MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

[Dx Revision Watch]

I've been asked in addition to "MUS", what other diseases and conditions are the current focus for provision of integrated psychological therapies.

"As set out in Implementing the Five Year Forward View for Mental Health the expansion of Improving Access to Psychological Therapies (IAPT) services will focus on people with long term conditions or medically unexplained symptoms.

"New psychological therapy provision will see physical and mental health care provision co-located.

"Therapy will be integrated into existing medical pathways and services – either primary care, or secondary care services (eg diabetes, cardiac, respiratory)."

https://www.england.nhs.uk/mentalhealth/adults/iapt/mus/sites/

The NHS "Integrated IAPT early implementers" page briefly describes 22 projects across the country which between them are building on existing services or developing new integrated provision for the following:


Long Term Conditions (LTCs), specifically:

chronic obstructive pulmonary disease (COPD)
respiratory disease
asthma
coronary heart disease
cardiac rehabilitation
cardiovascular disease
stroke
diabetes
pre diabetes
cancer
obesity
eczema and psoriasis
dementia care
perinatal
chronic pain management
musculoskeletal conditions

irritable bowel syndrome
chronic fatigue syndrome and ME

medically unexplained symptoms (MUS)
(which may include FM, IBS, CFS, ME)



A Call to bid for Transformation Funding to support the implementation of the Five Year Forward View closed on 18 January 2017. Notification of investment decisions is scheduled for March 2017.

The interventions for which transformation funding is available for Improving access to psychological therapies (Integrated IAPT) are:


Depression in the context of one or more long-term conditions

Anxiety Disorders (panic disorder, agoraphobia, generalized anxiety disorder,
social anxiety disorder, post-traumatic stress disorder, phobias, and obsessive
compulsive disorder) in the context of one or more long-term conditions

Health Anxiety

Irritable Bowel Syndrome (IBS)

Chronic Fatigue Syndrome (CFS)

Chronic pain that is markedly distressing or disabling

Persistent distress in association with medically unexplained symptoms that
cannot be classified as panic disorder, health anxiety, IBS, CFS, or chronic pain

 

[Countrygirl]

https://www.cambridge.org/core/jour...y-factorsdiv/36A766F07C70F491EF3CFA44023C5FA7


Chronic Fatigue Syndrome: Cognitive, Behavioural and Emotional Processing Vulnerability Factors

• Samantha K. Brooks (a1), Trudie Chalder (a1) and Katharine A. Rimes (a2)
• • DOI: https://doi.org/10.1017/S1352465816000631
  • Published online: 18 January 2017

Background: Cognitive-behavioural models of chronic fatigue syndrome (CFS) suggest that personality factors such as perfectionism and high moral standards may contribute to the development of CFS. Aims: To investigate cognitive, behavioural and emotional processing risk factors for CFS. Method: CFS patients (n = 67) at a UK specialist clinic completed questionnaires about psychological characteristics both currently and retrospectively (6 months pre-CFS onset). Responses were compared with those of healthy individuals (n = 73) who rated their current characteristics. Forty-four relatives retrospectively rated the pre-morbid psychological characteristics of the CFS participants. Results: CFS patients showed similar levels of current perfectionism to controls, though higher pre-morbid perfectionism. CFS patients showed greater self-sacrificial beliefs and more unhelpful beliefs about experiencing and expressing negative emotions , both currently but more markedly prior to onset. In the 6 months pre-illness onset, CFS patients showed more disruption to their primary goal and greater general stress than controls. Ratings of pre-morbid psychological characteristics by relatives were consistent with patients’ self-reports. The extent of overinvestment in one goal was significantly associated with fatigue. Conclusions: Perfectionism, self-sacrificial tendencies, unhelpful beliefs about emotions, and perceived stress may be present to a greater extent pre-morbidly in CFS patients compared with healthy individuals .

• 
  Request permission
  

https://www.cambridge.org/core/jour...-syndromediv/C18D294D94CA27348C04FC926129FE72

Competences Required for the Delivery of High and Low-Intensity Cognitive Behavioural Interventions for Chronic Fatigue, Chronic Fatigue Syndrome/ME and Irritable Bowel Syndrome

• Katharine A. Rimes (a1), Janet Wingrove (a2), Rona Moss-Morris (a1) and Trudie Chalder (a1)
• • DOI: https://doi.org/10.1017/S1352465814000290
  • Published online: 15 May 2014

