Where are the forgotten few? Or the invisible many?

1. Where are the forgotten few? Or the invisible many? IAPT for Older People with Long Term Conditions and Medically Unexplained Symptoms Cath Burley Thursday 14th June, 2012

2. Context New developments for IAPT LTC/MUS SMI CYP OP and Disability

3. Older people - Age but… Humorous Stoical Dignified Resourceful Perceptive Proud Hard working Thoughtful Cheerful Long lived Sensory loss Diabetes Cardiac problems Arthritis Memory loss Anxiety Depression Parkinson’s Disease COPD Over medication

4. Drivers 25% older people have depression – mostly unrecognised and untreated Each long term condition adds complexity Many older people are carers too Residential care costs are placing burden on families and the state IAPT OP personal budgets indicate people can become more independent Therapy works with OP

6. Statistics ‘People with one long-term condition are two to three times more likely to develop depression than the rest of the population. People with three or more conditions are seven times more likely to have depression.’

7. Statistics Over 15 million people in England – 30 per cent of the population – have one or more long‑term physical health condition. There is a close relationship between long-term physical conditions and mental health and wellbeing. Co-morbid mental health problems are highly common; an estimated 30 per cent of all people with a long-term condition also have a mental health problem. The prevalence of depression and anxiety is higher in people with physical illness compared to the general population. In a study of more than 245,000 people in 60 countries, an average of between 9·3 per cent and 23 per cent of participants with one or more chronic physical disease had co-morbid depression.

8. LTC The links between physical and mental health are clear. There are shared risk factors for illness: illness regularly presents with both psychological and physical symptoms; and being physically ill, particularly on a chronic basis, often has an impact on mental health and psychological wellbeing. Despite these obvious connections, many individuals do not receive care that addresses both their physical and psychological needs.

9. Context stigma – it may be easier to accept physical over emotional explanations for symptoms. a continued lack of expertise and training in psychological assessment, management and mindedness for many practitioners integrated service design and provision that is ‘patchy’ •commissioning structures and provider organisations which separate physical, mental health and whole-person care and outcomes.

10. Collaborative Care Physical Psychological Mental health

11. How do we demonstrate outcomes? ‘There are clear links between investment in treating co‑morbid mental health and physical health problems and potential gains in all of the QIPP elements.’

12. Questions How to develop and influence a pathway developed from a predominantly physical health background Who delivers interventions, how and when Effectiveness and outcome measures Work with family carers Complexities of co- morbid presentations Including cognitive loss and exec. problems

13. LTC/MUS Working group Links to other groups Outcome measures Best practice – SW and other Vascular risk factors Possible pathway

14. DH IAPT Team Timescales Publish ‘Working with OP module for existing IAPT Training Courses Specialist Module for SupervisionTraining Quality Standards & Commissioning Guidance for Commissioning Services Revised outcome measures for OP Engage with Alzheimer’s Society to extend psychological therapy to dementia carers Engage with DH Dementia Team re approaches to delivery of psychological therapies for early stage dementia Sept 2012 Sept 2012 Mar 2013 Mar 2013 April 2012 April 2012

15. Equality of ACCESS Acknowledge difference Understand what is different Meet that difference Raise awareness to others of all the above