stevenage practice based joint commissioning pilot for adult mental health overview and scrutiny...
TRANSCRIPT
Stevenage Practice Based Joint Commissioning Pilot for
Adult Mental Health
Overview and Scrutiny Committee12/6/07
ITEM 2
DR ALISON MUNN PRESENTATION
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• Wk 0 sees GP starts meds off work• Wk2 slight improvement• Wk4 feels more in control, v positive returns to
work• Wk8 less good increase dose• Wk12 problem at work off work• Wk 13 DNA• Wk14 no change change drug, refer• Wk16 feels worse• WK 18 no change, start guided self help• Wk22 resigned from work• Wk 27 Saw OPD • Wk 31 no better no worse• Wk 36 Saw OPD• Wk 40 Had letter from psychology• Wk 44 saw OPD• Wk 48 letter from psychology
What we would like to see:
• Wk 0 sees GP starts meds• Wk2 slight improvement• Wk4 feels more in control, v positive• Wk8 less good, referred to Primary Mental Health
Care Team • Wk10 assessment and plan 6 weeks CBT • Wk 20 completed CBT, full resolution of
symptoms.• Wk 46 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.