The Waiting List Group
The Waiting List Group is for all service users waiting for treatment on the non-psychosis pathway. The aim of the Waiting List Group is to reduce isolation, to maintain and where possible improve the wellbeing of service users whilst they are waiting for their therapy appointment. The Waiting List Group is not a therapy group, instead the group:- Provides support; Provides psycho education and information; Prepares service users for their forthcoming therapy. The group runs on a 12 week block cycle and is held in a warm, friendly and safe space. At the end of each 12-week cycle, if a service user has not been allocated to a practitioner, they can opt in for another 12-week cycle or opt for a monthly waiting list call. Service users can join the group at any point in the 12-week cycle.
What We Did
Sunderland has a population of nearly 300,000 people. Sunderland South Community Treatment Team is one of three Secondary Mental Health Teams covering this locality. We offer evidence based interventions for people experiencing moderate to severe mental health problems. Each team is made up of a number of health care professionals including Consultant Psychiatrists, Psychological Therapists, Registered Nurses Mental Health, Occupational Therapists, Clinical Support Assistants, Peer Support Workers and Junior Doctors. We have additional support from Specialist Services (including Specialist Psychological Services), Drug and Alcohol Services and Chaplaincy, and work closely with the Local Authority, Acute Hospitals and 3rd Sector Organisations.
Over the last 4 years Sunderland Community Services have undergone significant service development in collaboration with Statutory Services, 3rd Sector organisations, Service Users and Carers. We focus on
recovery: working alongside Service Users to enable them to follow their own recovery path; personalisation: meeting the needs of individuals in ways that work best for them; co-production and partnerships: delivering services with (rather than for) people with mental health problems; collaborative care: working with people as experts in their own mental health; promoting social inclusion; prevention through public health strategies and early interventions (physical health wellbeing, WRAP); Recovery focus; Biopsychosocial interventions utilising a MDT approach.
Sunderland has a high rate of deprivation, drug and alcohol misuse and unemployment. This along with better communication and reduced stigma for people with mental health needs have all contributed to a significant increase in our referral rates. This has been compounded by limited resources which is a consequence of the reduction in NHS funding.
Over the last 12 months, Sunderland South Community Treatment Team has received over 650 referrals for service users who require assessment and treatment for complex mental health problems. We have found that our demand for treatment exceeds our current resource resulting in increasing waiting lists for treatment.
Although we acknowledged the service gap in being able to offer treatment on completion of assessment of needs, we were keen to explore initiatives designed to improve capacity whilst maintaining service user choice.
Sunderland and South Tyneside Psychological Services are interested in what our service users think about the service they are accessing and how we can improve our service to better meet their needs.
In April 2016 a snapshot survey was chosen to obtain baseline data of what our service users thought of our service. The Points of You questionnaire (POY) was chosen, as this had been developed by service users and had been implemented in other areas of Northumberland Tyne & Wear NHS Foundation Trust; thereby standardising the way service user feedback is collated. It was hoped by taking this approach it would not only provide service user feedback, it would also enable psychological services across geographical areas to compare results and share good practice at a future date.
An 88% response rate was achieved from the April 2016 snap shot survey. Findings highlighted that overall service users were very happy with the service and treatment they received. The main area of concern was waiting times. 24% of respondents stated that they were not happy with waiting times to access treatment. Sunderland and South Tyneside Psychological Services reflected on this feedback and established a waiting list initiatives group to focus on ways waiting times could be reduced.
As psychology are embedded within Community Treatment Teams across Sunderland and South Tyneside, the findings from the POY survey were also disseminated across all teams and there was recognition that waiting times are high not only in psychology but for all service users accessing the Community Treatment Team. This led to further discussions regarding waiting times for service users.
Sunderland South Community Treatment Team acknowledged that waiting list initiatives to reduce waiting times would take time to embed and did not address the immediate concern that service users were waiting months to be offered treatment, which could be detrimental to their wellbeing. Most importantly, service users were not happy with waiting times.
Sunderland South Community Treatment Team started to explore initiatives that could be developed to offer service users something meaningful and helpful, that service users could access immediately while waiting for their treatment. The Waiting List Group was therefore established to meet this need.
A small group met to discuss how to address the concerns raised by service users. The Pathway Manager and Psychological Therapist were keen to develop a group environment which could “hold” service users until allocation of a clinician for treatment. Our ideas were supported by our Directorate Manager. We had interest from a Community Psychiatric Nurse and Peer Support Worker to support in the facilitation of the group.
