Dr. Thomas Richardson Clinical Psychologist (1,2) Dr. Lorraine Bell Consultant Clinical Psychologist (1) 1. Mental Health Recovery Teams, Solent NHS Trust, Portsmouth, UK 2. 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  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 analysis  General Linear Model (Mixed Factorial ANOVA)  Time X Clinician  All subscales analysed  Intent to Treat Analysis  For 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