eTherapy for Dual Diagnosis Leanne Chisnall

Self Help Services Established in 1995 Independent user-led mental health charity based in Manchester Provide a range of services across the North West: -eTherapy -Psychological Wellbeing Service -Positive Alternatives -Structured Courses -Drop in Groups -Counselling -The Sanctuary

eTherapy Award winning service delivery model devised by SHS Recognised Step 2 IAPT service for treatment of mild/moderate anxiety & depression Available across the North West at various community based venues or at home Various packages available including Beating the Blues, LLTFi, Breaking Free Online, Sleepio and Stressbusters NB: eTherapy is NOT simply computerised therapy but a fully structured and supported course of treatment.

eTherapy Venue Service All clients receive a 1 hour 1:1 assessment Followed by 8-12 sessions of eTherapy (dependent on package) IAPT measures taken at every session All clients FULLY supported by volunteer support workers as well as the service co-ordinator Clients receive regular 1:1 session reviews End of course review and discharge / signposting

eTherapy At Home Service Referrals processed in same way as with venue eTherapy but conducted entirely over the phone Followed by 6-12 sessions of eTherapy accessed at home (dependent on package) Weekly support calls are provided alongside the programme Excellent for clients that are unable to access venues due to work restrictions or disability.

Referral Pathway An agency worker can a referral form to Self-referral by phone, or via our website (either returned online or posted to us) Through a client’s GP

Manchester general population: 24% common mental health problems/ estimated 3.5% dependent drinkers & 3.3% frequent drug use (UK avg) 74.5% of users of drug services and 85.5% of users of alcohol services experience mental health problems Limited Dual Diagnosis provision available and the majority for those with more severe and enduring mental health difficulties Background

Dual Diagnosis A simple working definition of ‘dual diagnosis’ is: “A mental health problem and a substance misuse problem, both of which require some form of intervention and may or may not have been medically diagnosed” (Alcohol Concern, 1999)

Elison et al 2014 Aim: Evaluate clinical outcomes from eTherapy DD service Design: Standardised psychometric assessments taken at baseline and post treatment at discharge. Participants:74 Participants N=47; 30 male (62%) 17 female Findings: Statistically significant reductions in social impairment, depression, anxiety, social anxiety, alcohol and drug use. Fewer service users met clinical threshold for depression and anxiety post treatment compared to baseline.

Elison et al 2014 Measures taken at Baseline assessment and discharge: The Work and Social Adjustment Scale (WASA, Mundt et al., 2002) The Patient Health Questionnaire (PHQ-9, Kroenke et al., 2001) The General Anxiety Disorder Scale (GAD-7, Spitzer et al., 2006) The Alcohol Use Disorders Identification Test (AUDIT, Saunders et al., 1993) The Drug Use Disorders Identification Test (DUDIT, Berman et al., 2004) The IAPT Phobia Scale

MEASURES & OUTCOMES KPIValues Entering therapy117 Waiting over 28 days0 Average waiting time3 days Moving towards recovery (IAPT)43% Alcohol reduction29% Drug reduction60% Patient satisfaction100% DNA/Cancellation32%

CASE STUDY Male, mid-forties, who had been a cannabis smoker for 22 years Cut use down from 5 joints a day to a couple per week just before assessment Married with four children. Busy full-time job (taxi driver) Gave up on psychiatric treament in 2006 but wanted to finally address drug use. Attended weekly support calls AUDIT reduced from 8 to 5. DUDIT down from 19 to 1 PHQ9 reduced from 20 to 1. GAD-7 down from 21 to 3

Summary and Next Steps... eTherapy effective treatment for DD Referral Routes Attrition rates Integration into existing substance misuse services Further research Attitudes towards use of technology in health care