PICuP has an international reputation for being one of the few entirely psychology-led services for psychosis in the UK. It provides NICE guidelines adherent Cognitive Behavioural Therapy for psychosis (CBTp) and is also involved in the training and dissemination of specialist skills in CBTp, and in research. PICuP provides NICE adherent Cognitive Behavioural Therapy for psychosis (CBTp). CBTp is clinically and cost effective but only received by 10%. Those with psychosis are high-risk and socially complex with poor engagement and high relapse rates. This contributes to poor patient safety and financial costs. PICuP allows increased access to psychological therapies. Our clinic has enabled significant reductions in patient costs through reducing admissions and reductions in patient psychotic/emotional symptoms with 93% being very satisfied/satisfied with treatment.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
PICuP has an international reputation for being one of the few entirely psychology-led services for psychosis in the UK. It provides NICE guidelines adherent Cognitive Behavioural Therapy for psychosis (CBTp) and is also involved in the training and dissemination of specialist skills in CBTp, and in research. PICuP provides NICE adherent Cognitive Behavioural Therapy for psychosis (CBTp). CBTp is clinically and cost effective but only received by 10%. Those with psychosis are high-risk and socially complex with poor engagement and high relapse rates. This contributes to poor patient safety and financial costs. PICuP allows increased access to psychological therapies. Our clinic has enabled significant reductions in patient costs through reducing admissions and reductions in patient psychotic/emotional symptoms with 93% being very satisfied/satisfied with treatment. We are providing consistent safe care to those with long-term conditions and promoting patient safety which is why we are worthy award winners. Our service started out as a research trial (funding from 1999-2003), providing therapy to those who did not meet severity and risk inclusion criteria for their local community team. In 2003 having established a referrals base we became fully funded as a specialist NHS service. In 1999 we employed 1 assistant psychologist, 1 therapist, and 1 administrator. We have since grown to 2 assistants, 10 therapists, 2 administrators, and 2 peer-recovery officers. The first few years we had approximately 40 referrals per year, and provided therapy for a total of 20 people, with an average of approximately 15 patients in therapy at any one time.
The last few years we have had approximately 150 referrals, provided therapy to 130 people, with 45 patients in therapy at any one time. To date we have received 1444 referrals. Our therapy effect sizes are impressive for this type of population. Our latest initiative has been to set up a Peer Support Service for clients who access psychological therapy within the clinic. This has been designed by our service users and continues to be run by service users. Many of our service users have distressing past and present experiences and we wanted to make the process of engaging in talking therapy as supportive and easy to access as we could. Our Peer Supporters engage with service users whilst they are waiting for therapy to provide information and reassurance about the therapy process. They also provide support during therapy. Peer Supporters are involved in the screening of research projects that are submitted to the clinic and they provide feedback to research teams about their promotional materials and information and consent forms. There are also research protocols in place, co-developed with service users, to ensure any potential risks are managed and service users and carers are recruited for studies in a safe and timely manner.
What makes your service stand out from others?
PICuP has an international reputation for being one of the few entirely psychology-led services for psychosis in the UK. We coordinated the national demonstration site for the Improving Access to Psychological Therapies for Serve Mental Illness (IAPT-SMI) initiative that worked across our trust (2012-16). The clinic is involved in the training and dissemination of specialist skills in CBTp. We run regular supervision groups and individual supervision (including overseas (e.g. Hong Kong, Australia, Germany, Japan, Ireland) through the use of Skype), individualised training courses, provide national and international workshops (including in USA, Japan, Hong-Kong, Europe), and contribute to the teaching and supervision of a number of Postgraduate Diplomas in CBTp. The clinic provides a platform for a programme of clinical research, and our research register has supported over 50 projects (leading to nearly 100 publications), both from our own research group and for outside projects. We host visits from international colleagues who come to learn from our expertise in providing and training in CBTp (e.g. Japan, Norway, Hong Kong, Italy, Singapore and Spain).
