Audit to find out Have we increased access? Were the interventions effective? Were the patients satisfied with the service? Hywel Dda Local Health Board The future Stage 2 is planned to begin in next few months and will be concerned with increasing access for people with established psychosis Discussions with Learning Disability services to include them in the project Discussion with Swansea University, School of Health Studies to accredit the training Training to become part of induction process for all mental health professionals? Hywel Dda Local Health Board Now you can help us! What difficulties do you envisage introducing psychological interventions into TAU? Groups of 5 Brainstorm difficulties & solutions Feedback Hywel Dda Local Health Board

The challenge Integrating psychological interventions into normal care Care coordination and CBT- can they mix ? Fitting it all in- giving psychological care equal status Changing the habits of a lifetime or several lifetimes. Hywel Dda Local Health Board

Recently Viewed Presentations

  • Linear sys - Artificial Intelligence

    Linear sys - Artificial Intelligence

    Linear Systems (filters) 6-Oct-16. Linear filtering: Form a new image whose pixels are a weighted sum of original pixel values. Use the same set of weights at each point. S. is a linear system (function) iff it . S satisfies....
  • Maryland Commission on Civil Rights

    Maryland Commission on Civil Rights

    The Mission of MCCR. It is the mission of the Maryland Commission on Civil Rights to ensure opportunity for all through the enforcement of Maryland's laws against discrimination in employment, housing, public accommodations, and state contracts; to provide educational outreach...
  • The Great Depression - Alvin Independent School District

    The Great Depression - Alvin Independent School District

    Bank Failures. a. Banks close and loose $$$ b. People . default. ... OBJ #2 -Describe how the Great Depression affected people. Who was the president when it started, and what did he do to help? Who tried to help...
  • The Wind in the Willows - Notes From Mr. Snell's Office

    The Wind in the Willows - Notes From Mr. Snell's Office

    Simile, metaphor, personification, alliteration, hyperbole, onomatopoeia, and idiom. Poetry (choose one) Write a . poem for two of the four main characters (Mole, Rat, Toad, Badger) describing them physically, emotionally and behaviorally. Write an . acrostic poem for all of...
  • Update on Energy Storage Reliability Codes and Standards ...

    Update on Energy Storage Reliability Codes and Standards ...

    REFRAIN FROM USING PROSE IN PPT. USE CONCISE BULLETS IN YOUR PPT PRESENTATION. Energy Reliability C&S Program Metrics & Milestones. Number of ES Technical Standards Development Activities Supported. Number of ES Technical Standards Created or Updated.
  • Dyspepsia & Peptic Ulcer - Yola

    Dyspepsia & Peptic Ulcer - Yola

    A 40 year old man, had history of joints pain, he presented with upper abdominal pain and nausea after receiving oral NSAID ketoprofen. His GIT symptoms did not improve with addition of Ranitidine 150mg twice daily. His upper gastrointestinal endoscopy...
  • Bridging the gap Understanding the issues facing QPS

    Bridging the gap Understanding the issues facing QPS

    We realised we had access to a captive audience at the weekly Wall Walk and could use the live data to highlight to senior managers specific issues about releasing staff to attend Statman training and also about managing access to...
  • Meaning and Phraseology: A Corpus-Driven Approach

    Meaning and Phraseology: A Corpus-Driven Approach

    A Corpus-Driven Approach Patrick Hanks ... Driffield, which was a pleasant oasis in the East Riding of Yorkshire. ... That's what the GMB need to do, to grasp the nettle, to move forward. GROUP 5: [[Human]] grasps {at/for [[Physical Object]]}...