Background: Cognitive behavioural interventions are effective in the treatment of chronic fatigue, chronic fatigue syndrome (sometimes known as ME or CFS/ME) and irritable bowel syndrome (IBS). Such interventions are increasingly being provided not only in specialist settings but in primary care settings such as Improving Access to Psychological Therapies (IAPT) services. There are no existing competences for the delivery of “low-intensity” or “high-intensity” cognitive behavioural interventions for these conditions. Aims: To develop “high-intensity” and “low-intensity” competences for cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. Method:The initial draft drew on a variety of sources including treatment manuals and other information from randomized controlled trials. Therapists with experience in providing cognitive behavioural interventions for CF, CFS/ME and IBS in research and clinical settings were consulted on the initial draft competences and their suggestions for minor amendments were incorporated into the final versions. Results: Feedback from experienced therapists was positive. Therapists providing low intensity interventions reported that the competences were also helpful in highlighting training needs. Conclusions: These sets of competences should facilitate the training and supervision of therapists providing cognitive behavioural interventions for chronic fatigue, CFS/ME and IBS. The competences are available online (see table of contents for this issue: http://journals.cambridge.org/jid_BCP) or on request from the first author.Copyright
COPYRIGHT: © British Association for Behavioural and Cognitive Psychotherapies 2014

Corresponding author
Reprint requests to Katharine A. Rimes, King's College London, Institute of Psychiatry, Department of Psychology, De Crespigny Park, London SE5 8AF, UK. E-mail: katharine.rimes@kcl.ac.uk

Patients with medically unexplained physical symptoms experience of receiving treatment in a primary-care psychological therapies service: a qualitative study

• Chloe Gerskowitch (a1), Ian Norman (a2) and Katharine A. Rimes (a3)
• • DOI: https://doi.org/10.1017/S1352465815000235
  • Published online: 30 June 2015

As a pilot site under the primary-care Increasing Access to Psychological Therapies (IAPT) Long Term Condition/Medically Unexplained Physical Symptoms (MUPS) project, patients with MUPS were offered cognitive behaviour therapy (CBT)-based treatments or attendance at a mindfulness-based stress reduction (MBSR) programme. This study aimed to gain an understanding of the views and experiences of MUPS patients that received CBT-based therapy or MBSR within an IAPT service and to investigate the relationship between their experiences and health outcomes measured on self-report questionnaires. Thematic analysis was used to analyse data gathered via semi-structured interviews with 11 patients. Data collected from three self-report measures were considered in relation to key features of participants’ reported experiences and patterns identified. Four main themes emerged: (1) something needs to change; (2) making connections between physical symptoms and mood, thoughts or activities; (3) sharing experiences and feeling understood; and (4) reflections on treatment experience. Participants generally reported a positive experience of treatment and felt better able to cope with their symptoms, although treatment did not necessarily result in reliable change in symptoms as measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Work and Social Adjustment Scale (WSAS). This novel model of treatment appears to be acceptable for this patient group although evaluation of the pilot should consider the ability of routinely used measures to capture the value of treatment to patients, including improved coping with symptoms.

 

[NelliePledge]

I have PEM at mo so v short reply. Big problem with this is people newly diagnosed won't be finding this forum will be going to MEA AFME I got caught into IAPT when diagnosed. MECFS clinic some time later not good but a lot better service than IAPT. I will post more in a couple od days.

This is very interesting. I was referred after asking my GP 6 months after I'd been diagnosed...

Hi I realised I had given my story around diagnosis on the thread I've linked to (hopefully) above. The CBT was through self referral although I would not have taken that step if the GP hadn't given me the leaflet. I am a reasonably intelligent person with a career in the public sector I am fairly competent at getting my views across and standing up for myself. At the point at which I asked about CFS diagnosis (using that because that is the term used by them) I only had limited knowledge from NHS website and some other website like patient info.... I hadn't found MEA or AFME yet. Because of my poor sick absence record my manager was being asked questions and i was accountable through her to explain what was happening to address my illness I felt I had no option but to go for the CBT as the GP suggested it.

I will post more info later on.

 

[NelliePledge]

This is very interesting. I was referred after asking my GP 6 months after I'd been diagnosed...

Hi I realised I had given my story around diagnosis on the thread I've linked to (hopefully) above. The CBT was through self referral although I would not have taken that step if the GP hadn't given me the leaflet. I am a reasonably intelligent person with a career in the public sector I am fairly competent at getting my views across and standing up for myself. At the point at which I asked about CFS diagnosis (using that because that is the term used by them) I only had limited knowledge from NHS website and some other website like patient info.... I hadn't found MEA or AFME yet. Because of my poor sick absence record my manager was being asked questions and i was accountable through her to explain what was happening to address my illness I felt I had no option but to go for the CBT as the GP suggested it.

I will post more info later on.