We have been influential in providing the template for two CBTp clinics overseas, one in Melbourne, Australia, and one in New York, U.S.A. Outcome: -Significant reductions in service-use costs (admissions and home treatment team days) during therapy (total cost per month (N=69): £14,844) and in the year following therapy (£12,031), compared to the year prior to therapy (£32,901). -Equality of uptake of therapy, 49% are from BME groups (N=505). -Reduction in psychotic symptoms: voices (effect size: 0.52; N=248)) and delusions (effect size: 0.75; N=302) following therapy, which is maintained at follow-up (effect sizes: 0.44 and 0.82) (all significant at p<.001). -Reduction in emotional problems: anxiety (effect size: 0.44; N=362) and depression (effect size: 0.51; N=360) following therapy, which is maintained at follow-up (effect sizes: 0.29 and 0.34) (all significant at p < .001). -Reduction in general distress (effect size: 0.61; N=180) and increase in life satisfaction (effect size: 0.49; N=361) following therapy, which is maintained at follow-up (effect sizes: 0.47 and 0.47) (all significant at p < .001). -Improvement in patient PTSD symptoms (effect size: 0.60; N=114). -93% (N = 351) are very satisfied/satisfied with therapy. Our latest initiative has been to set up a Peer Support Service for clients who access psychological therapy within the clinic. This has been designed by our service users and continues to be run by service users. Many of our service users have distressing past and present experiences and we wanted to make the process of engaging in talking therapy as supportive and easy to access as we could. Our Peer Supporters engage with service users whilst they are waiting for therapy to provide information and reassurance about the therapy process. They also provide support during therapy. Peer Supporters are involved in the screening of research projects that are submitted to the clinic and they provide feedback to research teams about their promotional materials and information and consent forms. There are also research protocols in place, co-developed with service users, to ensure any potential risks are managed and service users and carers are recruited for studies in a safe and timely manner.
Staffing
How do you ensure an effective, safe, compassionate and sustainable workforce?
PICuP is an incredibly close and supportive team. Each member of staff has half a day a week CPD and staff are supported and encouraged to complete further training. For example, many of staff are actively engaged in research, teaching, supervision of trainees and many staff have completed the post-graduate diploma in CBT for Psychosis at King’s College London. PICuP has an international reputation for being one of the few entirely psychology-led services for psychosis in the UK that provides high quality psychology interventions, research and training. This supports are recruitment and retention of staff. Staff are offered monthly clinical and managerial supervision facilitated by clinical academics and team meetings include an in house training section and reflective practice to ensure staff are up to date with the latest developments but also have a support. PICuP staff are given autonomy, flexible working arrangements where appropriate, and engage in team social events in order to manage well being and a work life balance. PICuP value contributions from experts by experience and the team believe no service can work effectively without collaborative input from our service users. We therefore do have a Peer Support Service for clients who access psychological therapy within the clinic. This has been designed by our service users and continues to be run by service users who are employed by PICuP and paid by the trust.
Who is in your team?
Dr Emmanuelle Peters (Clinic Director) 8D; 0.2 wte Dr Nadine Keen (PICuP Coordinator) 8C; 0.6 wte Dr Juliana Onwumere (Clinical Psychologist) 8C; 0.2 wte Dr Vaughan Bell (Clinical Psychologist) 8B; 0.4 wte Dr Majella Byrne (Clinical Psychologist) 8B; 0.6 wte Dr Annis Cohen (Clinical Psychologist) 8B; 0.6 wte Dr Sarah Grice (Clinical Psychologist) 8B; 0.5 wte Dr Rumina Taylor (Clinical Psychologist) 8B; 0.4 wte Dr Rebecca Kelly (Clinical Psychologist) 8A; 0.8 wte Dr Liam Mason (Clinical Psychologist) 8A; 0.2 wte Dr Sorcha Mathews (Clinical Psychologist) 8A; 1.0 wte Elizabeth Harris (Psychology Assistant) 4; 1.0 wte Hannah Meechan (Psychology Assistant) 4; 0.5 wte Dorothy Abrahams (PICuP Administrator) 4; 1.0 wte Christopher Shoulder (Peer Recovery Officer) 4; 0.2 wte Marilyn Tuitt (Peer Recovery Officer) 3; 0.2 wte
How do you work with the wider system?
