The Student Pathway team offers a specific therapy pathway for students aged 16 and above who feel their academic studies are impacting on their mental wellbeing or vice versa. The purpose of the pathway is to provide a range of evidence-based therapies to this hard to reach and transient group with the aim of reducing symptoms of depression and anxiety as well as improving overall wellbeing. As part of the pathway, we deliver CBT-based Anxiety and Depression workshops from Durham University premises throughout the academic year. This takes the form of a seminar-style session. This enables students to engage in treatment in an environment and format that is familiar to them, with a view to normalising accessing such treatment and improving engagement rates.
Hours the service operates Monday - Friday 9-5 (9-8 on Thursday)
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The ‘Student Pathway’ team provides a specific therapy pathway open to all students who attend local schools, colleges, sixth forms and Universities in County Durham & Darlington. The aim of this Pathway is to provide evidence-based, student-specific interventions, in a timely manner, whilst being integrated into the respective Educational Establishments (EE). There is a “higher than average” prevalence of common mental health problems (CMHP’s) in the student population (Education Policy Institute 2018) due to students experiencing a multitude of unique psychosocial stressors, including: transitioning from childhood to adulthood; moving away from home; loss of social and support network; academic expectation and demands; exam stress. This has seen the rate of university student suicides increased markedly over past 10 years. As highlighted in a recent document (Minding Our Future, 2018) published by Universities UK we understand that there is a high demand for mental health services to improve links with the student population. Students often encounter great difficulty in accessing evidence-based talking therapies due to their transient living conditions and rigid mental health service design (Gallagher 2008, McCall et al 2001). These factors combined can in turn can lead to long waits in accessing the treatment that they need, further mental distress and ultimately the sub-optimal care of what is a vulnerable demographic.
The Student Pathway team offers a specific therapy pathway for students aged 16 and above who feel their academic studies are impacting on their mental wellbeing or vice versa. The purpose of the pathway is to provide a range of evidence-based therapies to this hard to reach and transient group with the aim of reducing symptoms of depression and anxiety as well as improving overall wellbeing. As part of the pathway, we deliver CBT-based Anxiety and Depresion workshops from Durham University premises throughout the academic year. This takes the form of a seminar-style session. This enables students to engage in treatment in an environment and format that is familiar to them, with a view to normalising accessing such treatment and improving engagement rates. Not only do these workshops enable students to access high quality, tailored interventions typically within 6 weeks of their referral, they also have a positive impact on organisational pressures in that the project eases the demand on the service by providing a high volume, demographic-specific psychological intervention to what is a high referrer during the academic calendar. Beyond the Student Pathway workshops, we: have established a designated and simplified referral process (mailbox) for EE to refer directly into; have attached a therapist from the Student Pathway team to each of the EE as a primary point of contact; deliver treatment clinics from the EE’s premises in order to improve accessibility and de-stigmatise engaging in therapy; have developed a targeted marketing campaign that runs throughout the year; delivered training to our entire workforce of therapists on the effective delivery of therapy to the student population; and perhaps most pertinently, developed a procedure that improves accessibility and timely access to treatment for students who reside out of our catchment area during academic term times – offering a level of flexibility and initiative that provides a potential solution to the aforementioned mental health ‘service rigidity’ issue.
What makes your service stand out from others? Please provide an example of this.
We believe that Talking Changes’ Student Pathway is somewhat of a ‘trailblazer’ in the field. To the best of our knowledge we were the first IAPT service to establish a formal pathway for students, with the pathway being conceived and implemented in 2011. In accordance with the ‘Five Year Forward View for Mental Health’, we have been fully integrated into our primary referral source Durham University since 2011. We have since rolled out the pathway and established strong relationships with all major Educational Establishments (EE) across all 3 CCG’s. The Student Pathway has went from strength to strength since being conceived in 2011. Over the past 8 years, the Pathway has received recognition and accolades from a variety of sources, including: –
The Pathway Lead Dominic Mossa being invited to present the Student Pathway at the IAPT National Networking Forum, Birmingham in January 2019; – Nominated for ‘Clinical Team of the Year’ and ‘Outstanding Initiative in Clinical Services’ at TEWV NHS Foundation Trust’s upcoming ‘Making a Difference Awards 2019’; – Receiving formal recognition from the National Intensive Support Team in 2017 that the Student Pathway is “a particular area of good practice” within the IAPT service, which they were “keen to publicise and promote more widely”; – Original project with Durham University being extended to all major educational establishments throughout County Durham & Darlington; – Receiving a letter of commendation from Durham University’s Welfare and Counselling services in 2014 – Several other IAPT services in the country requesting to replicate the ‘Student Wellbeing Workshops’ with the universities in their locality – Paper on Student Pathway nominated and shortlisted for the ‘Excellent Newcomer in Oral Presentations’ award by Scientific Committee at BABCP 2012 conference
Despite the above recognition to date, we feel that Talking Changes’ Student Pathway represents an excellent example of good practice within Primary Care Mental Health/IAPT, in terms of demonstrating an innovative way of working that aims to both improve the mental health of the population it serves, whilst reducing organisational pressures. On this basis and in light of recent developments in the Pathway we believe it to be worthy of this nomination.