I am not typical as due to having mild depression I have regularly been seeing a person-centred counselling therapist for 10 years. As I was having insomnia I was also having hypnotherapy. I was told I had to stop this private treatment in order to be accepted for CBT. The CBT was 6-8 30 minute fortnighlly sessions either face to face or by phone. I had understood that the person taking the sessions had worked with people with ME/CFS before. The sessions were entirely task based here's a worksheet go away and do your homework come back and report. 30 minutes just about enough time to do that but as someone used to talking through my freelings I consistently overran time and didn't get much engagement other than around the tasks. Couldn't wait to finish after 6 sessions and get back to my counsellor.

 

[CFS_for_19_years]

Background: Cognitive-behavioural models of chronic fatigue syndrome (CFS) suggest that personality factors such as perfectionism and high moral standards may contribute to the development of CFS. Aims: To investigate cognitive, behavioural and emotional processing risk factors for CFS. Method: CFS patients (n = 67) at a UK specialist clinic completed questionnaires about psychological characteristics both currently and retrospectively (6 months pre-CFS onset). Responses were compared with those of healthy individuals (n = 73) who rated their current characteristics. Forty-four relatives retrospectively rated the pre-morbid psychological characteristics of the CFS participants. Results: CFS patients showed similar levels of current perfectionism to controls, though higher pre-morbid perfectionism. CFS patients showed greater self-sacrificial beliefs and more unhelpful beliefs about experiencing and expressing negative emotions , both currently but more markedly prior to onset. In the 6 months pre-illness onset, CFS patients showed more disruption to their primary goal and greater general stress than controls. Ratings of pre-morbid psychological characteristics by relatives were consistent with patients’ self-reports. The extent of overinvestment in one goal was significantly associated with fatigue. Conclusions: Perfectionism, self-sacrificial tendencies, unhelpful beliefs about emotions, and perceived stress may be present to a greater extent pre-morbidly in CFS patients compared with healthy individuals

Love all the emoticons
From now on I hope to see more of these sprinkled throughout newly-posted abstracts , for anyone who is up to the task! Makes dull reading more enjoyable and easier to understand
Hey I love cats too.

 

[Countrygirl]

Love all the emoticons
From now on I hope to see more of these sprinkled throughout newly-posted abstracts , for anyone who is up to the task! Makes dull reading more enjoyable and easier to understand
Hey I love cats too.

 

[Dx Revision Watch]

...high moral standards...self-sacrificial tendencies...

 

[Dx Revision Watch]

I am not typical as due to having mild depression I have regularly been seeing a person-centred counselling therapist for 10 years...

Thank you NelliePledge for linking to your post in another thread. I noticed Dr Shepherd had replied in respect of the MEA's "Purple Book". I'm taking the liberty of cross posting the information he had given:

The MEA has funding available under our medical education programme to send out free copies of the MEA purple book direct to a GP at his/her surgery address

Please contact Gill or Helen at the MEA office in Buckingham if anyone wants to arrange for this to be done

The book is sent with a covering letter from myself and we can add a note about why it was requested if required

MEA purple book for health professionals:

http://www.meassociation.org.uk/201...ch-masterwork-is-published-today-1-june-2016/

 

[Dx Revision Watch]

There are no existing competences for the delivery of “low-intensity” or “high-intensity” cognitive behavioural interventions for these conditions...

I was initially confused by these terms when I was first putting material together for this thread.

https://www.ncbi.nlm.nih.gov/books/NBK83456/

6.1.1. Definitions of low-intensity interventions
Although there is no agreed definition on exactly what constitutes a low-intensity intervention they share several common characteristics. Low-intensity interventions use fewer resources (virtually none in the case of non-facilitated self-help) in terms of healthcare professional time than conventional psychological therapies. However the interventions are not necessarily less intensive (for example, the time taken to go through the self-help materials) for the individuals using them. These interventions are often delivered and/or supported by mental health workers without formal mental health professional training, who have been specifically trained to deliver low-intensity interventions (including primary care graduate mental health workers and psychological wellbeing practitioners).


https://www.healthcareers.nhs.uk/ex...herapies/psychological-wellbeing-practitioner

Psychological wellbeing practitioner


https://www.healthcareers.nhs.uk/explore-roles/psychological-therapies/high-intensity-therapist

High intensity therapist


You can see the terms used here:

https://www.england.nhs.uk/stps/tf-call-to-bid/

 

[Dx Revision Watch]

A note about the term "Health anxiety".

DSM-5 replaced DSM-IV's "Hypochondriasis" category with new term "Illness anxiety disorder."

ICD-11 Beta draft proposes to use the term "Hypochondriasis" for the core edition, with "Illness anxiety disorder" and "Health anxiety disorder" under Synonyms.

The forthcoming abridged primary care version of ICD-11's Mental or behavioural disorders chapter (which will be known as ICD-11 PHC) proposes to use the term "Health anxiety" - which is the term used in the Call for Bids document, above.

 

[Countrygirl]

Good one, Suzy!



