Ian Walton

Can Matrix Reimprinting Be Effective in the Treatment of Emotional Conditions in a Public Health Setting? Results of a U.K. Pilot Study

Objectives: This pilot study was carried out to establish the feasibility and effectiveness of Matrix Reimprinting (MR). A dedicated MR/ Emotional Freedom Techniques service was delivered in a community setting within the National Health Service in the metropolitan borough of Sandwell, United Kingdom. Method: Over a 15-month period, the study followed clients accessing the service for a range of emotional conditions. At the start and end of their treatment, clients were asked to complete the CORE-10 (psychological distress; main outcome variable), Warwick-Edinburgh Mental WellBeing Scale (WEMWBS; mental well-being), Rosenberg Self Esteem and Hospital Anxiety and Depression Scale (HADS; anxiety and depression) measurement scales. Results: 24 clients were included in the MR pilot study, and the mean number of sessions attended was 8.33 (Mdn = 6.5). There were both statistically and clinically significant improvements for CORE-10 (52% change, p < .001), Rosenberg Self-Esteem (46% change, p < .001), HADS Anxiety (35% change, p = .007), and HADS total score (34% change, p = .011) and a statistically significant improvement for WEMWBS (30% change, p < .001). All MR clients showed clinical improvements. Conclusions: Despite the limited sample size and other limitations, significant improvements were shown. The results support the potential of MR as a cost-effective treatment to reduce the burden of a range of physical and psychological disorders. Further larger studies are called for, with protocols to minimize dropouts.

Integrating services and education in primary care

When developing integrated services in primary care mental health and wellbeing you also need to skill the workforce to deliver it. This workshop uses a practical case for the audience to work through to illustrate a whole systems model and pathway and the appropriate development and training plus the research from literature reviews that backs this up. Integrated care services need to be intrinsically linked to local needs assessment, national/international policy and drivers. We will compare and contrast a researched and successful integrated primary care mental health and physical wellbeing model against other integrated care models identified through the literature, examining the outputs and outcomes of a horizontal and vertical integrated model of primary care mental health and wellbeing and conclude with key findings and recommendations for future organisational and workforce development. Our work researched and developed a whole system pathway going across the whole life cycle and across all conditions, bringing in Primary Care and the Community. Poor outcomes from treatment of mental illness are frequently attributed to the failure of GPs to follow guidelines, but according to a literature search, GPs do recognise and support their patients when they are in mental distress, but they work in a chaotic environment that has not been defined and where guidelines are difficult, if not impossible, to follow. Borders between mental distress due to adverse life events and true mental illness are hard to distinguish. For an integrated model and developed workforce to be successful it has to align itself with the reality in primary care and is. It is therefore much more likely to succeed if developed according to educational theory, through small group work, sharing, discussing successes and failures and learning from patients lived experiences, to improve and refine skills and attitudes. We will use a real case to demonstrate this with the audience. Leadership and peer education involving acute and secondary care plus patients participating as technical experts will improve relationships and help integration. Mental health in primary care is poorly understood and scarcely researched. Its practice is substantially different from the practice of the specialism of psychiatry, being targeted mainly at the 93% of patients with mental illness who remain in primary care and are not looked after by specialists in secondary care nor are case managed within primary care. Despite this, training for the workforce in all aspects of mental health is performed mainly by psychiatrists, because they are seen as the experts, but they are experts in a systems based approach that uses a classification system (DSM or ICD) which fails to recognise that primary care mental health is a very inexact science, and possibly more of an art, relying on the strength of the relationship between doctor, nurse and patient, an understanding of their social background and the ability to listen, support and empathise. Traditional style didactic education and pathways, using a guidelines approach, therefore fails to support patients and health professionals in primary care. The lack of a common language between primary, acute, social and secondary care does not help and leads to a strained interface with poor communication The developed integrated model and case based training challenged this and was replicated across a number of UK sites with investment made in the development of low intensity interventions consisting of psycho educational courses, wellbeing and self care approaches alongside talking therapies, navigation and social support. These interventions were offered both at a whole population (horizontal) and targeted level (vertical). A stepped approach to primary care mental health is offered, which uses different levels of care to ensure the consistent flow of service users between the steps, resulting in no waiting lists. Steps are graduated from low to high intensity and are non-exclusive and recovery is built into each step. People can be referred back to primary care at any point and step back if needed. People are offered a range of evidence-based approved interventions, to give a choice of services, with different interventions offered at each level. Wellbeing and recovery is built in to all levels. Using a two prong approach of education and an integrated model showed both reliable outcomes and clinical change and that we were hitting the diverse needs of the target group outlined by the needs analysis. Added benefits were reductions in lengths of stay and a reduction in hospital admissions.

Mental Health in Primary Care - Reducing the need for specialist services by building integrated mental health and wellbeing services in the community - How we are achieving it

Purpose: To ensure that patients with mental health problems receive appropriate treatment as early as possible by developing services in primary care . Theory: Our Primary Care mental health and wellbeing service are reckoned by the NHS Confederation to be the most progressive in England and we are an integrated care demonstrator site for the Kings Fund. By building services in and around GPs and their communities we are able to pick up patients and support them at a much earlier point in their illness, reducing suffering. Methods: Using psychiatric (CORE) and Wellbeing (WEMWBS) scores we are able to track our patients through services ensuring that clients are receiving treatment that is effective for them. Findings: Combining prevention, wellbeing services and talking therapies with a service in primary care for those with complex needs has led to demonstrable outcomes including significant reductions in usage of psychiatric beds (23%) and length of stay (46%) and referrals to secondary care generally. Discussion: Primary Care is not psychiatry and outcomes for patients with mental illness are often poor, but we will demonstrate how earlier intervention has made a crucial difference, significantly reducing the level of depression in one of Englands poorest boroughs, Sandwell.

The White Paper: will GP consortia invest in mental health services?

New governments have an obvious desire to demonstrate that they mean business, so the massive changes in the administration of the NHS proposed by the recent White Paper1 should come as no surprise. Many of us, however, will question whether its intentions can truly be carried out at the speed intended. The aim is to lead the change needed with GPs, the vast majority of whom have little experience of commissioning at the level the White Paper requires. With so much to focus on, how many GP commissioning consortia will treat mental health as a priority and what will this mean for our patients and for those of us who work in mental health services?. Copyright