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South London and Maudsley (SLaM) IAPT-SMI Demonstration Site for Psychosis Professor Philippa Garety Clinical Director, Psychosis Clinical Academic Group.

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Presentation on theme: "South London and Maudsley (SLaM) IAPT-SMI Demonstration Site for Psychosis Professor Philippa Garety Clinical Director, Psychosis Clinical Academic Group."— Presentation transcript:

1 South London and Maudsley (SLaM) IAPT-SMI Demonstration Site for Psychosis Professor Philippa Garety Clinical Director, Psychosis Clinical Academic Group Thursday 7 March 2013

2 Research suggests that only 1 in 10 access CBT, despite NICE guidance (Schizophrenia Commission, 2012) Service users want equal access to psychological therapies Rethink survey (2010)

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4 The Abandoned Illness The Schizophrenia Commission “Research has led to a range of evidence-based psychological treatments. We know much more about ‘what works’ than we used to... The committed individuals who went into the mental health profession to improve lives should be helped to do exactly that.” Prof Sir Robin Murray This is where IAPT-SMI comes in

5 Obstacles to access

6 Dolly Sen, Service User Consultant “I always asked for some kind of psychological therapy or talking therapy but was told, no, it was too dangerous. I had to wait 20 years for something that was the most beneficial thing. [Therapy] has changed my life basically.” Talking to Norman Lamb on 19 December 2012

7 94% have encountered obstacles in making psychological therapies available, including insufficient skilled staff 69% of Trusts have funding challenges for providing access to psychological therapies for people with a diagnosis of schizophrenia

8 Delays in accessing CBTp Peters et al 2009 (N=74) Mean length of illness was 8 years (range 0-32) Mean of 2.8 in-patient admissions (range 0-20) 96% were on antipsychotic medication

9 South London and Maudlsey NHS Foundation Trust: the context Core population - 4 South London Boroughs 1.3million; inner city, very high indices of social deprivation Substantially raised rates of psychosis Psychosis Care Pathways

10 SLaM Psychosis Demonstration site: Increasing access in two care pathways Promoting Recovery Pathway (Southwark, Croydon & Lewisham) Promoting Recovery Pathway (Lambeth) Early Intervention Pathway (Southwark, Lambeth, Croydon & Lewisham) IAPT-EI IAPT- SHARP IAPT- PICuP

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13 SHARP

14 What IAPT-SMI offers for service users CBT for psychosis: weekly or fortnightly individual 1 hour sessions 6-9 months therapy Therapists receive weekly-fortnightly group supervision FI for psychosis: Fortnightly 1 hour sessions with client and carer(s) Up to ten sessions, over a period of 3-9 months Therapy delivered by two trained therapists Therapists receive weekly-fortnightly group supervision

15 Overcoming obstacles to access

16 Work we have already done in SLaM Ten point charter addressing barriers and facilitators: –Service user involvement –Quality criteria and staff training –Data gathering, data systems and outcomes –Care pathways, ensuring integrated effective care in Early Intervention & Recovery pathways

17 Psychological treatments are not a quasi - medication =

18 Quality One key challenge has been a lack of clarity about quality – psychological therapy is different from a chemical compound Lack of criteria have resulted in an ‘anything goes’ approach to psychological therapy in MH services, and inflated estimates of provision We need nationally agreed criteria for training and competencies in CBTp and FI IAPT-SMI is doing this Locally we have already developed criteria and standards and established a portfolio of training opportunities

19 Training and Supervision

20 Portfolio of training opportunities in psychological therapies for psychosis, in partnership with KCL Span the workforce from non-clinical to managerial/supervisory Academically accredited training and in-service courses Short courses and modules build to an award Supervised practice strongly emphasised Supervision and support for supervisors

21 Training structure in the SLaM site

22 Service user and caregiver involvement & co-production Involvement in development, design and evaluation of psychological therapy services Training design and delivery Co-produced workshops at SHARP and in the SLaM Recovery college Co-working in group interventions: Hearing Voices; Mindfulness; Acceptance & Commitment Therapy Training, supervision and support (practical, financial and emotional) Personal development – CPD, co-authorship, conference attendance

23 SLaM demonstration site strategic approach to improving access to therapy A 50% increase in access with the funding provided Reduced waiting times Implementation of our 10 Point Charter, with highly trained staff, and care pathways Clear referral pathways, including self referral Regular assessment of progress in therapy Close and frequent supervision Assessing improvement in a range of outcomes and in health economics

24 Effectiveness

25 Clinical outcomes: Service-user reported symptoms

26 This graph shows a reduction in psychotic symptoms [voices (effect size:.73) and delusions (effect size:.59)] PICuP) following therapy ( PICuP) 89% (voices) & 90% (delusions) have paired data at end of therapy Evidence of clinical outcomes with medium-large effect sizes – voices and delusions