PICuP is a stand alone psychology service. This means we work closely with our service users wider system such as their social network (where consent given), and often their GPs and community teams which may be mental health teams or addiction services. We know people with severe mental illness die 15-20 years earlier due to poor physical health so it is crucial we support our service users to access other physical health services as well as mental health support. We very much advocate for our service users and often support them in negotiating housing and benefits. Therapy can also involve linking service users with voluntary agencies such as accessing extra curricular activities of interest or work. We encourage our service users to join our Peer Support Service after therapy to support others starting treatment.
Do you use co-production approaches?
Our latest initiative has been to set up a Peer Support Service for clients who access psychological therapy within the clinic. This has been designed by our service users and continues to be run by service users. Many of our service users have distressing past and present experiences and we wanted to make the process of engaging in talking therapy as supportive and easy to access as we could.Our Peer Supporters engage with service users whilst they are waiting for therapy to provide information and reassurance about the therapy process. They also provide support during therapy. The PICuP Research Register supports service users and carers to be involved in research. In particular, PICuP have supported research into psychological interventions for psychosis. The Research Register enables access to innovative talking therapies to service users and carers, such as, in the last year, AVATAR therapy, Compassion-Focused Therapy, and Cognitive Bias Modification therapy for paranoia. PICuP has service user and carer involvement throughout all stages of the support of a research project. Service users employed by PICuP as peer supporters are involved in the screening of research projects that are submitted to the clinic for support by the register, and in providing feedback to research teams about their promotional materials and information and consent forms. There are also research protocols in place, co-developed with service users, to ensure any potential risks are managed. Everyone on the register is provided with feedback on the outcome of the research supported by PICuP in an annual newsletter, in addition to summaries being provided for particular studies individuals have participated in.
Do you share your work with others?
PICuP is an award winning service integrating clinical practice, training and research. Following the award of an R&D grant to carry out an RCT of Cognitive Behavioural Therapy for psychosis (CBTp), it was successful in securing funding from the NHS Trust to continue as a clinical service, demonstrating best practice in translational research. All PICuP’s staff are clinical academics who regularly contribute to research. It provides a platform for a programme of clinical research, with the Research Register having supported over 60 projects in the last 10 years (leading to nearly 100 publications). This has ensured that real world clinical outcomes that matter to patients have been included adding value to research. The clinic is involved in the training and dissemination of specialist skills in CBTp. We run regular supervision groups and individual supervision (including overseas (e.g. Hong Kong, Australia, Germany, Japan, Ireland) through the use of Skype), individualised training courses, provide national and international workshops (including in USA, Japan, Hong-Kong, Europe), and contribute to the teaching and supervision of a number of Postgraduate Diplomas in CBTp. We also host international interns (e.g. from Canada), provide placements for trainees on the Doctorate in Clinical/Counselling Psychology, and provide Continuous Professional Development for approximately 10 qualified therapists per year (who volunteer with us on a sessional, temporary basis). Over 150 therapists have received supervision from us over the last 13 years.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
PICuP believe in evidence based practice and therefore used PROMS, CROMS and PREMS at baseline, before, during, after and 6 months after therapy. These outcome measures are completed by psychology assistants who are separate from PICuP therapists. We share are data with service users, teams, wider NHS trusts and CCGs as well as publishing our work. Our therapy effect sizes are impressive for this type of population. -Significant reductions in service-use costs (admissions and home treatment team days) during therapy (total cost per month (N=69): £14,844) and in the year following therapy (£12,031), compared to the year prior to therapy (£32,901). -Equality of uptake of therapy, 49% are from BME groups (N=505). -Reduction in psychotic symptoms: voices (effect size: 0.52; N=248)) and delusions (effect size: 0.75; N=302) following therapy, which is maintained at follow-up (effect sizes: 0.44 and 0.82) (all significant at p<.001). -Reduction in emotional problems: anxiety (effect size: 0.44; N=362) and depression (effect size: 