1. Evaluation of an ACT Trans-Diagnostic Pathway in an NHS Community Mental Health Team for Adults
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

2. Our Service 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

3. ACT Pathway
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)

4. ACT Training 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
12-16 sessions of individual ACT
Attempted to identify patients who were less complex but didn’t find many!
Explain we increased number of sessions to 16 for second case
Couple exceptions: one 24 sessions, one only 6

5. Retention of Therapists
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)

6. Method
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)
- 6 month data not yet available

7. Method 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

8. Sample Characteristics
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

9. Results: Post-Treatment (n=18)
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
- Risk explain only a few questions so not sensitive to change

10. Results: 3-Month Follow-Up (n=15)
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

11. Results: By Clinician
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.

12. Results: By Clinician
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

14. Conclusions
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
- Following up at 6 month but data not yet available