Sunderland Psychological Wellbeing Service (SPWS) – NTW NHS Foundation Trust, Sunderland Counselling Service, & Washington Mind – NCCMH – Increasing Access to IAPT
Sunderland Psychological Wellbeing Service (SPWS) are extending their IAPT services into community and acute health services (IAPT-LTC). The new IAPT-LTC pathways are targeted at people with respiratory disease (including COPD), cardiology, stroke, diabetes (including obesity), cancer and chronic pain. With a focus on prevention and early intervention, the service deliver psychoeducation programmes exploring coping strategies and promoting access to IAPT.
Sunderland Psychological Wellbeing Service (SPWS) are extending their IAPT services into community and acute health services (IAPT-LTC). The new IAPT-LTC pathways are targeted at people with respiratory disease (including COPD), cardiology, stroke, diabetes (including obesity), cancer and chronic pain. With a focus on prevention and early intervention, the service deliver psychoeducation programmes exploring coping strategies and promoting access to IAPT.
Access
All IAPT work streams (including IAPT-LTC) are expected to meet the same waiting times standards. The service accepts GP and professional referrals and self-referrals over the phone or via an online referral form.
IAPT (whole service) referrals
6505
99.6% of patients began treatment within 6 weeks of referral and 100% began treatment within 18 weeks of referral.
IAPT-LTC referrals only
2992*
Not available
Note – figures for referrals entering treatment in 2016/17 financial year
* referrals with a recorded LTC, not all will be presenting reason for referral
Assessment
Physical health is a standard component of the initial triage assessment. Where an LTC is indicated, its impact on mental health will be explored through further discussion during the narrative component of assessment. Staff use the Sunderland IAPT Pathway to help determine level of need and whether to assign to low or high intensity interventions. The presence of a comorbid LTC is recognised as a complexity factor, however allocation is always on an individual basis determined with consideration to chronicity, comorbidity, complexity, cluster, risk, questionnaire scores, response to previous interventions and client choice.
NICE-recommended interventions
Interventions are offered in accordance with NICE-recommendations on depression and anxiety disorders, medically unexplained symptoms and comorbidity. A working group has been formed to explore new interventions. This includes a bespoke managing pain and fatigue class for people with depression and/or anxiety disorders and LTCs, or MUS, which builds on SPWS’s already successful portfolio of psychoeducation classes. The content and structure of the class was agreed among the team with supervision and feedback on content from a Health Psychologist at Northumbria University. The class focuses initially on the physical symptoms as these are the primary presenting problem but then integrate CBT principles and formulations to assist the person to explore how their physical symptoms impact on their emotional wellbeing and CBT interventions such as behavioural activation, pacing, sleep hygiene, relaxation and mindfulness are utilised to assist the client to make changes and manage symptoms more effectively. Psychological Wellbeing Workers who have completed training in LTC and MUS also offer guided self-help.
Outcome measures
Nationally IAPT services are required to collect a Minimum Data Set (MDS) with all clients throughout therapy. Following discussions with local health professionals it was agreed that a quality of life measure would also be used to supplement the MDS with clients who have comorbid LTC. Research suggested that the Warwick-Edinburgh Mental-Wellbeing Scale (WEMWEBS) was the most reliable quality of life measure. It can also be useful to use diagnostic specific LTC questionnaires to aide initial assessment and monitoring of change during therapy and SPWS have also introduced use of the Client Service Receipt Inventory (CSRI), Brief Pain Inventory, Diabetes Distress Scale and the COPD Assessment Test.
Workforce
Training in LTC and/or MUS is extended across all IAPT services to ensure that all staff are equipped to provide effective care for people with physical comorbidities. 68% of the existing IAPT workforce have now attended training. Training is currently provided via Teesside University and includes 5 days training for PWPs and 10 days for high intensity therapists; offering 20 credits and 40 credits respectively at level 7. SPWS has also established mutual training arrangements with physical health colleagues on the LTC pathways whereby IAPT provided training on Mental Health Awareness to increase understanding of how depression and anxiety may present in clients, and received training on COPD, asthma and stroke awareness and gained further insight into how therapy may be adapted to meet the needs of people with an LTC. This mutual sharing of knowledge and training also assisted in building relationships for future collaborative working.
Clinical leads and managers
1 clinical manager, 3 specialist clinical leads band 8a), 0.5 low intensity service lead (band 7), 3 team coordinators (band 78 senior PWPs (band 6)
1 data lead (band 5), 11 community psychiatric nurses (9 band 6, 2 band 5), 2 CPN (band 5), 2 employment support advisers (band 5)
Note – the workforce numbers above are whole-time equivalents
Working with the wider system
As well as the training arrangements discussed above, Clinical Lead’s and Senior PWP’s have met with local physical health teams to discuss patient needs. This has helped to highlight gaps in service provision and to develop clearer referral pathways. Pathway links have been established between IAPT, the Psychiatric Liaison Service’s Rapid Assessment, Interface and Discharge (RAID) Team and Stroke Services in which RAID actively work with the hospital based stroke services and sign-post to IAPT when appropriate. Moving forward the SPWS have plans to link in with the Sunderland Vanguard to help with ongoing networking, awareness raising and improved access.
Quote from the service on their key learning and achievements
Forging new referral pathways with physical health services has resulted in an integrated way of working with a range of specialist health services. Open lines of communication and referral pathways between mental and physical health services, coupled with a stronger understanding of the roles and remits of each service results in patients receiving a seamless and more informed experience of care and treatment. Since the pathway work started in 2014 the percentage of clients accessing the service with comorbid LTHC and CMHP has increased.
From 2014-2016 the average recovery rate of the Managing Pain and Fatigue class as measured by the PHQ9 and GAD7 was 32%. This is under the average overall recovery rate reported nationally by IAPT services (45%) however this client group is known to have lower recovery rates on those measures due to their physical health difficulties and therefore their recovery rate may always be reduced. There was significant improvement in 47% of clients WEMWEBS score which suggests improvement to quality of life. Qualitative feedback from clients suggests that they have benefitted from the Managing Pain and Fatigue class. One client stated – “The course is very helpful and focused. I’m getting more into the mind-set of accepting change as opposed to thinking about what I used to be able to do. The course has made a significant and hopefully lasting impact.”
Engaging with the specialist training has increased staff confidence and competence in delivering treatment with this client group. Working closely with health professionals has allowed our PWP’s to demonstrate the scope and flexibility of low intensity interventions. This also offers clients with comorbid LTCs and common mental health disorders a more focused and specialised package of care.
Further details
Commissioning
Sunderland CCG
Providers
Northumberland, Tyne and Wear NHS Foundation Trust
