New developments in IMPARTS: Integrating Mental and Physical Healthcare: Research Training and Services Website: Follow us on

IMPARTS - recap AIM To improve detection and management common mental disorders in medical settings - web-based screening interface - patient-reported mental and physical health outcome measurement - embedded in routine clinical practice - informs patient care and referral

Page 2 IMPARTS informatics screening system: 1. Patients arriving for appointment are given information sheet explaining purpose of screening 2. Patients log on to an Ipad in the waiting room, using their Hospital ID and initials 3. Patients complete a series of short questionnaires tailored to their condition 4. Patients responses transfer directly to the electronic patient record

IMPARTS – the wider context Improve detection & management of symptom distress Inform clinical decision- making & promotes timely intervention Track change over time Routine collection of patient-reported outcomes Research database Evidence generation CLINICAL PRACTICERESEARCH Transformation of future care POLICY Identifying need & informing resource allocation Mental health services in general hospitals Mental health training for non- specialists

Informatics Routine collection of patient- reported outcomes with advice on care & referral Care pathways Development of mental health care pathways for patients identified via screening Training Training in mental health skills with ongoing supervision from a mental health specialist Self-help Portfolio of bespoke self- help materials, tailored to specific physical conditions The IMPARTS package

Implementation Rheumatology (KCH) Limb reconstruction (KCH) Hepatitis C (KCH) Sexual health (KCH) Breast cancer (KCH) Neurotrauma (KCH) Liver transplant (KCH) Neurocardiology (KCH) Pain services (GSTT) Obstetrics (GSTT/KCH) Congenital heart disease (GSTT) Dermatology (GSTT)

Rheumatology Pain VAS Fatigue VAS Depression PHQ-9 Anxiety GAD-7 Function HAQ Limb reconstruction Pain VAS Fatigue VAS Depression PHQ-9 Anxiety GAD-7 Limb function LEF Alcohol & drugs Occupational functioning Smoking Hepatitis C Sleep (Jenkins) Anger Depression PHQ-9 Anxiety GAD-7 Physical symptoms Alcohol & drugs QoL WHODAS Adherence to treatment

Acceptability of screening CLINICPts approachedPts declining screening n (%) Rheumatology29615 (5.1) Limb reconstruction1777 (4.0) Hepatitis C311 (3.2) Proportion of patients declining screening:

Depression (PHQ-9) CLINICRheumatology n=432 Limb Reconstruction n=169 Hepatitis C n=26 Probable Major Depression (MDD) 101 (23.4%)36 (21.3%)9 (34.6%) Severe MDD with suicidal ideation 14 (3.2%)7 (4.1%)2 (7.7%) Severe MDD without suicidal ideation 17 (3.9%)6 (3.6%)0 Moderate MDD42 (9.7%)17 (10.1%)5 (19.2%) Mild MDD28 (6.5%)6 (3.6%)3 (11.5%)

Anxiety (GAD-7) CLINICRheumatology n=432 Limb Reconstruction n=169 Hepatitis C n=26 Probable Generalised Anxiety Disorder (GAD) 107 (24.8%)33 (21.3%)6 (23.0%) Severe GAD42 (9.7%)20 (11.8%)5 (19.2%)

Alcohol (AUDIT) & Drugs CLINICLimb Reconstruction n=169 Hepatitis C n=26 Probable Alcohol Dependence 4 (2.4%)0 Harmful drinking01 (3.8% Hazardous drinking17 (10.1%)1 (3.8%) Probable Drug Dependence 4 (2.4%)3 (11.5%)

Post-traumatic Stress Disorder PTSD (PCL-4) Probable PTSD 10.4% Some symptoms 22.0% No problem 67.6% Limb Reconstruction (n=169)

IMPARTS Research Database IMPARTS screening data EPR clinical & demographic data IMPARTS pseudonymised Research Database RESEARCHER The database will bring together psychological & physical health outcomes into a single, searchable, anonymised data repository.

Prevalence; Associations Depression Anxiety PTSD Drug & alcohol misuse Physical symptoms (e.g.fatigue, pain); Biomarkers Health beliefs & behaviours e.g. non- adherence Limb reconstruction, rheumatology, Hepatitis C… Research opportunities (1)

Trajectories of depression, anxiety, alcohol misuse in different clinical populations Time 1 Time 2 Time 3 Research opportunities (2)

Research opportunities (3) Increased pain Increased inflammation Poorer adherence Depression Higher health costs Increased unemployment Higher mortality Alcohol dependence Outcomes of mental health problems in physically ill populations over time…

Depressed at T1 Depressed at T2 No depression at T2 Can we predict likelihood of non-remission? Research opportunities (4) - Less social support - Unhelpful health beliefs - Unemployed - More pain

Consent for contact We have ethical approval to prospectively request consent for contact via the IMPARTS screening interface I agree to be contacted by a researcher to offer me the opportunity to take part in relevant research projects if they think I may be a suitable participant. It would then be possible to deanonymise patient records to allow researchers to contact potential trial participants –when explicit consent has been given YesNoMore information

Teaching programmes and self-help materials

Claire Doyle Katie Steel More on breathlessness and anxiety later Example of Limb Reconstruction service

Teaching programme Risk assessment and referral Managing anger Supporting adjustment Scheduling activity Increasing adherence Working with thought and expectations

Self-help materials Learning to control your anger Are you on edge? Coping and living well Depression: are you struggling? Keeping active Getting on with your life after a trauma

Other bespoke teaching programmes Respiratory ward Speech and language therapists Rheumatology nurses

Materials of general relevance

…and more specific

Emphasis on strengths

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Join the IMPARTS mailing list Subscribe at: //mailman.kcl.ac.uk/mailman/listinfo/mentalphysicalhealthcareinterface the group: For more information on IMPARTS:

IMPARTS module in Core Mental Health Skills Delivered as part of Advanced Practice MSc module Open to all non-mental health specialists interested in developing their skills Special introductory offer £499 5 interactive taught days with e-learning component (Jan-Mar) For more info contact: The depressed/ anxious patient The agitated/ confused patient The substance misusing patient Medically unexplained symptoms Managing conflict

Prof Matthew Hotopf - Project Lead Dr Lauren Rayner - Project Coordinator Ms Faith Matcham – Research Assistant Dr Jane Hutton – Consultant Clinical Psychologist Dr Rina Dutta – Consultant Psychiatrist Dr Katie Steel – Clinical Psychologist Project Team