How do you ensure an effective, safe, compassionate and sustainable workforce?
All therapists on the Student Pathway team have completed IAPT accredited training on the delivery of (low and/or high intensity) CBT interventions. This has been supplemented by a series of in-house training events to practitioners across the locality to increase awareness and understanding of common difficulties experienced by the student population and how to tailor interventions to best manage them. This allows for staff to feel competent when working with this population as well as providing continued professional development to the team members who put together and deliver the training. Within the team, we continue to work towards forging new relationships with additional Academic providers. As we do so the demands of the Student Pathway team increase. The opportunity to be a member of a specialised team provides an incentive to staff who wish to develop their skills and could be argued to sustain the recruitment and retention our workforce. In relation to supporting the wellbeing of our staff, meetings are held every quarter to review our progress, our wellbeing, and to provide a space for supervision. Supervision is delivered using the IAPT model of weekly case management to review each of the students and monthly clinical skills supervision. Clinical skills supervision is delivered by a Senior Psychological Wellbeing Practitioner or a High Intensity Therapist with specific psychological wellbeing practitioner training.
Who is in your team?
Dominic Mossa – Senior High Intensity Therapist / Student Pathway Lead: Band 8a – full time Christopher Rae – High Intensity Therapist: Band 7 – full time Gabrielle Royer – Psychological Wellbeing Practitioner: Band 5 – full time Rebecca Wrightson – Psychological Wellbeing Practitioner: Band 5 – full time Cassandra Dunnipace – Psychological Wellbeing Practitioner: Band 5 – full time Roderic Brunini – High Intensity Therapist: Band 7 – full time
How do you work with the wider system?
Members of the Student Pathway attend the quarterly open days at Durham University as well as the various college and school open days throughout the year. We are regularly in attendance at Educational Establishment (EE) meetings to raise awareness of the pathway and to answer any questions from staff, parents and governors. In addition, at the beginning of each Academic year, we send information about the Student Pathway to the 23 colleges and sixth forms across County Durham and Darlington and following this, we actively contact them to promote the pathway for their students. At present, we run treatment clinics and workshops from within Durham University who have approximately 19,000 students studying within their institution each year. We have a strong working relationship with the clinical lead of the counselling service within the University and attend team meetings with the counselling service as a whole to share updates. This helps streamline transitions for students from the University from one service to another.
We also run regular clinics within Durham Sixth Form College where we work alongside their Health and Wellbeing officer. This again facilitates a swift referral and access routes into Talking Changes for students experiencing mental health difficulties. We have recently begun working with Middlesbrough College who have a number of students registered with GPs within our CCGs. In addition we are liaising with Sunderland IAPT service to explore co-working into areas on the boundary between our CCGs and theirs. This is with the aim to work towards equitable access to treatment for all students in the local area. The college has stated that they are, “excited to offer such a unique and valuable service to our students and we look forward to working with Talking Changes to embed this pathway into our college”.
Do you use co-production approaches?
When developing our Student Depression and Anxiety workshops we worked closely with a team from Durham University who helped us refine the content of our work to reflect the main presenting problems of students within their institution. The original Student Pathway team spent many months with the counselling and student services teams to create the pathway. Data that had been collated by the university around issues that students commonly required help with was used as a guide when creating the materials for the pathway. For example, procrastination and perfectionism were highlighted by the team at Durham university as being the two most common antecedents when students began to struggle with their mental health. We also involved patients in the production of our materials by utilising feedback gained from previous workshops. This is something we continue to do to ensure our materials remain relevant and meet the needs of the patient.
Do you share your work with others? If so, please tell us how.
– Attended multiple promotional events with all of our Educational Establishments including Fresher’s Days and Student Welfare team meetings – Paper on Student Pathway nominated and shortlisted for the ‘Excellent Newcomer in Oral Presentations’ award by Scientific Committee at BABCP 2012 conference – The Pathway Lead Dominic Mossa being invited to present the Student Pathway at the IAPT National Networking Forum, Birmingham in January 2019 – Shared our good practice with several other IAPT services in the country who subsequently requested to replicate the ‘Student Wellbeing Workshops’ with the universities in their locality
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Within the framework of IAPT, minimum data sets (MDS) and anxiety disorder-specific measures (ADSMs) are collected as a way of measuring patient recovery in terms of self-reported symptom reduction. We utilise these measures within the Student Pathway in order to gauge student’s response to treatment. We also collect patient experience questionnaires at the end of treatment and evaluation forms at the end of our Workshops to gain a more qualitative measure of patient improvement. We regularly review this data and use it to inform service development in terms of expanding the provision of our current materials and updating them when required. The Student Pathway has remained embedded within the service and has gone from strength to strength. We continue to foster strong working relationships with academic providers within the area to ensure consistent access to the service we provide. We also continue to review the content of the treatment we provide to ensure it remains relevant and in line with developments within the evidence-base. We continue to share our good practice with our board of commissioners to provide them with assurance of the quality of mental health care we deliver.
