1. Mental Health Access Team
Liz Holdsworth (MHAT Manager)
&
Caroline Williams (MHAT Clinical Lead)

2. Access to Mental Health Service
Mild to Moderate Anxiety and Depression
MHAT
Organic Mental Health
Memory Services
Concerns possible first episode Psychosis
Early Intervention Team
Urgent and ALL other mental health needs
SPA
Urgent out of SPA hours
IHBTT
Services work together to meet people’s need so will redirect
If not sure please ring and ask

3. Mild to Moderate Anxiety Common Mental Health Problems
Generalised anxiety disorder (GAD)
Post Traumatic Stress Disorder (PTSD)
Depression
Phobias
Obsessional Compulsive Disorder (OCD)
Body Dysmorphic Disorder (with mild impairment)
Panic disorder (with or without agoraphobia)
Social Anxiety
Health Anxiety

4. Mental Health Access Team
Primary Care Community Mental Health Nurse (CMHN) service
The CMHN service is needs led and targets people with the spectrum of anxiety and mood disorders and the team does not use diagnostic indicators as an eligibility criteria. If an individual fits within the new definition of eligibility for CPA , is experiencing psychosis, or a major affective disorder (e.g. bipolar disorder, cyclothymia etc), has recent and/or recurrent inpatient admissions and / or is currently on section 117 for after care, then they would not benefit from the primary care CMHN service and the individual would be more suitable to have their needs met in secondary care mental health services.
Improving Access to Psychological Therapies (IAPT) service
The IAPT programme is an initiative that aims to increase the availability of NICE recommended psychological treatments for depression and anxiety. IAPT should be planned and not offered in an acute crisis. It is not focussed on all mental health conditions but specifically on ‘common’ mental health conditions which include Generalised anxiety disorder (GAD), PTSD – simple presentation, Unipolar Depression, Specific Phobias, OCD, Body Dysmorphic Disorder (with mild functional impairment), Panic disorder (with or without agoraphobia), Social Anxiety & Health Anxiety.

5. IAPT Primary Purpose
“The aim is to develop talking therapies services that offer treatments for depression and anxiety disorders approved by the National Institute for Health and Clinical Excellence (NICE) across England by March 2015” DH (2011) Talking therapies: A four-year plan of action

6. Primary Care Nurse Service
Staff
Liz Holdsworth (Manager) Tom Brown (Team Leader) Caroline Williams (Clinical Lead)
Admin
Primary Care Nurse Service
Community Mental Health Nurses
IAPT
Psychological Wellbeing Practitioners
Counsellors
Cognitive Behaviour Therapists
Psychologist
Link Practitioners

7. Referral Process Referrals Everyone - Consent
Admin – Logged on Systems
Allocation Meeting
Next working day
Appointment Sent for Screening
Screened- PWP – Link Practitioner
Accepted Treatment / Signposted
Possible Waiting List
Treatment

8. IAPT Stepped Care – Model
Focus of the intervention
Nature of the intervention
Step 3:
mild to moderate or persistent depression that has not responded to a low-intensity intervention
initial presentation of moderate or severe depression
GAD with marked functional impairment or that has not responded to a low-intensity intervention
moderate to severe panic disorder;
OCD with moderate or severe functional impairment; BDD with mild impairment
PTSD.
NICE approved high intensity psychological treatments for:
Depression: CBT, behavioural activation (1:1 and group), counselling
Generalised Anxiety Disorder (GAD): CBT
Panic disorder: CBT,
Obessional Compulsive Disorder / Body Dysmporphic Disoder (mild impairment): CBT (including ERP).
Post Traumatic Stress Disorder (PTSD): Trauma-focused CBT (group and individual), EMDR.
Health Anxiety: CBT
Chronic Bereavement: Counselling
Phobias – CBT
Social Anxiety: CBT
Step 2: Persistent sub-threshold depressive symptoms or mild to moderate depression; GAD; mild to moderate panic disorder; mild to moderate OCD; PTSD (including people with mild to moderate PTSD).
NICE approved low intensity psychological treatments for:
Depression: Individual facilitated self-help, computerised CBT, structured physical activity & group-based peer support (self-help) programs (Recovery through reading / Stress Pac)
Panic disorder: Individual non-facilitated and facilitated self-help, psycho-educational groups, Agoraphobia package (for Panic with Agoraphobia).
OCD: Individual CBT (including ERP).
PTSD: Psycho-education
Phobias: Graded Exposure programs
All problems = Stress Pac (psycho-education)

9. High Intensity Treatments
Depression: 16 – 20 hours / sessions Social Anxiety:14 sessions of 90 minute duration Generalised Anxiety Disorder: hours / sessions PTSD: 8-12 sessions for ‘simple’ PTSD (exposure work for 90 minute duration) Panic: 7 – 14 hours / sessions OCD – up to 20 sessions

10. Low Intensity Treatments -PWP
6-8 weeks of guided self help
Stress Pac
cCBT
Workshops
Pain Management
College

11. Primary Care Nurses Recovery Focussed Interventions
Step 3 clients who are not stable, to complex or too ill to access therapy via IAPT

12. IAPT Targets - Measures
IAPT Measures taken each session
Expected that 15% of people with common mental health problems (the prevalent population) will access IAPT by 2015 (26,316 – 3,947)
50% of those entering treatment will have moved to recovery

13. Moving to Recovery
Recovery under IAPT is defined as moving from above the set threshold of symptom measurement at the start of treatment to below this level at end
Set at 10 for PHQ-9 and 8 for GAD-7
Important to receive right referrals that we can provide therapy for

14. Success - Full Roll Out Achieved 2014 - 2015

15. Other Data People who self refer as more likely to attend
March 350 DNA - £4, – 46 full working days
2014 / referrals

16. How Achieved
Waiting list audit – development of CBT / PWP groups = 67% reduction on overall waiting list.
Workshops
Pathways
Perinatal
Rainbow Tick
Long Term Conditions
Tightening of acceptance criteria
Reduction of therapist drift

17. Exercise

18. Therapy Collaborative Means trusting someone to share Facing fears
Being willing to put it into practice
Homework
Understanding / formulation

19. Referrals Consent Correct contact details
History of risk to self and others
What does client want
Talking therapies – not counselling
Self refer if no risk

20. Top Tips Watchful waiting PHQ9 & GAD7 – useful tools to monitor
Ask what they want ??
Exercise
Information / Education – panic
Self Help Book
cCBT

21. Top Tips Stress Pac Workshops Refer for advice – list in packs
Look at pros and cons of problems
Relaxation techniques
As soon as people have problems

22. Top Tips Reduce fears re Groups Discuss motivation / right time
Challenge people who have not attended
Encourage to use techniques learnt in therapy
Ring and ask if not sure

23. Last Bits Rooms Packs Please ask client if want to be referred
Travelling to appointments
Waiting times / clients choice

24. Thank You for Listening Questions ?