The Demonstration Site So Far – Improving Recovery for People with a Diagnosis of Bipolar Disorder

1. The Demonstration Site So Far – Improving Recovery for People with a Diagnosis of Bipolar Disorder Birmingham and Solihull Mental Health Foundation Trust And The Spectrum Centre for Mental Health Research

2. The Team Spectrum Centre for Mental Health Research • Professor Steven Jones • Dr Fiona Lobban • Dr Elizabeth Tyler • Rita Long • Professor • Bruce Hollingsworth Birmingham and Solihull Mental Health Trust (BSMHFT) Dr Amanda Gatherer Karen Charles Dr Jayne Eaton Chris Mansell Elizabeth Kyte

3. IAPT and Severe Mental Illness 6 demonstration sites:- • Personality Disorder (3) • Psychosis (2) • Bipolar Disorder(1) www.iapt.nhs.uk

4. Background Information • A person diagnosed with bipolar disorder in their mid 20’s loses –9 years of life –12 years normal health –14 years of working life Prien& Potter, 1990 • Bipolar disorder (BD) has received only 1/7th of the research spend on schizophrenia despite similar prevalence and morbidity Mental Health Research Funders Report, 2005

5. How common is bipolar disorder? • 1-2 in 100 people for DSM-IV bipolar disorder • Equate about 1 million people in UK • 4-8 in 100 for bipolar spectrum conditions –Similar clinical and functional outcomes to BD • Around 50% of people presenting with depression may fit in the bipolar spectrum

6. Negative consequences • Cost to UK £ 5.2 billion • Unemployment rates of over 50% • Completed suicide 18 times higher than general population • Elevated mortality from cardiovascular disease and accidents (x1.5-2) Gareth Hill et al, 1996; Kupfer et al 2002; Angst et al., 1999 • High rates of drug and alcohol misuse • Lifetime prevalence rates for -46% alcohol disorder -41% drug disorder • 12 month rates of dependence compared to general population -10 times higher for drug -8 times higher for alcohol Regieret al., 1990;Compton et al., 2007; Hasinet al., 2007

7. Key issues • It is not good enough to offer people therapies developed for other conditions • There are a wide range of psychological interventions available for BD • The right intervention delivered by correctly trained therapists significantly improves functional and symptom outcomes • Badly matched treatment delivered by inadequately trained therapists makes people worse

8. IAPT for Bipolar Disorder Project Objectives • Identify a best practice pathway across primary and secondary specialist services • Create a knowledge, skills and competencies framework • Develop a suite of resources and outcome measures

9. Key deliverables • Identify a best practice pathway across primary and secondary specialist services • Right treatment, right time, right place • Review current pathway by mapping current service • And speaking to service users and their families • Review of unmet need and undetected case stories / missed opportunities • Explore the primary care pathway within selected GP practices

10. Key deliverables • Create a knowledge, skills and competencies framework for clinicians • Focused project in selected GP surgeries – understand awareness and educational / training needs • Develop and test education and awareness raising tools • Evaluate resources to support primary care • Review awareness and skill set in secondary specialist services • Identify and respond to training needs

11. Key deliverables 3. Create a suite of resources and outcome measures • Thorough evaluation of existing clinical interventions delivered via Bipolar Disorder service in Birmingham and Solihull • Formalise a minimum data set for use within Bipolar Disorder services • Review the introduction of self-management resources for selected primary care settings • Create and consult on a Charter for Good Practice • Publication and dissemination of data and good practice findings at the end of the 12 month period

12. BSMHFT Bipolar Disorder Service • Psychology-led service but integrated pathway with specialist mental health care • Provided across the whole of Birmingham and Solihull (pop. 1.2 million) • Psychological interventions and recovery focused • 100 – 120 referrals a year (2.6 wte Clinical Psychologists, 1 wte Assistant and full time admin) • Mood on Track – 10 group sessions (80 – 90 complete p/a) • Follow up and on-going support – individual and group

13. Self Referral Mental Health Services for Older People (MHSOP) Youth and Early Intervention for Psychosis (EIP) Direct Referral from GP and Healthy Minds (IAPT) Current and Planned Pathway Intake (via GP referral, Healthy Minds or acute care pathway) Referral / assessment in secondary services - CMHT Referral to Bipolar Service MOT course declined or not suitable On-going follow-up by CMHT Assessment Mood On Track Programme Discharge from CMHT to Primary Care/ Healthy Minds On-going Relapse Prevention Sessions

14. ‘Mood On Track’ Programme • On-going access to Bipolar service: • Newsletter • Support group • Refresher workshops • Telephone contact • Consultation 4 – 6 Individual Relapse Prevention Sessions: to develop an early warning signs and relapse prevention plan Assessmentby Bipolar Disorder Team Psychologist (invite to session extended to family or friend) 10 sessions of group work: ‘Mood On Track’ course Session 6: Family therapy engagement session Family therapy assessment / formulation / intervention NB. Some clients will also continue to receive input from community mental health services and family interventions can be provided at any time

15. IAPT SMI Outcome Measures for Bipolar Disorder

16. Outcome data • Paired samples T-Tests were carried out to determine whether there were any significant differences between pre-therapy and end of therapy scores (week 10) on all outcome measures. • Service user’s scores on depression (PHQ-9) and anxiety (GAD-7) scales were significantly reduced by the end of the mood on track programme. • Scores on the ISS sub-scale – well-being, increased significantly indicating improvement in well-being. • Scores on the WASAS significantly reduced indicating that mood difficulties were impacting less on individuals day to day functioning. • There was also a significant increase in participant’s scores on the BRQ measure, indicating a higher subjective sense of recovery

17. Key Challenges Project wide • Cross site project team (across 125 miles) • However benefits due to applied research / clinical expertise • Both teams bring knowledge regarding national need Pathway • Accessibility of resources and interventions Knowledge, Skills and Competences • Didactic versus active facilitation • Understanding the agents of change within group based interventions • Practitioner and service user experience e.g. of measures • Engaging GPs Resources • Deciding upon an minimum data set

18. Any Questions?