0.51; N=360) following therapy, which is maintained at follow-up (effect sizes: 0.29 and 0.34) (all significant at p < .001). -Reduction in general distress (effect size: 0.61; N=180) and increase in life satisfaction (effect size: 0.49; N=361) following therapy, which is maintained at follow-up (effect sizes: 0.47 and 0.47) (all significant at p < .001). -Improvement in patient PTSD symptoms (effect size: 0.60; N=114). -93% (N = 351) are very satisfied/satisfied with therapy. Peters et al. (2015). The long-term effectiveness of cognitive behavior therapy for psychosis within a routine psychological therapies service. Frontiers, 29, https://www.frontiersin.org/articles/10.3389/fpsyg.2015.01658/full What do service-users say about our service? “I wouldn’t be here today if I hadn’t had CBTp. Not only did it help me recover but it was educational and empowering.” What do carers say about our service? “My son has had a severe mental illness for over 30 years. With the therapy the change in him is remarkable – within months we could see the change in his attitude to life and the people around him. He now works part-time, something we could never have foreseen before. For the first time we feel he stands a chance of leading a more fulfilled life.” What do referrers say about our service? “My patient had been on extended sick leave from work for over 4 years. However he made excellent use of the CBT at PICuP, successfully returning to work and sustaining employment subsequently.”
Has your service been evaluated (by peer or academic review)?
PICuP is an award winning service and has received recognition from SLaM as well as external organisations. We regularly publish our work as described above. Awards to date: Dr Emmanuelle Peters, BPS Award for Distinguished Contributions to Psychology in Practice, 2018 Clinical Research Network South London Finalists 2018 Winners Quality, Excellence, Training, SLaM, 2017 HSJ Patient Safety Award Finalists, 2017 Dr Vaughan Bell, May Davidson Award, BPS, 2017 Winners Psychology and Psychotherapy Service User Involvement Award, 2015 Highly Commended Clinical Governance Awards, SLaM, 2005 and 2007
How will you ensure that your service continues to deliver good mental health care?
PICuP provides a different mode of provision i.e. enabling access to time-limited intervention in psychological therapies team rather than MDT, to cater for different needs of population with psychotic symptoms. We regularly promote this to our commissioners and we provide psychological interventions where there are gaps in provision – not duplication. For those: – Not meeting severity/risk/MDT criteria for general community teams – Non-schizophrenia diagnoses (e.g. Mood, Affective & Personality disorders) – Highly psychologically complex (e.g. requiring trauma-focused work combined with psychosis work). The clinic is also involved in the training and dissemination of specialist skills in CBTp. The training programme has grown over the last 13 years from generating £3K of income per year for the clinic to £100K in 2011-12 and £150K in 2017-18. The clinic provides a platform for a programme of clinical research, and our research register has supported over 50 projects (leading to nearly 100 publications), both from our own research group and for outside projects. The central ethos to PICuP is evidence-based practice. This has ensured that real world clinical outcomes that matter to patients are translated to clinical practice.
What aspects of your service would you share with people who want to learn from you?
We are a specialist or add on service. We always have to justify ‘our presence’ especially at times of great austerity within the NHS. We have done this by finding a niche area and by proving we can increase access to psychological therapy and deliver NICE adherent CBT for psychosis. We also demonstrate we can do this by evaluating our work constantly, sharing our outcomes and publishing our data. We coordinated the national demonstration site for the Improving Access to Psychological Therapies for Serve Mental Illness (IAPT-SMI) initiative that worked across our trust (2012-16). We are keen to improve the delivery of CBT for psychosis and therefore are a centre of excellence for the training of CBT for psychosis which also provides us with an additional funding stream. We share are expertise with others and have free CPD opportunities for other therapists. We host visits from international colleagues who come to learn from our expertise in providing and training in CBTp (e.g. Japan, Norway, Hong Kong, Italy, Singapore and Spain). We have been influential in providing the template for two CBTp clinics overseas, one in Melbourne, Australia, and one in New York, U.S.A. We have seen the value in having experts by experience working alongside us. Our Peer Support Service for clients who access psychological therapy within the clinic. This has been designed by our service users and continues to be run by service users. Many of our service users have distressing past and present experiences and we wanted to make the process of engaging in talking therapy as supportive and easy to access as we could. This service has allowed more patients to access therapy and be supported during the process.
