Dr. Thomas Richardson Clinical Psychologist (1,2) Dr. Lorraine Bell Consultant Clinical Psychologist (1)

1. Mental Health Recovery Teams, Solent NHS Trust, Portsmouth, UK2. School of Psychology, University of Southampton, UK

National Health Service (NHS) Community Mental Health Recovery Team for Adults Secondary Care: Severe and Enduring problems

Service covers whole of Portsmouth Wide range of problems: psychosis, bipolar disorder,

personality disorders etc. Comorbidity the norm

Most band 6 staff (nurses, occupational therapists and social workers) required to train in a therapy: DBT, CBT for psychosis or ACT

Psychological therapies service offers CBT, DBT, Schema Focused Therapy, CAT, EMDR, Mindfulness and Psychoeducation Groups

6 pathways: Emotional Dysregulation, Psychosis, Depression, Trauma, Anxiety, Trans-Diagnostic

ACT placed on transdiagnostic pathway (alongside CAT) and depression pathway (alongside CBT)

Between Oct 2013 – Feb 2014, over 5 days n=9 psychological therapists (2 from Eating Disorders) n=11 non-psychologist staff (psychiatric nurses, OTs and

SWs)

Training delivered by two Consultant Clinical Psychologists: experienced in using ACT in secondary mental health

Dr. Helen Bolderston and Prof. Sue Clarke, Bournemouth University Department of Mental Health

Fortnightly supervision 12-16 sessions of individual ACT Attempted to identify patients who were less complex but

didn’t find many!

At present ACT currently delivered by:5/11 of non-psychologist staff originally trained(2 maternity leave, 1 retired, 1 left service, 2 opted out)

6/9 psychologist staff originally trained (2 maternity, 1 adoption leave)

Five remaining staff committed: agreed to attend regular supervision and take on two cases (with support from managers)

Aims: Determine if evaluation effective and whether differences in psychologists versus non-psychologist staff

Case series: measures given pre and post therapy, 3-month follow up.

CORE: A 34 item measure of global mental health (e.g. I have felt OK about myself)

PHQ-9: A 9 item measure of depression (e.g. Little pleasure in doing things)

Valued Living Questionnaire: how important values such as family are, how much currently living in line with values

Cognitive Fusion Questionnaire: 7 item measure of ‘Cognitive Fusion’ (e.g. I struggle with my thoughts)

Statistical analysisGeneral Linear Model (Mixed Factorial ANOVA)Time X ClinicianAll subscales analysed

Intent to Treat AnalysisFor Follow-Up: Last Observation Carried Forward

18 participants in service evaluation so far 14 women, 4 men

Recurrent depression most common primary diagnosis (one bipolar disorder)

Most had co-morbidity: PTSD, Anxiety Disorder, Personality Disorder Traits, Physical Health problems, Alcohol Problems, Transient Psychotic Disorder.

A number had attempted suicide in past

One Anorexia and Two Bulimia cases Majority had had other therapies in past

Statistically significant improvement for:◦ CORE Total: F=10.2, p<.01◦ CORE Total (-Risk): F=12.9, p<.01◦ CORE Functioning: F=14.7, p<.001◦ CORE Problems and Symptoms: F=18.5, p<.001◦ CORE Well-Being: F=18.9, p<.001

◦ PHQ (Depression): F=18.8, p<.001◦ Valued Living: Importance: F=7.6 p<.05◦ Valued Living: Action: F=7.7, p<.05◦ Cognitive fusion: Valued: F=14.6, p<.01

No improvement for:◦ CORE Risk: F=.08, p>.05

Statistically significant improvement for:◦ CORE Problems and Symptoms: F=7.9, p<.05◦ CORE Total (-Risk) F=14.9, p<.01◦ PHQ (Depression): F=7.0, p<.05◦ Cognitive fusion: F=7.7, p<.05

Trend for:◦ CORE Total: F=4.2, p<.10◦ CORE Functioning: F=3.7, p<.10

No improvement for:◦ CORE Risk: F=0.0, p>.05◦ CORE WellBeing F=3.0, p>.05◦ Valued Living: Importance: F=1.1, p>.05 or Action: F=0.2, p>.05

Post-Treatment, no significant interaction between changes over time and clinician (8 psychologists, 10 non-psychologists):◦Wilks Lambda: F(10,7)=1.8, p>.05

Drop out higher:◦ non-psychologists: 36.4% (n=4) dropped out◦ Psychologists: 12.5% (n=1) dropped out

Psychologists also took on the more complex cases: high risk, co-morbid personality disorder, physical health problems etc.

At three months (7 psychologists, 8 non-psychologists) ◦ Trend for outcomes on CORE Total (-Risk) better for

psychologists than non-psychologists: F=3.6, p<.10

ACT effective as a component of depression and trans-diagnostic pathways for complex secondary care population

Improvements in global mental health, depression, cognitive fusion and values post-treatment

Partially maintained at follow- up (data collection ongoing)

High rates of therapist attrition for non-psychologist staff Higher drop out for non-psychologist staff non-psychologist staff who stay committed to delivering ACT

have good outcomes similar to psychologists Possibility that longer-term outcomes better for psychologists