Service Innovation Bulletin
Mental Health Trusts
- Acupuncture Service for the Treatment of Anxiety and Depressive Illness
- Early Detection and Intervention Team (EDIT)
- IPAS – In-patient Activity Service
- Day Hospital Service Redesign – Older People’s Mental Health
Acupuncture Service for the Treatment of Anxiety and Depressive Illness
Manchester Mental Health and Social Care NHS Foundation Trust
The service was established by a Consultant Psychiatrist and Clinical Nurse Specialist in Mental Health, both are Medical Acupuncturists and also trained in Traditional Chinese Acupuncture. The acupuncture clinic has been running for 25 years and originally treated physical problems amongst a psychiatric population. The service now provides acupuncture solely for the treatment of mental illness.
Any patient with a mental health problem can be referred to the service; referrals are made mostly for treatment – resistant anxiety and depressive illness. Acupuncture is not used as a first line treatment for patients suffering with psychotic illness. However, any patient with a formal mental illness can be treated for concurrent physical and/or emotional problems. In addition, acupuncture is used for in patients and out patients with dual diagnosis to help with addictions to heroin, crack cocaine, cannabis, alcohol and cigarettes.
A 2008 audit of the last 1000 patients referred to the service indicated that; 40% were referred for treatment of anxiety and or depression; 14% were for treatment of addictions; 16% for pain and general medical conditions in the setting of mental illness; 16% for other psychiatric conditions including: Personality Disorder, Eating Disorder, Post Traumatic Stress Disorder, OCD and Sleep Disturbance.
A patient satisfaction survey indicated that: 90% of patients agreed they had been helped to some extent by acupuncture; 50% saying that their condition had improved “a great deal”; 62% had been able to reduce their prescribed medication to some extent and 90% stated that they would use the service again.
Patient satisfaction with the service is good. Failure to attend appointments is currently running as low as 3%.
Early Detection and Intervention Team (EDIT) – Young People At Ultra-High Risk Of Developing Psychosis
Bolton, Salford and Trafford Mental Health NHS Trust
The EDIT service has been established to prevent the onset of psychosis in young people aged 14–35 years who are at ultra-high risk of developing psychosis. It was established following a randomised controlled trial, which
demonstrated that cognitive therapy was effective in preventing the transition to psychosis during the 12-month
follow-up period. The service has demonstrably lowered the rate of transition to psychosis. Over a 12 month period
only 4 people, identified as being at ultra-high risk, have developed psychosis (equating to a transition rate of 8%).
Local data would suggest a transition rate of 22–30% in the absence of targeted preventative interventions and
international data would suggest a rate of 36–50%.
The PACE assessment criteria are used to identify individuals who have an ultra-high risk of developing psychosis.
Clients in the high-risk group are offered up to 12 months of cognitive therapy, and then monitoring appointments
for up to 3 years post-therapy.
Referrals to the service are received from community mental health teams, GPs, young people’s organisations (such as Connexions), youth offending teams, A&E crisis, counseling, colleges, primary care and psychology services.
Self referrals are also accepted.
The main benefits of this service include preventing young people’s transition to psychosis, reducing their distress and reducing the duration of untreated psychosis.
IPAS – In-Patient Activity Service
Manchester Mental Health and Social Care NHS Trust
The IPAS model was developed originally by an Occupational Therapist and an Assistant Psychologist. It is a multidisciplinary approach within the in-patient activity services to promote, maintain and improve the quality of life of individuals. Based on the philosophy that activity is a human right, individuals should have access to facilities to engage in activity of their choice whilst in hospital, as far as possible. It utilises existing staff resources and is designed to compliment existing systems and processes to achieve its aims. The assertion is that the multi-disciplinary team has responsibility for engaging individuals in activity; this promotes engagement and is an effective vehicle for promoting effective health and social care outcomes.
The original pilot post-implementation questionnaires completed by service users on one ward indicated that there was an increase in the number of service users who approached staff to engage in activity, the number who were
moderately/very satisfied in the level of activity offered and the level of satisfaction in the range of activity offered
(0 to 93.3% 7.1% to 83.3% and 0 to 63.3% respectively).
Day Hospital Service Redesign – Older People’s Mental Health
Pennine Care NHS Trust
In 2004 it was discovered that traditional mental health day hospital services for the over 65s were not having the
desired effect on the mental health of clients.
Consultation with clients led to the development of a two-part life-skills programme, incorporating an introduction to
information technology (IT). An on-site information and communications technologies (ICT) suite was established and
clients can access tuition from a dedicated tutor from the Workers Education Association.
Discharge has been redefined in terms of positive outcomes; the approach is a ‘need led’ recovery approach, combined with evidence based practice. The benefits of this approach include: the well-being of 100% of participants has improved (using the Becks Anxiety Rating Scale and the Well-being Inventory Scales); clients now attend the day hospital for fewer days, or on a sessional basis and many make their own way to the day centre; clients can acquire IT skills contributing towards social inclusion.
Since the introduction of this programme no clients have been readmitted onto acute mental health wards, or back to
the day hospital.