The Waiting List Group
The Waiting List Group is for all service users waiting for treatment on the non-psychosis pathway. The aim of the Waiting List Group is to reduce isolation, to maintain and where possible improve the wellbeing of service users whilst they are waiting for their therapy appointment.
The Waiting List Group is not a therapy group, instead the group:-
• Provides support
• Provides psycho education and information
• Prepares service users for their forthcoming therapy
The group runs on a 12 week block cycle and is held in a warm, friendly and safe space. At the end of each 12-week cycle, if a service user has not been allocated to a practitioner, they can opt in for another 12-week cycle or opt for a monthly waiting list call. Service users can join the group at any point in the 12-week cycle.
The group is facilitated by a therapist from psychology and a Community Psychiatric Nurse. A Peer Support Worker (who is an individual who has lived experiences of mental health and accessing services, who now works for the team) supports the Waiting List Group.
All service users on the existing waiting lists were offered the opportunity to attend the Waiting List Group, as well as new service users. Service users who receive a monthly waiting list call, are also given the opportunity to attend the group each month during their telephone contact.
Once a service user decides they would like to attend group, they are offered a meet and greet appointment. This is to improve engagement, answer any questions and to provide the service user with a risk management plan prior to joining the group. We also ask each service user to choose topics they would like the facilitators to cover in the group and their personal goals. An underpinning principle of this group, is that the group is shaped and developed by its members.
How The Waiting List Group has made a Difference to staff and service users
The group started in October 2016 and is now on its third 12 week cycle. The Waiting List Group has made a real difference to the people who have accessed it. Data gathered to date shows that, 100% of service users were happy with the time it took to access the group, Warwick-Edinburgh Mental Wellbeing Scales cores that are taken at the start, mid-point and end of the 12-week cycle, all show an improvement in service user wellbeing.
Below are also some of the comments taken from The Waiting List Group service user feedback forms:
“I really enjoyed it and it’s helped me focus on how I can change situations”
“I found this group really enjoyable and I seemed to need each topic at different times so they will all come in handy … staff were really lovely and understandable and listen NO judgemental. Other people in group were lovely and I enjoyed every week. “
“The waiting list for my treatment was too long/ the waiting group helped miracles”
“…helped with my anxiety while awaiting treatment. It also made me look forward to treatment”. “
“I have really enjoyed the course. I found depression and low mood good because it made me look at things different.”
“I have enjoyed the creative side of the sessions, I find it a help coming to the group as it gives me support while I wait for therapy among people who may experience similar problems”
“The advice on trying to sleep better, helped my sleep patterns”
“We all had our say and was asked for our input as it was about us”
“The group was a lifesaver”.
In addition to the difference it has made to service users who have accessed this group, it also led the Community Treatment Team to think about treatment groups and whether this may be something that may be helpful to both service users and help reduce treatment waiting times. As a result of this, a new ‘Understanding your Emotions’ group has been established to help people learn emotional regulation skills. This is currently in its first cycle. Other treatment groups are currently being discussed, including a mentalisation group.
This initiative has also provided Sunderland South Community Treatment Team staff an opportunity to facilitate a group, therefore developing their skill set and experience in group work. The Peer Support Worker who supports the Waiting List Group has also expressed an interest in engaging with further group training. Anecdotal feedback from other team members, is that it has been good to offer service users a service they can access immediately rather than a waiting list call only. The group also runs on a cascade training approach, so that if one facilitator leaves the service, the group can still continue.
We also offer monthly telephone contact with service users waiting for allocation of a clinician. This is to ensure there is no significant change in need, to assess motivation and ability to engage in treatment and to reassure service users that they are thought about and we will allocate as soon as practicable. We ensure that the same clinicians maintains this contact to promote rapport and consistency.
Service users are offered a choice in how they are supported whilst on treatment waiting list.
Wider Active Support
Service user feedback from the Points of You (POY) snap shot survey was the primary reason The Waiting List Group started. The POY snap shot model that was used to help inform the Waiting List Group has been shared across Northumberland Tyne and Wear NHS Foundation Trust Heads of Psychology, Clinical Management Team and Sunderland and South Tyneside Community Treatment Teams.
As the model has been successful in terms of response rate, Sunderland and Newcastle Community Treatment Teams are now working together to improve co-production. In addition, Northumberland Tyne and Wear NHS Foundation Trust have started 3 Big Questions initiatives, where service users are asked questions relevant to the service they are accessing. This work is continuously developing.
