1. Jo Farrow, Consultant Psychiatrist
Psychological support for people with Diabetes
HPFT’s Wellbeing (IAPT) Service
Michael Elkabbas
Still of the service user who will be speaking
Can take a still of Alan

2. Regional and national award winning initiative….!!!!
HPFT Wellbeing Team scoops national award for diabetes project
We’ve done a pretty good job – regional champions for the “innovations in mental health award”

3. IAPT Long Term conditions pilot
Improved Access to Psychological Therapies
142 IAPT services in England
22 of which selected by NHS England to pilot ‘Integrated care for people with long term conditions’
Whole person approach

4. Reminder why we did this: The impact of a MH problem
Long Term Condition (eg diabetes)
Depression, anxiety
Self care is compromised
Physical health deteriorates/ increased disability and distress, ability to stay in a job is compromised
Increased pressure on NHS

5. Challenges we had to overcome
Overcoming resistance with stakeholders:
Our staff,
Our service users
Our colleagues in physical health care…
Developing a pathway that caters for everyone
Demonstrating outcomes

6. Dedicated team of therapists with LTC interest
How we did it
Dedicated team of therapists with LTC interest
Specially commissioned training: Psychology for LTC
Recruited a great team! In order to deliver this we recruited from within our team of therapists a dedicated group of people who had a real interest in LTC and who wanted to make this happen
We then sent these staff on specially commissioned training which helped them adapt psychological interventions to make them relevant for people with LTC

7. What made it a success? Service user input from the start
How to overcome barriers to engagement
Design of service promotion materials
Finding creative ways of reaching out to people
Offering routine screening for MH problems for everyone with diabetes
The model we opted for
Our staff
Our service users
Our colleagues in physical health
Merge with next slide
Introducing screening for MH problems for everyone as part of routine care for people with diabetes now covered in pathway slide

8. Service users: “The why psychology challenge”?
Merit of psychological intervention questioned
Co-production essential

9. Model sensitive to engagement challenges
Referral
Face to face assessment by Integrated CBT therapist
Client provided with psychological formulation and treatment plan
Step 2 intervention
Step 3 intervention

10. Treatment options tailored to individual needs
Not “just” Cognitive Behavioural Therapy
Interpersonal therapy (IPT)
Couples therapy for depression
Dynamic interpersonal therapy (DIT)

11. How we achieved integration
Persuading busy physical healthcare colleagues this is a good idea…!
Relationship building crucial: pairing up therapists with healthcare staff
Required (non clinical) time investment
Co-education  highly appropriate referrals

12. Outcomes - Shoulder to shoulder work
“Running a clinic with a therapist was inspiring…they very skilfully engaged my patients in a conversation about their difficulties in a way that was reassuring and de-stigmatising. My patients have self referred and are getting great support”
KF Diabetes Specialist Nurse
Paired out therapists up with DSNs

13. The outcomes – our service users
Discharge data show high recovery on measures of depression and anxiety
Staggering 33% reduction in physical healthcare appointments following treatment
Better self management of diabetes

14. CSRI: Impact on healthcare utilisation
CSRI: Impact on healthcare utilisation 34% drop in physical health appointments 53% clinical recovery
p<0.0066

15. Impact on GP appointments
45% drop in GP appointments

16. Diabetes Distress Scale
DDS correlated with HbA1c (Todd et al., 2017)
p<0.0001

17. Service user feedback
“This service provided me with the space to talk about worries about my diabetes no one else has asked me about before …. I really valued that ..as well as the subsequent support…”
LS Service User

18. Exemplar of positive practice in NHS publications

19. Any questions?