Guided Self-Help for Common Mental Health Difficulties: Gloucestershire Primary Mental Health Service

1
Guided Self-Help for Common Mental Health
Difficulties Gloucestershire Primary Mental
Health Service

• Alison Sedgwick-Taylor (Consultant Clinical
  Psychologist)
• Anna Lambert (Graduate Mental Health Worker and
  Self Help Guide)

2
Overview

• Background
• Gloucestershire Service
• Definition
• Potential Advantages of GSH
• Effectiveness
• Role of Guide/Tape
• Workbook Content
• Evaluation

3
Availability of Psychological Treatments

• Psychological treatments are effective for a wide
  range of psychiatric disorders (Roth and Fonagy,
  1996 Parry et al., 2002)
• Much public enthusiasm for psychological
  interventions (Andrews, 1996)
• Cognitive Behaviour Therapy (CBT) strongest
  evidence base particularly for depression and
  anxiety
• NICE Guidelines
• Access?

4
New Ways of Working

• Intensities of therapy (Stepped Care continuum)
• Setting
• Workforce
• ie Provide a range of different interventions
  across settings, delivered by people with less
  specialist training

5
Gloucestershire Solution

• Stress Management Courses
• Anger Management Courses
• Computerised Cognitive Behaviour Therapy (CCBT)
• Guided Self-Help
• Depression
• Anxiety
• Anger (in development)
• Maternal Mental Health (in development)

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Self-Help Interventions A Definition

• Cuijpers (1997)
• The patient receives a standardised treatment
  method with which he can help himself without
  major help from the therapist. In the self-help
  approach it is necessary that treatment is
  described in sufficient detail, so that the
  patient can work independently. Books, in which
  only information about depression is given to
  patients and their families cannot be used

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Definition Continued

• Distinction between providing information to
  people and providing self-help
• Structured approach which requires the subject to
  act on advice provided within the self-help
  material
• Clear model and structure of treatment which
  focuses on problems of relevance to the patient
• Almost all self-help approaches have used a
  cognitive, behavioural or problem-solving approach

8
Definition Continued

• Emphasis on homework (putting into practice what
  has been learned)
• Emphasis on how patient can improve their skills
  to cope with and manage their own difficulties

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Potential Advantages of Self-Help

• Empowering mental health service users
• Move away from paternalistic system
• Service user and professional collaborate to find
  a solution to problem(s)
• Using expertise and experience of users
  themselves

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• Greater accessibility and acceptability to
  patient
• Reduce stigma
• Preferred option (Jorm et al., 1997)
• More availability/ enlarges choice for patients
• Enables patients to receive help they might
  otherwise reject
• Low cost
• More accessible delivery methods, e.g., telephone
  and computer
• Limited waiting time
• No geographical limits

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Potential Advantages of Self-Help Continued

• More efficient/creative use of professional time
• Compliments existing usual care (improve outcome,
  discharge route, maintenance gains)
• Low intensity psychological intervention that can
  be used in primary care
• Delivering guided self-help uses the graduate
  mental health worker workforce effectively

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Evidence for Effectiveness

• Report to the DoH Research and Development
  Programme (Lewis et al., 2003)-NICE Guidelines
• Under researched
• Much of the research in USA poor quality
• Despite this-
• Significant benefit of self-help materials, based
  upon a CBT approach, for depression, anxiety,
  bulimia and binge eating disorders when given in
  the context of
• - Clinical assessment
• - Ongoing monitoring
• - Alternative options available if self-help
  intervention ineffective or unacceptable

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Recommendations

• Self-help material should be
• Based on CBT
• Include case vignettes
• Large format with photocopiable or removable
  sheets
• Modest reading age
• Attractively produced
• Further research needed
• - No vested interest

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Guided Self Help Service Protocol

• GP/PHCT
• Gateway Mental Health Nurse/Triage Nurse
• Guided Self-Help (1 option)
• Depression
• Anxiety
• Anger
• Maternal Mental Health
• Workbook (5)
• Call us for a Guide
• Telephone calls for 8-12 weeks
• Patient finishes the programme
• Follow up (6 months)

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Tape

• To illustrate
• Up-beat approach
• Cognitive restructuring
• Collaboration

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Role of the Guide

• Assess
• Support
• Monitor
• Motivate
• Teach
• NOT a therapist
• BUT a skilled role (training and supervision)

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Book Content

• Goal Setting / Self Monitoring
• Behavioural
• Breathing
• Relaxation
• Graded Practice
• Cognitive
• Catching, challenging and changing negative
  thinking
• Life Skills
• Assertiveness
• Time Management
• Problem Solving
• Lifestyle diet, sleep, exercise

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Evaluation

• University of Bath MHDU ? independent research
• Acceptability
• Accessibility
• Effectiveness of guided self help
• Explore
• Demographic variables impact
• Telephone versus face-to-face contact
• Book alone versus book guide
• Ethical approval awarded
• CORE outcome measure
• December 1st 2005 to December 1st 2006

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References

• Andrews, G. (1996). Talk that works the rise of
  cognitive behaviour therapy. British Medical
  Journal, 313, 1501-1502
• Cuijpers, P. (1997). Bibliotherapy in unipolar
  depression a meta-analysis. Journal of Behaviour
  Therapy and Experimental Psychiatry, 28, 139-147
• Jorm, A.F., Korten, A.E., Jacomb, P.A., Rodgers,
  B., Pollitt, P., Christensen, H. (1997).
  Helpfulness of interventions for mental
  disorders beliefs of health professionals
  compared with the general public. British Journal
  of Psychiatry, 171, 233-237
• Lewis, G., Anderson, L., Araya, R., Elgie, R.,
  Harrison, G., Proudfoot, J., Schmidt, U., Sharp,
  D., Weightman, A., Williams, C. (2003).
  Self-help interventions for mental health
  problems. Report to the DoH Research and
  Development Programme LondonDoH
• Parry, G., Bateman, A., Churchill, R., Clifford,
  P., Hearnshaw, H., Khunti, K., Lindsay, A.,
  Moorey, S., Roth, A., Rowland, N., and Tylee, A.
  (2002). Treatment choice in psychotherapies and
  counselling. Evidence based clinical practice
  guideline pp. 1-68. LondonDoH.
• Roth, A., and Fonagy, P. (1996). What works for
  whom? A critical review of psychotherapy
  research. New York Guildford Press.

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Workshop Aims

• Increase understanding of the Graduate Mental
  Health Worker role
• Introduce key CBT techniques for the management
  of depression
• Increase awareness of Guided Self-Help
• Gather resources to assist you in your practice

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Introducing Ros

• I am 24 years old
• I have been married to Simon for 2 years
• We have two children Jamie who is 2 years old
  and Jenna who is 5 months old
• I suffered with depression when I was a student
• I suffered from postnatal depression after my
  first child Jamie was born
• I used to be very active and outgoing, but now I
  lack time, energy and enthusiasm

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3 Workshops (20 minutes)

• Participation not optional
• Ask questions
• Enjoy!

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Summary

• Workshop 1 Psychoeducation/Goal Setting
• Workshop 2 Behavioural Change
• Workshop 3 Cognitive Change