Our specialist Psychotherapy Services supervise the Waiting List Group facilitators and are currently discussing ways the group can be developed. In addition, other services such Cognitive Analytic Therapy Service have shown an interest in our Waiting List Group model to help manage their waiting lists.
As the Waiting List was only established in October 2016, we are waiting to see further service user feedback before linking with other partner organisations. However, we do plan to disseminate findings to our partner organisations.
As stated in the ‘What We Did’ section due to the high response rate from the April 2016 Points of You snap shot survey, it was recommended that this model should be repeated at different intervals to measure change and to continue to gather service user views and experiences.
In November 2016 when this model was repeated, we received a 93% response rate. As this model has been successful, it is being replicated across other departments within our Trust. One example of this is the ‘3 Big Questions’ initiatives, where service users are asked questions relevant to the service they are accessing.
As it appears we have the implementation model correct, we wanted to ensure that Points of You questions that were designed by service users several years ago were still relevant. We plan to hold focus groups with our service users to see if they want to change or develop any of the questions asked. We are also asking staff and carers for their views too.
Focus groups are also being held to discuss waiting time initiatives. It is anticipated that with this joint working between staff, carers and service users, we will be able to produce something meaningful to help reduce treatment waiting times.
The Waiting List Group is developed by its members, each group picks the topics of interest to them over the 12 week period. Facilitators then provide materials, strategies and so forth to meet the needs of the group. The group are often asked for feedback on how to shape and develop the sessions in the group.
Co-production has started within our team and we are engaging with this framework. We plan on continuing to develop this with our service users, carers and staff, as we want the best for our service users and their carers. We truly believe that by working together we can create meaningful and sustainable change.
Looking Back/Challenges Faced
Service user’s motivation to engage can change whilst waiting for treatment. There are a number of reasons why this should happen, for example, it may be a result of natural improvement of mental wellbeing, feeling demotivated by not receiving treatment following assessment, or service user is not ready/able to engage in psychological intervention at this time. We recognise that although service users may benefit from interventions, they may not be psychologically motivated to engage in treatment. We also acknowledge that some service users struggle to engage in treatment because of their mental health and we ensure we actively engage such service users.
We believe that service users should be informed of choices regarding treatment and for therapy to be successful, they invest time to attend appointments and to complete agreed interventions outside of 1-1 therapeutic time with clinician. We have already commenced completing Therapy Agreements with our service user group once allocated for treatment and this is to be rolled out to all service users once it is collaboratively agreed that interventions are required from our team to improve their mental health.
Service users often believe that 1-1 interventions are “better” as they have the individual attention of the clinician. Promoting the benefits of group work is challenging: service users often have concerns around confidentiality, talking in front of others, transportation issues and mental health issues which they believe will increase in a group setting. We need to dispel the myth of group work and promote its benefits. We can achieve firstly this by educating our clinicians, involving service users in promoting groups, providing written positive stories to keep in reception area
We believe that the model of group work is sustainable and will promote service user flow, improve service user experience, develop the skills of our team, improve staff motivation and their health and wellbeing. This will be achieved by providing more group work across a number of different mental health presentations, for example anxiety management, depression management, voice hearing. This will reduce the waiting time from assessment to treatment, ensuring service users’ needs are met in a timelier manner and improving service user’s experience of their journey through services. All staff will have the opportunity to develop skills by co facilitating and then facilitating groups. When staff progress and leave our team, their vacancy will not result in a gap in service delivery as other staff will be trained in this area. The team will be able to recognise and acknowledge innovation at work, reduced waiting lists and this should have a positive impact on their own emotional wellbeing. We will ensure the development of groups is a collective process involving clinicians and service users in a collaborative approach.
We already have a shared drive accessible by the team where all group material is held. This will allow staff to cover any group at short notice.
Evaluation (Peer or Academic)
The Waiting List Group has not been independently evaluated. However, service users are asked to complete feedback forms and WEMWBS which helps to evaluate if the group aims are being met and if service users are finding the group helpful.
The Waiting List Group has made a real difference to the people who have accessed it. Data gathered to date shows that, 100% of service users were happy with the time it took to access the group, Warwick-Edinburgh Mental Wellbeing Scales cores that are taken at the start, mid-point and end of the 12-week cycle, all show an improvement in service user wellbeing.
We intend to produce a report for dissemination initially across Northumberland Tyne and Wear NHS Foundation Trust. This will then be shared across other organisations with the hope that our experiences and outcomes can be adapted to improve the recovery journey for a much wider mental health population.