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The right kind of help when you need it

The right kind of help when you need it. Dr Paul Sigel – Primary Care Psychology. Where PCP Fits in the Pathway. Screening. Physical Health Problem: Assess mental health & coping. Review prn, aim for annually in those with chronic diseases (no longer in QOF). Bio-psychosocial Assessment.

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The right kind of help when you need it

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  1. The right kind of help when you need it Dr Paul Sigel – Primary Care Psychology

  2. Where PCP Fits in the Pathway Screening Physical Health Problem: Assess mental health & coping Review prn, aim for annually in those with chronic diseases (no longer in QOF) Bio-psychosocial Assessment High suicide risk Primary Care Psychology Pt wants therapy Crisis/ CMHT  Engagement Issues PCPCS (Tavi)

  3. Primary Care Psychology Treatment for patients in PbR clusters 5-7 & difficult to engage Complex presentations, including co-morbidity, significant social problems & risk. Neuropsychological assessment & Rx management. Treatments for mild- moderate autistic spectrum disorder, eating problems, psycho-sexual problems. Supervision, training & clinical management PCP Service Model Clinical Health Psychology: LTC & MUS Condition-specific clinical health psychology interventions; Admission avoidance & condition management within acute/community LTC pathways. Consultation, training & treatment planning to acute & community MDTs Supervision and training IAPT • Protocol-based treatments for common mental health problems for patients in PbR Clusters 1-4: • --mild, moderate and severe [but not complex] depression & disorders [panic, GAD, social anxiety, post-traumatic stress disorder] • --mild to moderate-severe obsessive- compulsive disorder, • Protocol-based clinical health psychology interventions for physical health conditions, including long-term conditions.

  4. Low –Intensity • 1:1 Telephone and Face to Face Therapy • Psycho- education & Skills Groups • Condition-specific interventions for LTC High Intensity • CBT for Common Mental Health Problems • Mindfulness-Based CBT for Depression • Interpersonal Therapy for Depression [IPT] • Couples Therapy • EMDR for PTSD • Condition-specific interventions for LTC • CBT for Chronic/ Complex Depression & Anxiety Disorders Treatment Modalities

  5. PCP sees a disproportionately high proportion of severe presentations

  6. IAPT services vary significantly in the proportion of patients with chronic/complex anxiety or depression. • Most large IAPT services in areas of social-deprivation have high proportions of more severe presentations. This includes the City & Hackney service. Large iapt services in areas of social deprivation have more severe & chronic/complex patients

  7. Working with GP Practices • 1. Seeing patients in Surgeries • 2. Attending practice mtgs • Joint work with pts presenting with risk. • High Quality Primary Mental Health Care– Let us know about patients requiring special management through our rapid access pathways

  8. Managing Long-Term Conditions: Primary Care Psychology Dr. Melanie Rendall

  9. Long-term condition pathways • Gastroenterology (e.g., IBD; IBS) • Dermatology (e.g., eczema; psoriasis; acne; complex leg ulcers) • ASD/Aspergers • Cardiac • Chronic Obstructive Pulmonary Disease (COPD) • Diabetes • Older Adults (e.g., dementia) • Women’s Health (e.g., gynaecological issues; reproductive health; menopause; endometriosis) • Tinnitus/hyperacusis

  10. Additional LTC services • Adult Community Rehabilitation Team (ACRT) • Graham Stroke Unit (GSU) • Pain management • Sickle Cell & Thalassemia • Admission avoidance (pilot project completed)

  11. Long term conditions & older people in Hackney • 71% stated that they, or a family member, had a LTC • 49% had multiple LTCs • 25% of those with LTC endorsed depression or other mental health issue • 76% of those who were depressed had LTC • 44% were living alone

  12. Long term conditions & older people in Hackney • Do we have any audit data about referral numbers for older adults? • If not, perhaps just a general reflection about low numbers referred through GP and mention that cohort which one would presume might not be likely to self-refer • Could comment on the admission avoidance project and how sig number were >70 - need to creatively target this group????

  13. Carers and mental health • Up to 40% of carers experience psychological distress or depression (RCGP, 2007) • Carers have an increased rate of physical health problems (Carers UK, 2007) • 51% of carers for someone with dementia report don’t feel they get support to talk about their needs (Carers Trust Report, 2013)

  14. Carers and mental health • Carers should be routinely screened for depression and mental health problems as they often ‘neglect’ their own well-being (Clare Gerada, 2013) • Recommended creating a register to help those experiencing depression or psychological problems • Current best practice?

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