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TalkingSpace & TalkingHealth
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Transcript of TalkingSpace & TalkingHealth
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TalkingSpace & TalkingHealth
The IAPT service, Oxfordshire and Buckinghamshire NHS Foundation Trust
Christina Surawy: Oxford Mindfulness Centre, Oxford University Department of Psychiatry
With thanks to: Emma Evans, Clinical Supervisor and Clinical Psychologist
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Outline of the session
Overview of TalkingSpace TalkingHealth: Services for people with long-
term health conditions MBCT within IAPT Questions and answers
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Referrals to TalkingSpace
TS receives 6500 referrals a year Primarily self-referral The service is meeting nationally agreed
recovery rates (40-50%)
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The stepped care model
Step 4 – Secondary Care (e.g. CMHT)
Eating Disorders, Drug and Alcohol addictions, Severe OCD, Severe depression, Bipolar disorder, Psychosis
Step 3 – Primary Care (High Intensity Therapy)Moderate to severe depression, mild to moderate anxiety, including GAD and health anxiety, OCD, social phobia, PTSD
Step 2 – Primary Care (Low Intensity Therapy)
Mild to moderate depression or anxiety
Step 1 – Active monitoring (often GP)
Psychological problem identified
PHQ-9 and GAD-7 completed at least 5 weeks apart
Patient direct to self-help materials
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Typical patient journey
ROUTE A: Patient consults GP and mental health concerns are raised
GP: Discuss and assess patient suitability for IAPT. GP gives patient TalkingSpace leaflet
Patient:Calls in to book initial telephone assessment (or sends in brief form)
ROUTE B: Self-referral
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Typical patient journey
Route C: Mental health concerns identified during consultation with other health professional
Health professional: Discuss and assess patient suitability for IAPT. Gives patient TalkingHealth leaflet OR recommends further assessment
with GP
Patient: Calls in to book initial telephone assessment (or sends in brief form) OR
sees GP
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Patient journey continuedPatient booked for initial brief telephone assessment (20-30 minutes maximum)
If appears appropriate for TalkingSpace: Step 2 class Step 2 guided self help for anxiety and depression or computerised CBT for
depression Step 3 High Intensity CBT assessment
BUT IF Primarily seeking help with adjustment/transition/loss/relationship issues AND/OR prefers a non-structured treatment
Referral to GP practice-based counselling (PML)
If referral appears inappropriate or unclear:
May involve: liaison with GP,CMHT/Psychological Therapies (Step 4)
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Treatments offered
Step 2 (LI)
Psychoeducation courses – anxiety, depression, insomnia, emotional well being in diabetes
Information giving Bibliotherapy & Guided-self help Computerised CBT (Beating the Blues) 3-month follow ups as standard
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Psychoeducation courses
Offered in various locations throughout Oxfordshire
Depression, anxiety or insomnia Four sessions (five for insomnia) Stand-alone treatment or an introduction to CBT
skills 1 month follow up call
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Psychoeducation classes: patient comments It would do a majority of people good. It’s really helpful/reassuring to meet other people
suffering from the same thing. It’s nice to talk within a group and not just one to
one which is quite intense. Excellent and friendly presentation. Useful and informative. Has certainly helped me
to overcome some of my problems.
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Treatments offered
Step 3 (High Intensity) Groups – depression, OCD, anxiety (transdiagnostic),
carers’ groups for people caring for people with dementia Individual CBT Mindfulness Based CT group for depression (relapse
prevention) Mindfulness Based CT group for long-term conditions IPT (Interpersonal therapy) DIPT (Brief Dynamic Interpersonal Therapy)
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Additional interventions and services
Employment support (Restore) to liaise, provide signposting and support for people struggling to stay in employment
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Who can’t we see? Children (under 18) Acute mental health crisis/ high risk to self or others Previous unsuccessful treatment at Step 3 Severe depression/anxiety Severe OCD Eating disorder Psychosis/Bipolar disorder Personality disorder Significant substance misuse Currently seen by another mental health service/
already receiving psychological therapy or counselling Not registered with Oxfordshire GP
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TalkingHealth: A service for people with long-term physical health conditions Part of TalkingSpace Initially developing services for people living
with: Diabetes Cardiac rehab and heart failure CFS Long term conditions (including MS and MUS)
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TalkingHealth
Higher rates of depression and anxiety when living with a long-term health condition
People do not access services at the expected rates – possible reasons: Focus on physical health? Mental health symptoms considered ‘inevitable’? Interaction between physical health and mental
health difficulties results in typical mental health treatments not seen as relevant/appropriate?
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Self-referral or referral from any health professional
Work flexibly (telephone, GP practices and other settings)
Aim to work closely with those involved in physical health care
Priorities
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Cardiac services
Input to classes run by nursing staff (psychoeducation)
Guided self help (step 2) Individual CBT and staff supervision groups
(step 3)
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TalkingHealth: Diabetes The number of people recorded as having diabetes
accessing the service has doubled over the last year
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Emotional well-being in diabetes course Four session psychoeducation group for people with
diabetes and depression. CBT based Adapted from step 2 class ‘Managing your mood’ Looks at interaction between physical and mental health Topics covers:
Behavioural activation Problem solving Goal setting Cognitive challenging
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Evidence to support a course
Initial outcomes suggest:
Greater improvements in mood (PHQ-9) than in standard class Improvements in physical health (HBA1c)
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MBCT in TalkingSpace and TalkingHealth OMC have undertaken to train step 3 IAPT
practitioners to deliver MBCT for recurrent depression and anxiety (TS) and LTC’s including MUS). Also a specific MBCT course for CFS
Hoffman et al. (2011) showed that MBCT reduces anxiety and depression across a range of physical diagnoses
So far 8 courses have run Average no. of participants in TS= 16 Fewer in talking health
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MBCT for LTC’s
Open to all patients with anxiety and depression (or previous anxiety and depression) as a result of any physical health condition, and including carers.
Some data: Spring 2013 course, mean pre
post change in PHQ9= 11.25 – 6.75 with >50% moving from clinical to non clinical range
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MBCT for LTC’s
For GAD 7, the change was from 9.12 to 5.5 with 50% moving fromclinical to non clinical range
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Case example – Bill
66 year old male Physical health: Multiple sclerosis (diagnosed 25
years), neuropathic pain, referred by pain clinic Mental health: Low mood, self-critical, frustration,
tense, restless, body/pain the enemy (constant battle) Treatment: Mindfulness based cognitive therapy
group (8 week programme) Outcome: improved mood, more relaxed, not fighting
pain/body, reduced scores on PHQ-9 & GAD-7
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Future directions
Continue to adapt and develop MBCT for LTC’s and MUS
Individualised measures Developing links with pain services
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Questions?