TalkingSpace & TalkingHealth

1. 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

2. Outline of the session • Overview of TalkingSpace • TalkingHealth: Services for people with long-term health conditions • MBCT within IAPT • Questions and answers

3. Referrals to TalkingSpace • TS receives 6500 referrals a year • Primarily self-referral • The service is meeting nationally agreed recovery rates (40-50%)

4. The stepped care model

5. 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

6. 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

7. Patient journey continued Patient 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)

8. 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

9. 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

10. 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.

11. 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)

12. Additional interventions and services • Employment support (Restore) to liaise, provide signposting and support for people struggling to stay in employment

13. 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

14. 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)

15. 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?

16. Priorities 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

17. Cardiac services • Input to classes run by nursing staff (psychoeducation) • Guided self help (step 2) • Individual CBT and staff supervision groups (step 3)

18. TalkingHealth: Diabetes • The number of people recorded as having diabetes accessing the service has doubled over the last year

19. 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

20. Evidence to support a course Initial outcomes suggest: • Greater improvements in mood (PHQ-9) than in standard class • Improvements in physical health (HBA1c)

21. 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

22. 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

23. MBCT for LTC’sFor GAD 7, the change was from 9.12 to 5.5 with 50% moving fromclinical to non clinical range

24. 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

25. Future directions • Continue to adapt and develop MBCT for LTC’s and MUS • Individualised measures • Developing links with pain services

26. Questions?