Has your service been evaluated (by peer or academic review)?
– National Intensive Support Team – Evaluation questionnaires completed by students upon completion of every workshop – Every student who completes treatment with service requested to complete patient experience questionnaire – Performance/clinical measures evaluation internally by service’s Performance & Research Manager – Paper wrote, evaluating pilot pathway in its early years
How will you ensure that your service continues to deliver good mental health care?
– Continued evaluation of Pathway performance – Continued openness and responsiveness to student and key stakeholder feedback – Continued training and professional development of therapists on pathway – Continued supervision and wellbeing support of therapists on pathway
What aspects of your service would you share with people who want to learn from you?
– 117 referrals in Quarter 4 of 2018/19 – Average of 10-15 students per Durham University Workshop
How do people access the service?
– Self referral via website or telephone – GP referral – Direct referral from specialised Student Pathway Mailbox
How long do people wait to start receiving care?
– 3 days for assessment from point of referral – Can access workshops within 6 weeks from point of assessment
What is your service doing to identify mental health inequalities that exist in your local area?
The Student Pathway was born out of an understanding of our high student population in Durham and Darlington. As a service, we are constantly striving to deliver an IAPT service that truly ‘improves access’ and given that students are a large hard to reach demographic we wanted to ensure that this important population were able to access psychological help when needed. Durham University, alone, close to 18,000 students and given that about a third of students will experience a common mental health problem during their studies, we felt it pertinent to address this. The university had the most diverse population within the community as a whole; they currently estimate that 35% of the student population will be from overseas by 2027. We have carried out a great deal of work with academic institutions to address stigma and we continue to work to break down the barriers to people accessing our service. The academic program has worked hard to tackle mental health stigma by engaging in a number of strategies. One of these strategies was the development of a strong social media platform, posting and campaigning on current mental health issues. We have promoted through our platform national campaigns such as the 2016 Heads Together campaign. This was launched with the aim of ending stigma around mental health by raising awareness and providing help for people with mental health challenges. There is a strong social stigma attached to mental ill health, and people with mental health problems can experience discrimination in all aspects of their lives particularly when they are at school, sixth form and University.
Many people’s problems are made worse by the stigma and discrimination they experience from society, but also from families, friends and employers. We have also worked with Durham University language department to look at the concept of mental health and how we can work to reframe our language and use of materials when working with overseas students. By doing this we positively promote the concept of mental health to a group of people who may have potentially never talked around this issue prior to coming to University. Our academic program staff have worked with University and college staff about the issues of mental health, encouraging teachers and mentors to get young people thinking and talking about mental health. We have with a number of sixth forms in the local area attended school assemblies, particularly around exam times to explore how mental health shouldn’t be a taboo subject, and that it is a topic everyone should be talking about. We also attend all academic fresher events and open days, linking in with local community events such as Pride, Academic Graduations, Job and Career events, University staff induction events.
In addition to this our website has been recently re-designed with the specific intention of being locally relevant and breaking down barriers. This is done with the use of local imagery, patient quotes, self-identifying language and simple referral routs to increase general access. The Student Pathway Team deserve this award as they have for many years worked in collaboration with our students to develop and deliver a specific therapy programme for the local student population. The academic team work to promote the values and behaviours of the Trust at all times. As Clinical Lead of the IAPT service across Durham and Darlington I am very proud of this initiative and the staff that work on this innovative programme. The staff work tirelessly to continuously improve the programme, to deliver treatment to this hard to reach group with compassion and expertise, they work in collaboration with patients, their families and academic tutors to ensure that all students who are suffering from anxiety and depression are offered high quality treatment in a timely manner.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
– Students being unable to access treatment in a timely manner due to transient living conditions and rigid service design
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
– Single Point of Access Telephone Assessment – PHQ9 – GAD7 – Phobia scales – Work and social adjustment scale – Anxiety disorder specific measures
What support do you offer families and carers? (where family/carers are not the service users)
– Provide family and carers the opportunity to sit in on sessions and be a part of treatment plan – Supporting family and carers with signposting information should they require any support
Commissioner and providers
Commissioned by: North Durham CCG; DDES CCG; Darlington CCG
Provided by : Talking Changes IAPT – Tees, Esk & Wear Valleys NHS Foundation Trust
Brief description of population (e.g. urban, age, socioeconomic status):
Student population from all Further and Higher Educational Establishments in County Durham & Darlington
Size of population and localities covered: 18,707 (2018/19) students at primary partner Durham University. Population across all other Educational Establishments in County Durham & Darlington unknown
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