Transcript SELF HELP SERVICES - Breaking Free Group

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 email a referral form to
‘[email protected]’

Self-referral by phone, email or via our website
www.selfhelpservices.org.uk (either returned online
or posted to us)

Through a client’s GP
Background
•
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
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
KPI
Entering therapy
Values
117
Waiting over 28 days
0
Average waiting time
3 days
Moving towards recovery (IAPT)
43%
Alcohol reduction
29%
Drug reduction
60%
Patient satisfaction
100%
DNA/Cancellation
32%
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.
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Attended weekly support calls
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AUDIT reduced from 8 to 5. DUDIT down from 19 to 1
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PHQ9 reduced from 20 to 1. GAD-7 down from 21 to 3
Summary and Next Steps...
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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