Introducing IMPARTS: Integrating Mental & Physical healthcare: Research Training & Services

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IMPARTS Project Overview  Aim: To improve the mental healthcare of patients presenting in physical healthcare settings  Objectives: 1.To map mental health-related services provided by KHP’s acute trusts 2.To design and deliver training on mental health issues to non-specialists 3.To develop informatics to improve detection and management common mental disorders in medical settings

KHP’s acute trusts King’s College Hospital Guy’s Hospital St Thomas’ Lewisham & Croydon Mental health-related services Psychiatry Psychology Counselling Generic services.. A&E outpatient liaison inpatient liaison paediatric liaison Disease-specific services.. Respiratory, cardiology, cancer, epilepsy, Huntingdon disease, diabetes, liver, rheumatology, perinatal, HIV, Parkinson’s disease, dermatology etc MAPPING PROJECT 1) Mapping Project

2) Masters module in Psychological Medicine  To be offered by KCL’s Advanced Nursing Masters courses from 2013  One week taught course with web-based interaction: The depressed/ anxious patient The agitated/ confused patient The substance misusing patient Medically unexplained symptoms Managing conflict

3) IMPARTS informatics screening system To use informatics systems to screen medical patients for CMD and other symptoms whilst they wait for their outpatient appointment, making the results immediately available to the clinician prior to consultation, and flagging up any issues that should be addressed.

IMPARTS informatics system Improve detection & management of symptom distress Inform clinical decision- making & promotes timely intervention Track change over time Routine collection of patient-reported outcomes Research database Evidence generation CLINICAL PRACTICERESEARCH Transformation of future care POLICY Identifying need & informing resource allocation Mental health services in general hospitals Mental health training for non- specialists

IMPARTS informatics system Integrative FlexibleIterativeSustainableScalable

Page 8 Rheumatology pilot Objectives 1. To determine whether informatics screening is feasible in a busy clinic setting 2.To determine whether informatics screening is acceptable to patients and staff 3.To determine the rate of common mental disorder in a rheumatology clinic setting

Page 9 Procedure: 1. Patients arriving for appointment are given information sheet explaining purpose of screening 2. Patients log on to a laptop/ e-tablet in the waiting room, using their Hospital ID and initials 3. Patients select their diagnosis and complete a series of short questionnaires tailored to their condition 4. Patients scores transfer directly to the EPR/ specialty database

Feasibility Pts on clinic list n=288 Pts attending appt. n=210 Pts not screened 22 (10%) Reasons not screened: Pt declined 8 (3.8) IT problem 7 (3.3) No English 3 (1.4) No time 2 (1.0) Disability 1 (0.5) Incomplete 1 (0.5) Pts screened n=188 (90%) Screening encounters n=269

Embedding in clinical practice IT barriers Core mental health skills for clinical teams Meeting demand Challenges

Urgent referral to liaison psychiatry Suicidal ideation AND severe depression (PHQ-9 score=20-27) Referral to liaison psychiatry Suicidal ideation OR severe depression (PHQ-9 score=20-27) Referral to clinical psychology Mild to moderately severe depression (PHQ-9=<19) WITH complex interaction with medical problem Referral to IAPT Mild to moderately severe depression (PHQ-9=<19) WITHOUT complex interaction with medical problem Referral pathway

Bespoke self-help portfolios for specific LTCs DepressionAnxiety Sleep hygiene Pain management Activity scheduling Rheumatology DepressionAnxiety Alcohol Problem- solving Stress Orthopaedics

Informatics Routine collection of patient- reported outcomes with advice on care & referral Training Training in mental health skills… (managing distress, appropriate referral, problem- solving) Supervision Ongoing supervision & support of clinic staff by mental health specialist Self-help Portfolio of bespoke self- help materials, tailored to specific long- term conditions The IMPARTS package

Research opportunities IMPARTS screening data EPR clinical & demographic data IMPARTS pseudonomysed Research Database Patterns of mental disorder, symptoms, disability & health behaviour Associations between symptoms, function, QoL & demographic & clinical variables Predictors of good and poor outcomes Comparative effectiveness studies Pathways through care RESEARCHER

Recruitment into trials We are seeking ethical approval to prospectively request consent for contact via the IMPARTS screening interface “Would you be happy for a researcher to contact you if your responses suggest that you might be suitable for a research project currently taking place at the hospital?” It would then be possible to deanonymise patient records to allow researchers to contact potential trial participants –when explicit consent has been given

Routine data collection Research database Trial recruitment Data analysis & evidence generation Implementing evidence in clinical care Evaluating outcome of change in practice Generating new hypotheses for investigation Long-term view:

Prof Matthew Hotopf Project Lead Dr Lauren Rayner Project Coordinator