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Aims of ISP

• To give the service user in crisis the following
  hopeful Recovery message
• Their distress is understandable and taken
  seriously
• Their central role in making things change is
  demonstrated.
• To teach new ways of coping and support the use
  of these skills.
• To enable all staff to work with the
  psychological model, through training,
  supervision and support from the therapy service.

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Third Wave term coined by Hayes

• Mindfulness Based Stress Reduction (Kabat-Zinn)
• Mindfulness Based Cognitive Therapy (Segal,
  Teasdale Williams)
• Dialectical Behaviour Therapy (Linehan)
• Mindfulness groups for voices (Chadwick)
• Compassion focused therapy (Gilbert)
• Acceptance and Commitment Therapy (Hayes)

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Emotion and Behaviour Based Formulation Template
Past abuse, trauma etc.
Recent triggering event
Try to escape from the emotion by avoidance, self
harm etc.
Feel better short term
Another maintaining cycle feeding the emotion
Aversive Emotion
Bad longer term consequences. Aversive emotion
worse.
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Skills teaching and coaching a team response

• Staff trained, supported and supervised to
  deliver basic psychological strategies to break
  the cycles
• Assessment and support on the practical side by
  Occupational Therapy staff.
• Programme of psychologically informed group work.
  
• Individual coaching on the ward or by Hospital at
  Home staff.
• Including carers, partners etc. where relevant

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Skills Programme

• Anxiety and stress management.
• Breathing techniques.
• Management of arousal - up and down
• Managing attention - Mindfulness
• DBT techniques
• Interpersonal effectiveness
• Distress tolerance
• Emotion regulation
• Managing the self-self relationship - Self
  compassion
• Managing psychotic symptoms
• Living with unusual experiences groups
• Self designed prevention and wellness process -
  WRAP

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Evaluating the Programme

• 3 papers
• Quantitative Pre and post measures
• Qualitative Staff perceptions of ISP on
  individual and team work, milieu and impact on
  service user
• Qualitative 2 Service user experiences of ISP

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Study 1

• Participants - 46 male, 85 female (N 131)
• Mean age of 38.15 (SD 12.01)

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Study 2Investigating the Impact on Acute Staff

• Sample of 10
• Nursing staff
• Occupational therapists
• Mental health practitioners
• Team managers
• Interviewers have been through acute services
• Semi structured interviews
• Thematic analysis

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Study 3The Perspective of the Service User

• REC/RD approved
• Aiming for sample size of 12
• Interviewers have been in acute services
• Semi structured interviews
• Thematic analysis
• Individual experience of ISP, what works well
  and what needs improving, longer term impact

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Contact details, References and Web addresses

• Isabel.Clarke_at_southernhealth.nhs.uk
• David.Araci_at_nhs.net
• Durrant, C., Clarke, I., Tolland, A. Wilson, H.
  Designing a CBT Service for an Acute In-patient
  SettingA pilot evaluation study. Clinical
  Psychology and Psychotherapy. 14, 117-125.
• Clarke, I. (Ed.) (2010) Psychosis and
  Spirituality consolidating the new paradigm.
  Chichester Wiley
• Clarke, I. (2008) Madness, Mystery and the
  Survival of God. Winchester'O'Books.
• Clarke, I. Wilson, H.Eds. (2008) Cognitive
  Behaviour Therapy for Acute Inpatient Mental
  Health Units working with clients, staff and the
  milieu. London Routledge.
• www.isabelclarke.org