Guided Self-Help for Common Mental Health Difficulties: Gloucestershire Primary Mental Health Service

1. Guided Self-Help for Common Mental Health Difficulties: Gloucestershire Primary Mental Health Service Alison Sedgwick-Taylor (Consultant Clinical Psychologist) Anna Lambert (Graduate Mental Health Worker and Self Help Guide)

2. Overview Background Gloucestershire Service Definition Potential Advantages of GSH Effectiveness Role of Guide/Tape Workbook Content Evaluation

3. Availability of Psychological Treatments Psychological treatments are effective for a wide range of psychiatric disorders (Roth and Fonagy, 1996; Parry et al., 2002) Much public enthusiasm for psychological interventions (Andrews, 1996) Cognitive Behaviour Therapy (CBT) � strongest evidence base � particularly for depression and anxiety NICE Guidelines Access?

4. New Ways of Working Intensities of therapy (Stepped Care continuum) Setting Workforce ie Provide a range of different interventions across settings, delivered by people with less specialist training

5. Gloucestershire Solution Stress Management Courses Anger Management Courses Computerised Cognitive Behaviour Therapy (CCBT) Guided Self-Help Depression Anxiety Anger (in development) Maternal Mental Health (in development)

6. Self-Help Interventions � A Definition Cuijpers (1997) � The patient receives a standardised treatment method with which he can help himself without major help from the therapist. In the self-help approach it is necessary that treatment is described in sufficient detail, so that the patient can work independently. Books, in which only information about depression is given to patients and their families cannot be used�

7. Definition Continued Distinction between providing information to people and providing �self-help� Structured approach which requires the subject to act on advice provided within the self-help material Clear model and structure of treatment which focuses on problems of relevance to the patient Almost all self-help approaches have used a cognitive, behavioural or problem-solving approach

8. Definition Continued Emphasis on homework (putting into practice what has been learned) Emphasis on how patient can improve their skills to cope with and manage their own difficulties

9. Potential Advantages of Self-Help Empowering mental health service users Move away from paternalistic system Service user and professional collaborate to find a solution to problem(s) Using expertise and experience of users themselves

10. Greater accessibility and acceptability to patient Reduce stigma Preferred option (Jorm et al., 1997) More availability/ enlarges choice for patients Enables patients to receive help they might otherwise reject Low cost More accessible delivery methods, e.g., telephone and computer Limited waiting time No geographical limits

11. Potential Advantages of Self-Help Continued More efficient/creative use of professional time Compliments existing usual care (improve outcome, discharge route, maintenance gains) Low intensity psychological intervention that can be used in primary care Delivering guided self-help uses the graduate mental health worker workforce effectively

12. Evidence for Effectiveness Report to the DoH Research and Development Programme (Lewis et al., 2003)-NICE Guidelines Under researched Much of the research in USA � poor quality Despite this:- Significant benefit of self-help materials, based upon a CBT approach, for depression, anxiety, bulimia and binge eating disorders when given in the context of: - Clinical assessment - Ongoing monitoring - Alternative options available if self-help intervention ineffective or unacceptable

13. Recommendations Self-help material should be: Based on CBT Include case vignettes Large format with photocopiable or removable sheets Modest reading age Attractively produced Further research needed - No vested interest

14. Guided Self Help Service Protocol GP/PHCT Gateway Mental Health Nurse/Triage Nurse Guided Self-Help (1 option) Depression Anxiety Anger Maternal Mental Health Workbook (�5) Call us for a �Guide� Telephone calls for 8-12 weeks Patient finishes the programme Follow up (6 months)

15. Tape To illustrate: Up-beat approach Cognitive restructuring Collaboration

16. Role of the Guide Assess Support Monitor Motivate Teach NOT a therapist BUT a skilled role (training and supervision)

17. Book Content Goal Setting / Self Monitoring Behavioural Breathing Relaxation Graded Practice Cognitive Catching, challenging and changing negative thinking Life Skills Assertiveness Time Management Problem Solving Lifestyle � diet, sleep, exercise

18. Evaluation University of Bath MHDU ? independent research Acceptability Accessibility Effectiveness of guided self help Explore: Demographic variables impact Telephone versus face-to-face contact Book alone versus book + guide Ethical approval awarded CORE outcome measure December 1st 2005 to December 1st 2006

19. References Andrews, G. (1996). Talk that works: the rise of cognitive behaviour therapy. British Medical Journal, 313, 1501-1502 Cuijpers, P. (1997). Bibliotherapy in unipolar depression: a meta-analysis. Journal of Behaviour Therapy and Experimental Psychiatry, 28, 139-147 Jorm, A.F., Korten, A.E., Jacomb, P.A., Rodgers, B., Pollitt, P., Christensen, H. (1997). Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public. British Journal of Psychiatry, 171, 233-237 Lewis, G., Anderson, L., Araya, R., Elgie, R., Harrison, G., Proudfoot, J., Schmidt, U., Sharp, D., Weightman, A., & Williams, C. (2003). Self-help interventions for mental health problems. Report to the DoH Research and Development Programme: London:DoH Parry, G., Bateman, A., Churchill, R., Clifford, P., Hearnshaw, H., Khunti, K., Lindsay, A., Moorey, S., Roth, A., Rowland, N., and Tylee, A. (2002). Treatment choice in psychotherapies and counselling. Evidence based clinical practice guideline pp. 1-68. London:DoH. Roth, A., and Fonagy, P. (1996). What works for whom? A critical review of psychotherapy research. New York: Guildford Press.

20. Workshop Aims Increase understanding of the Graduate Mental Health Worker role Introduce key CBT techniques for the management of depression Increase awareness of Guided Self-Help Gather resources to assist you in your practice

21. Introducing Ros I am 24 years old I have been married to Simon for 2 years We have two children � Jamie who is 2 years old and Jenna who is 5 months old I suffered with depression when I was a student I suffered from postnatal depression after my first child Jamie was born I used to be very active and outgoing, but now I lack time, energy and enthusiasm

22. 3 Workshops (20 minutes) Participation not optional Ask questions Enjoy!

23. Summary Workshop 1: Psychoeducation/Goal Setting Workshop 2: Behavioural Change Workshop 3: Cognitive Change