1. Referral Process: Referral options Referral form to be completed by members of treatment team. OR Self-referral & referral form signed by consultant Processing referrals On receipt of referral, individuals contacted and informed of when next group is likely to commence (letter copied to consultant) All groups are closed. Pre-group assessment Meeting with group facilitator. Evaluating individual needs. Battery of measures (BDI-II, Altman Mania Rating Scale), Consent to participate in research (Protocol in development) How the programme evolved: Phase 1 : September – October 2009 (Pilot) Phase 2 : November 2009 –February 2010 Phase 3 : March 2010 – May 2010 Phase 4 : Due to commence Introductory Workshop : Provided on an as-required basis (Day therapy programme, St. Michael’s unit) “On the Level” A community based intervention for individuals A community based intervention for individuals with Bipolar Affective Disorder (BPAD) with Bipolar Affective Disorder (BPAD) Daniel Flynn, Senior Clinical Psychologist, Mary Kells, Clinical Psychologist, Maria O’ Sullivan, Psychologist in Clinical Training, Gráinne Kearney, Volunteer Clinical Psychology Assistant Department of Clinical Psychology, North Lee Adult Mental Health Service Practice-Based Evidence Logistics of providing psychological support to individuals with BPAD: Demand exceeds available supply of individual therapy sessions. Focus group: Patients reported: “BPAD is not talked about” “BPAD is not talked about” “Feeling isolated” “Feeling isolated” “Not realising other people were “Not realising other people were experiencing similar episodes” experiencing similar episodes” Key aims of the Programme Understand and discuss what BPAD is Identify early warning signs for episodes Identify early warning signs for episodes Develop behavioural and cognitive strategies Develop behavioural and cognitive strategies for managing both depression and mania for managing both depression and mania Deal with stressful events that can trigger episodes Deal with stressful events that can trigger episodes Monitor and understand mood symptoms Monitor and understand mood symptoms Play an active part in their ongoing recovery Play an active part in their ongoing recovery and relapse prevention and relapse prevention Evidence into practice Research to date has shown that group interventions using a CBT framework as an adjunct to traditional treatment for BPAD are beneficial in regard to relapse prevention, enhancement of treatment for residual depressive symptoms, and improvement in functionality. Furthermore they may also be a cost effective way of delivering psychosocial treatments. Research to date has shown that group interventions using a CBT framework as an adjunct to traditional treatment for BPAD are beneficial in regard to relapse prevention, enhancement of treatment for residual depressive symptoms, and improvement in functionality. Furthermore they may also be a cost effective way of delivering psychosocial treatments. 1,4,5 What is the On the Level group? The ‘On the Level’ group is a skills training programme offering persons with a diagnosis of BPAD an adjunct to their existing treatment. The programme is based on cognitive behavioural therapy (CBT), which aims to support individuals with bipolar disorder in monitoring, examining and changing thinking and behaviour that can be associated with extreme mood states. Inclusion Criteria Currently attending North Lee Adult Mental Currently attending North Lee Adult Mental Health Services (open to all sectors within Health Services (open to all sectors within North Lee) North Lee) Primary diagnosis of BPAD Primary diagnosis of BPAD Mood currently stable. Mood currently stable. References: 1.Castle, D., Berk, M., Berk, L., Lauder, S., Chamberlain, J. and Gilbert, M. (2007) Pilot of group intervention for bipolar disorder, International Journal of Psychiatry in Clinical Practice, Vol. 11, No. 4. 2.Centre for Clinical Interventions () Keeping your Balance Programme. 3.National Institute for Health and Clinical Excellence (2006) Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. UK, National Collaborating Centre for Mental Health. 4.Patelis-Siotis, I., Trevor Young, L., Robb, J., Marriott, M., Bieling, P., Cox, L. and Joffe, R. (2001) Group cognitive behavioural therapy for bipolar disorder: a feasibility and effectiveness study. Journal of Affective Disorders, Vol. 65. 5.Zaretsky, A., Rizvi, S., and Parikh, S. (2007). How well do Psychosocial Interventions work in Bipolar Disorder? The Canadian Journal of Psychiatry, Vol. 52, No. 1. 6.Beck, A.T., Steer, R.A. and Brown, G.K. (1996) Beck Depression Inventory II, Psychological Corporation, USA. 7.Altman, E. Hedeker, D. Peterson, J.L. and Davis J.M. (1997) The Altman Self rating Scale. Biological Psychiatry, 42 pp. 948 -955 Evidence-Based Practice: NICE Guidelines Healthcare professionals should assist clients with Bipolar Affective Disorder by: Bipolar Affective Disorder by: Building a therapeutic relationship Building a therapeutic relationship Advising on careful & regular self-monitoring of Advising on careful & regular self-monitoring of symptoms(including early warning signs & symptoms (including early warning signs & triggers) triggers) M anaging lifestyle M anaging lifestyle (e.g. sleep hygiene & work patterns) (e.g. sleep hygiene & work patterns) Developing coping strategies (1.1.1.3) 3 Developing coping strategies (1.1.1.3) 3 The treatment of BPAD is based primarily on The treatment of BPAD is based primarily on psychotropic medication to reduce the severity of psychotropic medication to reduce the severity of problems, stabilise mood and prevent relapse… problems, stabilise mood and prevent relapse… However a range of psychological and psychosocial However a range of psychological and psychosocial interventions can also have a significant impact in the interventions can also have a significant impact in the short and long term (1.4 + 1.5) 3 short and long term (1.4 + 1.5) 3 The Journey: Phase 1 - Pilot based on ‘Keeping your balance’ 2 programme & supplementary materials. Participants: 6 already attending individual therapy Evaluation: Focus group Attrition: 4 completed programme. Phase 2 - Revised programme content based on feedback from pilot. Evaluation: Introduced pre- & post- measures Participants: 7 commenced programme Attrition: 3 completed programme Reasons: 2 moved counties, 1 hospitalized, 1 infrequent attendee not present for final session. Phase 3 Developed information leaflet (approved by communications office) Manual devised for programme Evaluation: Ongoing assessment (BDI-II 6 Altman Mania Rating Scale 7 ) Participants: 9 pre-assessment, 7 commenced group Attrition: 4 completed programme Reasons: 2 hospitalized, 1 infrequent attendee. Phase 4- Next Steps Delivery: Extend to 10 sessions (due to time pressure phase 3) Manual: Further refinement based on feedback Research: Introduction of waiting list group Proposed: Ongoing support group and family education group - survey attendees. Changes Step by Step Step by Step Ψ