Improving Access to Psychological Therapies for individuals with a Personality Disorder

Providing services for the treatment seeking population

Identifying strategies for engaging with the treatment reluctant population

Working within the current economic position

What direct therapies does IMPART provide?

• Fully programmatic and adherent Dialectical Behavioural Therapy• Cognitive Behavioural Therapy adapted for Personality Disorder• Mindfulness Based Cognitive Therapy• Mindfulness skills group• Managing Emotions group (in-patient)• Motivational Interviewing• Psychoeducational groups (anxiety, anger, healthy lifestyle)• Supporters (carers) evenings• Supporters (carers) DBT skills workshops

Improving Access means inclusivity

IMPART works with:

8 of the 10 DSM-IV Personality Disorders*

Older adultsmild learning disabilitiesco-morbid substance abusehigh risk

* The clinical and business case for ASPD has been developed andis being discussed with leadership and commissioners

0

20

40

60

80

100

120 Primary PD Diagnosis

IMPART Direct Provision

2010 – 2011 1245 Open cases [13.1 wte]2011 – 2012 921 Open cases

6m of IAPT 177 new referrals accepted374 discharged cases602 open cases

22 – average caseload

10.7 wte staff

Indirect provision

• Training on working effectively with PDMental Health ServicesPsychiatric Liaison and A&E staffHousing workersSocial ServicesChild protection servicesProbationMagistrates GPsHealth visitors

Improving Access needs robust pathways

Mental HealthMental Health

Primary Care

Primary Care

Local Authority

Local Authority

Criminal JusticeCriminal Justice

WeeklyPsychologyReferrals Panels*

WeeklyPsychologyReferrals Panels*

Psychology DepartmentsPsychology

Departments

IMPARTIMPART

GPGP

Fewer assessmentsReduced waiting times

CAMHSCAMHS

Engaging with the treatment reluctant population

In-patient IMPART Therapistassessments facilitating pathways to community treatmentmotivational enhancementpsychoeducation and coping skillsstaff support groupsward based DBT skills groups

Working within the current economic position

Providing the case for redeployment of resources

Mental Health CostsReturn of OAT contracts Reduction in ISA placementsReduction in bed days

Social Care CostsIncreasing employmentStabilizing housingReducing children in care

2010-2011

660 less bed days4 ISA returns

Cost savings:£443,765

30% SU gained employment or education during treatment

Measuring Outcomes

IAPT Dataset

PHQ-9IAPT employment statusWSAS (Work and Social Adjustment)EQ-5D (Quality of Life)WEMWBS (Warwick-Edinburgh Mental Well Being Scale)SAPAS (Standardized Assessment of Personality)Rates of self harm and suicide attemptsService utilization

IMPART dataset

SCID I and IIStaxi (Speilberger Anger Scale)Christo (modified drug/alcohol)Treatment history (one year)

Challenges faced by IMPART

Demands to see individuals with ASPDCare coordination – pressures on the systemRequests for more training /consultation/supervisionContinual restructuring – disrupted care pathwaysManaging a wait list – high risk clients

Key Deliverables

• psychological therapy – across PDs• training package - ‘Recognizing and Working with PD’• Handbook - ‘Setting up an IMPART’• Consultation service for Trusts developing IAPT SMI (PD) services• Increasing access for difficult to engage population

South AsiansMothers with BPDHigh comorbidity

IMPART Open Day

Tuesday 9th April, 2013 9:30am-4:30pm

Ford Sports Centre, Aldborough Rd S, Ilford, Essex IG3 8HG - near Newbury Park Tube Station

RSVP – john.liverpool@nelft.nhs.uk; 0300 555 1213

I want to live, I want to die.A silent tear, I need to cry.A pain so deep, so ragged and raw,it feels like an open infected sore.

Help is at hand, it is there for you.Learn to trust, and let it through, to have a future free from pain,and a life worth living once again. I need you IMPART and the group.The things you teach are starting to rootinto little buds, starting to shoot.Soon a tree I will see, and future on thehorizon of where I want to be.

JM 2012