Complementing IAPT for people with medically unexplained symptoms (MUS) unable to access services Professor Helen Payne, University of Hertfordshire Susan Brooks, Pathways2wellbeing east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

IAPT and MUS Patients with MUS in primary care are high health utilizers and cost the NHS £18 billion in th most expensive category in primary care The most costly diagnostic category of out-patients (Bermingham et al 2010, Creed e al 2011) especially neurology (Stone et al 2009) Insecure attachment style relates to frequent attending in primary care ( Taylor et al 2012) Patients with MUS in primary care 2.47 times more likely to have insecure attachment. (Taylor et al 2000) Recommendation for people with MUS to be referred to IAPT; funding put in place (Morriss et al 2012) east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

What kind of symptoms? IBS Chronic Pain Fibromyalgia Chronic Fatigue ME Chest pain; Back pain; Head ache Muscular-skeletal pain Breathing problems Skin conditions Palpitations Insomnia And many, many more…………

What is The BodyMind Approach (TBMA)™? A course akin to those in Recovery Colleges Uses experiential learning, NV/body awareness, verbal Employs creative imagination to access/modify thoughts, behaviour, feelings and body sensations A facilitated group based on the social model Engages experienced Masters level health professionals trained and assessed in TBMA Bio-psychosocial, integrates mental & physical health Changes perceptions towards the body, symptom, self east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

TBMA in CCGs in Hertfordshire Based on research at UH (Payne & Stott 2010) UH sponsored a spin out ‘pathways2wellbeing’ DH QIPP project positive outcomes mirrored research (Payne 2014; Payne 2015; Payne & Brooks 2015) Two pilot courses commissioned Both CCGs commissioning further courses east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

Why TBMA for people with MUS? CBT helps those patients with MUS who have a psychological explanation for their symptoms Most patients with MUS perceive their symptoms as having a medical cause so they find TBMA, which focuses on the body and control, helpful Overcoming stigma/discrimination attached to MH enables a buy-in to TBMA from MUS patients east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

The TBMA course Self/GP referrals Patients with MUS need time to come to terms with their condition to learn to self manage Comprises 24 hours group workshops, individual consultations, 1-1 monitoring appointments 9-12 months duration (phases 1 & 2) Individual action plans for self-management devised during the last workshop east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

Data collection Data is collected at three points Phq9; GAD; GAF; MYMOP2; questionnaire for demographics Evaluation by service users Data analysed at individual level for GPs Reports produced for CCGs east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

Outcomes Participants report having enjoyed the courses and found them helpful in a variety of ways: Increased overall feeling of wellbeing Increase in day-to-day activity/functioning Increased self-management of symptoms Decreased distress from symptoms Decrease in depression Decrease in anxiety All sustained at 6 months follow up Participants’ attendance is exceptional They rate the courses as excellent/very good

How do TBMA courses help IAPT with patients with MUS? Enables IAPT to further support those more suited to a psychological approach/frees up workers Increases attendance rates and positive outcomes Improves access/future engagement in CBT Saves funds as less wastage/reduced attrition rates east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

Why commission TBMA for MUS in IAPT? Patients enjoy TBMA groups Attendance and completion rates are very high resulting in cost effectiveness for the NHS Outcomes are excellent After completion of TBMA patients can more willingly accept CBT as they see its relevance Can deliver anywhere in the East of England Region east of England IAPT conference 1 July 2015 copyright pathways2wellbeing

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References Bermingham S; Cohen A; Hague J; Parsonage M (2010) The cost of somatisation among the working-age population in England for the year Mental Health in Family Medicine, 7, Creed F, Barksi A, Leiknes KA (2011) Epidemiology: prevalence, causes and consequences. In F Creed, P Henningsen, P Fink (eds): Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services pp1–42. Cambridge University Press. Morriss, R et al (2012) Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Family Practice, 13:39 Payne, H; Stott, D (2010) Change in the moving bodymind: Quantitative results from a pilot study on the BodyMind Approach (BMA) as groupwork for patients with medically unexplained symptoms (MUS). Counselling and Psychotherapy Research, 10,4, Payne, H (2014) Patient experience: push past symptom mysteries. The Health Service Journal, 124, 6390, Payne, H (2015) The Body speaks its Mind: The BodyMind Approach® for Patients with Medically Unexplained Symptoms in the UK Primary Care Health System. Arts in Psychotherapy, 42, Payne, H; Brooks, S (2015) Clinical outcomes from The BodyMind Approach™ for the treatment of patients with medically unexplained symptoms in an English primary care setting: Practice-based evidence. Reviewed Stone J, Carson A, Duncan R, et al (2009) Symptoms unexplained by organic disease in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain, 132: 2878–88 Taylor RE, Mann AH, White NJ, et al (2000) Attachment style in patients with unexplained physical complaints. Psychological Medicine, 30: 931–41 Taylor RE, Marshall T, Mann A, et al (2012) Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychological Med, 42: 855–64 east of England IAPT conference 1 July 2015 copyright pathways2wellbeing