Transcript Stevenage Practice Based Joint Commissioning Pilot for Adult

ITEM 2
DR ALISON MUNN
PRESENTATION
Stevenage Practice Based
Joint Commissioning Pilot for
Adult Mental Health
Overview and Scrutiny Committee
12/6/07
Gaps
NICE stepped care approach
(Anxiety and Depression)
Step 5
Risk to Life, Severe
Symptoms/Need
Medication, combined
treatments, ECT
Step 4:
Complex & Enduring
Symptoms/Need
Medication, Complex
Psychological Interventions,
Combined Treatments
Step 3
Moderate or Severe
Symptoms/Need
Medication, Psychological
Interventions, Social Support
Step 2
Mild Symptoms/Need
Watchful Waiting, Guided Self
help, Brief Psychological
Interventions
Step 1
Recognition
Assessment
NICE stepped care approach
(Anxiety and Depression)
Step 5
Risk to Life, Severe
Symptoms/Need
Medication, combined
treatments, ECT
Step 4:
Complex & Enduring
Symptoms/Need
Medication, Complex
Psychological Interventions,
Combined Treatments
Step 3
Moderate or Severe
Symptoms/Need
Medication, Psychological
Interventions, Social Support
Step 2
Mild Symptoms/Need
Watchful Waiting, Guided Self
help, Brief Psychological
Interventions
Step 1
Recognition
Assessment
Gaps
• Psychological services for patients with
mild symptoms / need
NICE stepped care approach
(Anxiety and Depression)
Step 5
Risk to Life, Severe
Symptoms/Need
Medication, combined
treatments, ECT
Step 4:
Complex & Enduring
Symptoms/Need
Medication, Complex
Psychological Interventions,
Combined Treatments
Step 3
Moderate or Severe
Symptoms/Need
Medication, Psychological
Interventions, Social Support
Step 2
Mild Symptoms/Need
Watchful Waiting, Guided Self
help, Brief Psychological
Interventions
Step 1
Recognition
Assessment
Gaps
• Psychological services for patients with
mild symptoms / need
• Psychological services for patients with
moderate symptoms / need who would
prefer a psychological approach over drug
treatment
NICE stepped care approach
(Anxiety and Depression)
Step 5
Risk to Life, Severe
Symptoms/Need
Medication, combined
treatments, ECT
Step 4:
Complex & Enduring
Symptoms/Need
Medication, Complex
Psychological Interventions,
Combined Treatments
Step 3
Moderate or Severe
Symptoms/Need
Medication, Psychological
Interventions, Social Support
Step 2
Mild Symptoms/Need
Watchful Waiting, Guided Self
help, Brief Psychological
Interventions
Step 1
Recognition
Assessment
Gaps
• Psychological services for patients with mild
symptoms / need
• Psychological services for patients with
moderate symptoms / need who would prefer a
psychological approach over drug treatment
• Rapid access to psychological services for
patients with moderate to severe symptoms /
need who have not improved with drug therapy.
A composite story
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Wk 0
Wk2
Wk4
Wk8
Wk12
Wk 13
Wk14
Wk16
WK 18
Wk22
Wk 27
Wk 31
Wk 36
Wk 40
Wk 44
Wk 48
sees GP
starts meds
slight improvement
feels more in control, v positive
less good
increase dose
problem at work
DNA
no change
change drug, refer
feels worse
no change, start guided self help
resigned from work
Saw OPD
no better no worse
Saw OPD
Had letter from psychology
saw OPD
letter from psychology
off work
returns to work
off work
What we would like to see:
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Wk 0
Wk2
Wk4
Wk8
• Wk10
• Wk 20
• Wk 46
sees GP starts meds
slight improvement
feels more in control, v positive
less good, referred to Primary Mental Health
Care Team
assessment and plan 6 weeks CBT
completed CBT, full resolution of symptoms.
end of meds
Aim to Provide:
• Psychological services for patients with mild
symptoms / need
• Psychological services for patients with
moderate symptoms / need who would prefer a
psychological approach over drug treatment
• Rapid access to psychological services for
patients with moderate to severe symptoms /
need who have not improved with drug therapy.