Oh! Ugh! This photo always made my heart sink as standing next to.................HIM..........in the brown mac ...................( reminds me of the one disgusting, troubled individuals wear when you hear they have been arrested for very, very naughty behaviour in public in the presence of women and young girls) ............is my excellent (now retired) consultant Prof Anthony Pinching.

However, can anyone identify the other 'self sacrificing' 'perfect' bunch of rogues, please? (Reminds me too of that photo that did the rounds of Cort, founder of Phoenix Rising, standing smiling like a Cheshire cat with three or so lead members of the same dirty brown mac brigade as they they huddled lovingly in a close embrace.

(Can't trust a soul can you??!!!!!)

 

[Dx Revision Watch]

Good one, Suzy!

Oh! Ugh! This photo always made my heart sink as standing next to.................HIM..........in the brown mac ...................( reminds me of the one disgusting, troubled individuals wear when you hear they have been arrested for very, very naughty behaviour in public in the presence of women and young girls) ............is my excellent (now retired) consultant Prof Anthony Pinching.

However, can anyone identify the other 'self sacrificing' 'perfect' bunch of rogues, please? (Reminds me too of that photo that did the rounds of Cort, founder of Phoenix Rising, standing smiling like a Cheshire cat with three or so lead members of the same dirty brown mac brigade as they they huddled lovingly in a close embrace.

(Can't trust a soul can you??!!!!!)

Michael Sharpe, back row, 2nd from left.
PD White, back row, 5th from left (looking in my opinion somewhat off his face but perhaps he always looks so jolly, though I doubt he looks as jolly now, as he did when that photo was taken).

Can't ID any of the others, apart from that guy in the dodgy mac.

 

[slysaint]

Cort, founder of Phoenix Rising, standing smiling like a Cheshire cat with three or so lead members of the same dirty brown mac brigade as they they huddled lovingly in a close embrace.

when was this?............this game of 'catch up' is neverending!

 

[Countrygirl]

Low intensity therapists deliver Devon's BA.......Behavioural Activation therapy.

Sounds great for ME!!

We also have COBRA CBT in Devon, Durham and Leeds. Aren't we lucky bunnies!........don't all get jealous


http://www.exeter.ac.uk/mooddisorders/cobra/

If my GP continues to insist that I take the course I shall tell the CBT/BA therapist that I am highly traumatised by 40 years of medical abuse and talk of nothing else. I suggest we all do the same. After all.........it is absolutely true.

There is more than one way to skin a cat (horrible phrase!)

 

[Countrygirl]

Michael Sharpe, back row, 2nd from left.
PD White, back row, 5th from left (looking in my opinion somewhat off his face but perhaps he always looks so jolly, though I doubt he looks as jolly now, as he did when that photo was taken).

Can't ID any of the others, apart from that guy in the dodgy mac.

Thanks Suzy!

Does anyone recognise the others?

 

[Dx Revision Watch]

Low intensity therapists deliver Devon's BA.......Behavioural Activation therapy.

Sounds great for ME!!

We also have COBRA CBT in Devon, Durham and Leeds. Aren't we lucky bunnies!........don't all get jealous


http://www.exeter.ac.uk/mooddisorders/cobra/

If my GP continues to insist that I take the course I shall tell the CBT/BA therapist that I am highly traumatised by 40 years of medical abuse and talk of nothing else. I suggest we all do the same. After all.........it is absolutely true.

There is more than one way to skin a cat (horrible phrase!)

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31140-0/abstract

Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial

Open access

also

http://www.nets.nihr.ac.uk/news/all...ffective-as-cbt-for-depression,-at-lower-cost

Behavioural Activation as effective as CBT for depression, at lower cost
26 July 2016


SMC Expert reaction to paper:

http://www.sciencemediacentre.org/expert-reaction-to-behavioural-activation-therapy-for-depression/

 

[Countrygirl]

when was this?............this game of 'catch up' is neverending!

It did the rounds about six years ago. I think it was posted here at about that time. They were obviously good friends and knew each other. Probably still do.

We know the brown mac brigade are members here. One in particular.........

As I said, you can't trust a soul...........or a forum.

You never know who is in bed with whom.

Literally.

 

[Dx Revision Watch]

Michael Sharpe, back row, 2nd from left.
PD White, back row, 5th from left (looking in my opinion somewhat off his face but perhaps he always looks so jolly, though I doubt he looks as jolly now, as he did when that photo was taken).

Can't ID any of the others, apart from that guy in the dodgy mac.

Did you spot the Compo photobomb, middle row, 1st on left?

 

[Countrygirl]

Did you spot the Compo photobomb, middle row, 1st on left?

I have been staring at photobomb. Decided he must be a patient from a high-security institution who has served as a visual aid. (No money-saving low intensity BA therapy for him, clearly)

Just who...........???

 

[trishrhymes]