How many people do you see?
March 2017-March 2018 number of referrals = 276 Accepted = 216 Bipolar Group or Compassionate Therapy Group 6 attendees
How do people access the service?
Referral from GP, CMHT or other (assessment and liaison; addictions) We liaise with CCGs directly to arrange funding for those who are finding it hard to access. Before and during therapy our Peer Supporters work with service users to help them access the service. We have a dedicated PICuP Coordinator who triages all referrals, coordinates funding, assessment, allocation to a therapist.
How long do people wait to start receiving care?
Referrals are seen within 2 weeks for assessment. The wait for therapy is then 3-6 months. This is shorter than other services.
How do you ensure you provide timely access?
We have a dedicated PICuP Coordinator who triages all referrals, coordinates funding, assessment, allocation to a therapist.
What is your service doing to identify mental health inequalities that exist in your local area?
We collect outcome measures at baseline, before, during and after therapy. -Patients receive 6-9 months of therapy (median = 19 sessions; 20% have 26+ sessions); 5% come back for 6 booster sessions. -Of those who start therapy, only 8% don’t engage (<5 sessions); in RCTs the average drop-out rate is 25%. -Patients get access to service-user volunteers to help attend sessions and community activities. -Significant reductions in patient costs through reducing admissions and home treatment contacts and equality of access despite ethnic background. -Reductions in patient psychotic and emotional symptoms and general distress with 93% being very satisfied/satisfied with the treatment received.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
We know traditionally BME service users find it difficult to access services. We have been very conscious of this and this is a key outcome for us. We have equality of access. Equality of uptake of therapy, 49% are from BME groups (N=505).
What is your service doing to address and advance equality?
All staff receive regular equality and diversity training. We work closely with service users from our local population and encourage them to join our Peer Support Service so we can learn about their needs and seek their expertise. We have a dedicated Peer Support Service to help and increase access and reduce stigma. We evaluate who is accessing our service to check it is accessible to all populations. Therapy is tailored to the person to ensure personal understandings of psychosis and goals are what drive therapy.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
All service users have a detailed assessment at baseline, before, during, after therapy. We also meet with our service users 6 months later. We work with clients to link them in to any services they require such as medical or housing.
How do you meet the needs of people using the service and how could you improve on this?
PICuP provides NICE adherent Cognitive Behavioural Therapy for psychosis (CBTp). CBTp is clinically and cost effective but only received by 10%. To date we have received 1444 referrals. Our therapy effect sizes are impressive for this type of population. We prepare our service users for ending by spacing our sessions towards the end of therapy, linking them in with our Peer Support Service so they can be part of our team, and offer longer 6 month follow ups.
What support do you offer families and carers? (where family/carers are not the service users)
We offer family interventions as part of our service where information about mental health problems, treatment and care options are provided. We provide carer support and can arrange carer assessments. We link into local services such as carer groups.
Brief description of population (e.g. urban, age, socioeconomic status):
We work with adults (18-65 years). Most of the referrals are from SLaM and the wider South East sector although we do have referrals from throughout the UK. Referrals range in diagnosis and severity, from articulate professionals who require help with a single psychotic experience, to individuals with chronic mental health difficulties with cognitive impairments, social deprivation, and history of trauma.
Size of population and localities covered:
Primarily boroughs of Southwark, Lambeth, Lewisham and Croydon but we do accept referrals from other trusts throughout the UK.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Southwark, Lambeth, Lewisham, Croydon CCGs
Provided by (e.g. name of NHS trust) or your organisation: *