27 This graph shows a reduction in emotional problems [anxiety (effect size:.47) and depression (effect size:.55)] PICuP following therapy PICuP 85% have paired data at end of therapy Evidence of clinical outcomes with medium- large effect sizes – anxiety and depression

28 85% (QoL) & 67% (CHOICE) have paired data at end of therapy Evidence of clinical outcomes with medium- large effect sizes – quality of life (QoL) and recovery This graph shows an increase in people’s quality of life (measured on the Manchester Short Assessment of Quality of Life; effect size:.51) and recovery ratings (measured on the CHOICE; effect size.79) following therapy

29 Cost-effectiveness

30 Randomised Controlled Trial ( Peters et al, 2010) – therapy costs are off-set by fewer inpatient costs at 3 months follow-up (N = 74)

31 Reduction in service-use costs (admissions & home treatment team days) in the year following therapy, compared to the year prior to therapy (Wilcoxon test: p <.05*) N = 70 Data obtained from ePJS, Jan 2012

32 Progress and preliminary outcomes

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34 VariableNew clients in the service Age distributionMean 38 years (18-70) Gender43% male, 57% female Ethnicity36% white, 64% BME New clients - demographics

35 Demonstration site CBTp & FIp referral targets are being achieved ExistingProjectionMonthly Referral Target (over 12m) Progress at 4 months CBTFICBTFICBTFICBTFI

36 Waiting times are reduced (in days) Referral received to opted-in Opted-in to assessed Assessed to receiving therapy Total % reduction in waiting times %

37 Health Utilisation data ServiceMean number of days in 12m before therapy Mental health admission10.5 (0-126) Crisis team / home treatment0.7 (0-23) Psychiatric liaison (A&E)0.1 (0-2)

38 IAPT-SMI: CBT assessments Pre PSYRATS – Voices & Beliefs WEMWBSWSASEQ-5DShort CHOICECORE-10Brief IPQMeasures Feedback 3-monthly PSYRATS – Voices & Beliefs WEMWBSWSASEQ-5DShort CHOICECORE-10Brief IPQMeasures Feedback Satisfaction with therapy Post PSYRATS – Voices & Beliefs WEMWBSWSASEQ-5DShort CHOICECORE-10Brief IPQMeasures Feedback Satisfaction with therapy Short CHOICE weekly

39 IAPT-SMI: Carer assessments Pre Experience of caregiving inventory WEMWBSDASS-21CORE-10IPQ carer versionConfidant questionMeasures Feedback 3-monthly Experience of caregiving inventory WEMWBSDASS-21CORE-10IPQ carer versionConfidant questionMeasures Feedback Satisfaction with therapy Post Experience of caregiving inventory WEMWBSDASS-21CORE-10IPQ carer versionConfidant questionMeasures Feedback Satisfaction with therapy

40 Patient Reported Outcome Measures MeasureCompletion rate Session by session short CHOICE 81% of attended sessions Pre-therapy: PSYRATS Questionnaires 98% 100%

41 London Tonight report from 19 December 2012 – visit to SLaM by Norman Lamb, Care and Support Minister and the official launch of the IAPT-SMI demonstration sites: 20/maudsley-hospital-pioneers-mental-health- therapy-scheme/

42 Operational Group Dr Louise Johns, Project Lead Dr Miriam Fornells-Ambrojo, IAPT-EI Lead Rosanna Michalczuk Bina Sharma Psychology Assistants Dr Suzanne Jolley, Lambeth Recovery Psychology Lead Dr Juliana Onwumere, FI Lead Dr Craig Milosh, Clinical Psychologist, SHARP Devon Elliott, Business Intelligence Analyst

43 Steering Group Lucy Canning, Psychosis CAG Service Director Prof Philippa Garety, Psychosis CAG Clinical Director Jonathan Beder, Psychosis CAG Deputy Director, Business and Performance Dolly Sen and Garry Ellison, Service User consultants Roger Oliver and Lorna Wilkinson, Carer consultants Prof Tom Craig, Consultant Psychiatrist, SHARP Marieke Wrigley, Team Leader, SHARP Prof Elizabeth Kuipers, NICE Schizophrenia guideline lead Dr Emmanuelle Peters, PICuP Director Adrian Webster, CAG Psychological Therapies Lead Jo Lawrence, Clinical Service Lead, EI Dr Sarah Dilks, Lead Psychologist, Promoting Recovery pathway Dr Eric Morris, Lead Psychologist, Early Intervention pathway Penelope Fell, Head of Business Development Dorothy Abrahams, Administrator

44 Thank you for listening! You are welcome to our SLaM Demonstration Site Visit Thank you for listening! You are welcome to our SLaM Demonstration Site Visit Monday 1 July pm


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