1. Talkingsense.org Mental health e-clinic

3. What is an E-Clinic?

5. Who AppropriateNot-Appropriate Cant get into the clinic? Problems with travel/mobility Work commitments Childcare issues Do they have basic computer skills Access to the internet? Prefer using the computer Difficulties reading and writing If the individual prefers another option Severe symptoms/pathology and risk behaviour e.g. high suicidality Borderline personality disorder Currently no translation tools so may be a language barrier

6. How How to refer - We need the *patients name, *date of birth, *NHS number & *email address -The referrers name and date of referral How the patient uses it –They log onto www.talkingsense.org and choose an appointment thats convenientwww.talkingsense.org –They then log in for the appointment, complete the measures (either by themselves or while chatting to the clinician) and click to join conversation How we work with the patient –We then use either chat or audio/video and work using the same methods we would in a face-to-face meeting: guided self-help based on CBT –We have self-help materials available on the website which the patient can download; alternatively we can email or send a link to material via the live-chat

7. e-clinic benefits patients Convenient access to therapy at the click of a mouse from any computer or device with internet access Increased access to psychological therapies (e.g. LTC and children) Reduced waiting times Improved comfort and safety (research supports this)

8. e-clinic benefits organisations No other tool like this in NHS Reduction in cost of space for clinics Increased recruitment potential More time focused on treatment/increased capacity Reduced waits Reduction in staff travel costs Increased job satisfaction

9. Some of the Research Name of StudyMethodFindings Kessler et al. (2009) Lancet 374: 628- 634 Multi-centre RCT 297 Ps primary care BDI 14+ -2/3 of Ps were severely depressed -BDI and QoL significantly improved at 4 and 8 month follow up Preschl et al. (2011) BMC Psychiatry 11: 189 RCT Online therapy Vs face- to-face CBT Aim: is the therapeutic rship effected? (therapeutic rship is widely recognised as a predictor of clinical outcome in many psychotherapies) -no significant difference between online and face to face -significant correlations between clients perception of therapeutic relationship and clinical outcome in online group Ruwaard et al. (2012) Non-controlled 1500 adults patients Manualised web-based cbt for depression and anxiety disorders -as effective as face-to-face clinical practice (about 50% of patients recovered and progress was maintained at follow up) -low drop out rate (29% drop out)

10. Examples Extended working hours- appointments in work time Limited language End of Step 4 appointments

11. Other Information The most important point to mention is that although the E-Clinic has been specifically developed within the Mental Health arena the e-clinic can be utilised within any setting, for example to reduce out patient appointments, conduct other appointments via this portal. We are developing a childrens e-clinic, and looking to use it in schools, and our community staff (Health visitors, stop smoking)

12. Further Information If anyone would like further information please contact; Michelle Larkin Business Development & Marketing Director Michelle.larkin@rdash.nhs.uk 01302 821432 Or 07769135557