Guided Self Help in NHS Dumfries & Galloway Dr Rosaleen Isles- Cognitive Behaviour Therapist Ian Hancock – Director Psychological Services Dumfries & Galloway

Dumfries & Galloway Guided Self Help Service - summary Ist Tier short term, face to face individualised intervention for Mild/moderate Psychosocial problems Service delivered to all GP practices Between 1000 and 1200 referrals annually

Dumfries & Galloway Guided Self Help Service - Milestones 2001 – One GSHW covering two GP practices (Waiting Times initiative) 2003 – Four GSHW covering half D&G (Local Health Partnership funded) 2004 – Eight GSHW covering whole D&G (Doing Well By People with Depression) 2006 – Recurring Funding by NHS D&G

Dumfries & Galloway Guided Self Help Service – Service/Costs Budget = £203K. Includes:- Service Lead (CBT/Manager) 0.8 wte Senior SHW 0.6 wte SHW x 9 4.7 wte Secretary 0.4 wte

Dumfries & Galloway Guided Self Help Service Psycho-social problems of life:- - validate - normalise - promote personal responsibility - resilience Maximum 3 sessions Tight referral criteria Lay workers

Selection of Self Help Workers Experience of life- different work environments/ people No formal mental health qualifications Varied interests Personal qualities- kindness/ humour/ trust/ creative/ adaptable.

Training of Self Help Workers Background reading of all self help materials Five sessions Cognitive Behavioural Model Experiential- role play/ self awareness One week in sessions with experienced SHW

Supervision of Self Help Workers Weekly- with CB therapist lead Plus individual for 6 months for new workers Regular review of recorded sessions 3 monthly workshops Social

Aim of supervision Skills development Adherence to service remit Self Awareness Mutual support Confidence building

Monitoring service Contact time – within 1 week of referral Waiting times - 3 weeks max Operational Policy- Details of the whole service Suitable/ unsuitable referrals Referral on Risk Administration Cross cover – exceeding wait time/ sick leave

Monitoring service Outcome measures:- Demographic Survey HADS Work & Social Adjustment Scale ( WSAS) Client Satisfaction Questionnaire

Context of Service Delivery SHW based, where possible in GP practices Close contact with referrers Regular updating of community/ voluntary provision in all areas Managed within Psychology

Why the service is managed within Psychology Psychological model of care CBT based model Facilitates a stepped care approach

Based on 2880 clients Of which: 2061 females (72%) 819 males (28%) DWPD Evaluation Based on 2880 clients Of which: 2061 females (72%) 819 males (28%) 1

Referrer 1

Appointment Response Times Mean = 11.76 days Range = 0 – 85 days From date of initial contact to date of first appointment with Self Help Worker Mean = 11.76 days Range = 0 – 85 days 46% of referrals 21% 16% 9% 4% 1% 1% 0.5% 0.3% 0.4% Dumfries & Galloway Self Help Project 1

Nature of Problem From available data from those referred: Dumfries & Galloway Self Help Project 1

GP Choices Alternative Interventions GPs Would Have Chosen If Self Help Service Was Not Available: 1

Client Satisfaction Questionnaire Outcomes Summary of Total Scores Mean = 28.99 Points (Maximum score on CSQ-8 = 32) Range = 13-32 Points 90% of those discharged 9% 1% Dumfries & Galloway Self Help Project 1

Work & Social Adjustment Scale – Total Score Dumfries & Galloway Self Help Project

HADS Depression Hospital Anxiety & Depression Scale - provides a measure of anxiety and a measure of depression for each client. It is completed prior to Self Help intervention and immediately following the final contact with a Self Help Worker N = 2387 N = 1053 N = 539 Dumfries & Galloway Self Help Project

HADS Anxiety Hospital Anxiety & Depression Scale - provides a measure of anxiety and a measure of depression for each client. It is completed prior to Self Help intervention and immediately following the final contact with a Self Help Worker N = 2387 N = 1053 N = 539 Dumfries & Galloway Self Help Project

Alternative or additional to medication? Final Thoughts Alternative or additional to medication?