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

slysaint

slysaint

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Sorry for more depressing stuff :
Kings College London
The IAPT Postgraduate Diploma in Cognitive Behavioural Therapy

"Cognitive behavioural therapies
IAPT HI PgDip in CBT
Introduction
Cognitive behavioural therapy (CBT) has received wide-spread recognition from clinicians, researchers and more recently the National Institute of Clinical Excellence (NICE) guidelines for anxiety and depression.

This recognition stems from its emphasis upon evaluating its models and methods and thus the evidence base which has accumulated, its short-term nature and the economical use of resources that this implies, and its acceptability to clients.

Whilst many clinicians have had some exposure to CBT models and methods in professional training, few have had the opportunity to develop competency. The rapidity of the research development is also proceeding far ahead of the ability of clinicians easily to absorb these new developments into their practice."

http://www.kcl.ac.uk/ioppn/depts/psychology/study/pgdips/CBT/index.aspx

"Successful students will be able to:
begin to practice as “scientist practitioners” continuing to advance their knowledge and understanding, and to develop new skills to a high level;"

"There are no course fees. The course is funded by the Department of Health as part of their Improving Access to Psychological Therapies initiative."

http://www.kcl.ac.uk/ioppn/depts/psychology/study/pgdips/CBT/programme.aspx

ETA: Just about every Uni are doing them :aghhh:
 
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slysaint

slysaint

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Interesting definition of High Intensity CBT from a PTSD sufferer:
"My experience is that this is just a label in the UK for the number of NHS counselling sessions you're allowed. In my experience in practice it's not to do with the quality of treatment or even specialist work. It refers rather to the number of staff hours they have to input. Low intensity is 'watch and wait'/ a chat with GP a one-off counselling session, medium intensity is 6 sessions, high is 12-20 sessions."
"
...absolutely, a waste and even mismanagement of NHS resources. I actually had this conversation with the last 'flash-in-the-pan' T. By week 4 I was asking him if he would please help me lobby for a longer period with him because it was obvious that we weren't going to scratch the surface. We pondered the proposition that I'm not suffering from a one-off bereavement or depressed because my partner's left me, normal life challenges compared with the nightmare events that produce PTS.
Finally, though, I heard today that I got 'bumped upstairs'. After 7 years I have an appt to see a real psychiatrist. If they'd done that in the first place then literally scores of £thousands perhaps wouldn't have been wasted on all this IAPT short term kwikfix stuff."
 
Dx Revision Watch

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Reposting this post from earlier in the thread re "Low intensity" and "High intensity" in the context of IAPT:

Dx Revision Watch said:
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/

bid-call.png
Click to expand...
 
Dx Revision Watch

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Published just in time for ME Awareness Week...


Journal of Mental Health

Editorial

“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

Trudie Chalder & Claire Willis

Pages 1-5 | Received 03 Mar 2017, Accepted 05 Mar 2017, Published online: 09 May 2017

Full paper and PDF
http://dx.doi.org/10.1080/09638237.2017.1322187

(...)

The study of MUS often attracts debate and sometimes controversy. Even the label MUS comes under fire. Persistent physical symptoms (PPS) is a new patient-centred term that refers to MUS. For several reasons, we prefer to use the term PPS. Firstly, two surveys of different populations preferred the term. One group consisted of healthy subjects (Marks & Hunter, 2015 Marks E, Hunter S. (2015). Medically unexplained symptoms: an acceptable term? Br J Pain, 9, 109–14[CrossRef], [PubMed], [Google Scholar]) and the other group involved patients with CFS (Picariello et al., 2015 Picariello F, Ali S, Moss-Morris R, Chalder T. (2015). The most popular terms for medically unexplained symptoms: the views of CFS patients. J Psychosom Res, 78, 420–6[CrossRef], [PubMed], [Web of Science ®], [Google Scholar]). People found the term more acceptable as it avoids mind–body dualism and has cross-cultural relevance. Secondly, it includes symptoms associated with medically diagnosed long-term conditions such as diabetes, rheumatoid arthritis and multiple sclerosis which may present co-morbidly with MUS. Thirdly, it also concurs with changes in the latest edition of the Diagnostic and Statistics Manual (DSM-5). The DSM-5 has consolidated previous terms including somatization disorder, conversion disorder, hypochondriasis into a new diagnostic term and somatic symptom disorder (SDD). This refers to persistent (>6 months) and clinically significant somatic complaints accompanied by excessive and disproportionate health-related thoughts, feelings and behaviours regarding the symptoms (American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association [CrossRef], [Google Scholar]). We will use the new term PPS to refer to MUS but continue to use the term MUS when referring to the work of other authors who have used this term.

(...)

The high prevalence and complexity of PPS with increased access to treatment in new and developing primary care services demands a treatment approach that is effective and also “efficient” with relative ease of dissemination across the NHS. Transdiagnostic approaches have the potential to provide effective treatment across a range of conditions that often present co-morbidly. Overlap of symptoms and co-morbidity in PPS as well as commonality in cognitive and behavioural responses suggests that a transdiagnostic approach may be suitable. We argue that a transdiagnostic approach needs to be flexible enough to accommodate specific responses peculiar to certain conditions. We are currently carrying out a RCT to test the efficacy of such an approach in PPS.
 
Keela Too

Keela Too

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So constantly change the wording. Now that patients are "onto" MUS, they need to find a new acronym that patients might not immediately recognise as psychiatry based.

Oh yes and while they are at it, they'll try and sweep in as many other long term conditions as possible, and tell those patients too that their persistent symptoms are just perpetuated by the mind....

Oh oh....
 
alex3619

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Keela Too said:
So constantly change the wording. Now that patients are "onto" MUS, they need to find a new acronym that patients might not immediately recognise as psychiatry based.

Oh yes and while they are at it, they'll try and sweep in as many other long term conditions as possible, and tell those patients too that their persistent symptoms are just perpetuated by the mind....

Oh oh....
Click to expand...
Business as usual for them.
 
Dx Revision Watch

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Via @postersandme



http://bmjopen.bmj.com/content/7/4/e014720

Medical education and training
Research

Improving teaching about medically unexplained symptoms for newly qualified doctors in the UK: findings from a questionnaire survey and expert workshop
  1. Katherine Yon1,
  2. Stephanie Habermann1,
  3. Joe Rosenthal1,
  4. Kate R Walters1,
  5. Sarah Nettleton2,
  6. Alex Warner1,
  7. Kethakie Lamahewa1,
  8. Marta Buszewicz1
Abstract
Objectives Medically unexplained symptoms (MUS) present frequently in healthcare, can be complex and frustrating for clinicians and patients and are often associated with overinvestigation and significant costs. Doctors need to be aware of appropriate management strategies for such patients early in their training. A previous qualitative study with foundation year doctors (junior doctors in their first 2 years postqualification) indicated significant lack of knowledge about this topic and appropriate management strategies. This study reviewed whether, and in what format, UK foundation training programmes for newly qualified doctors include any teaching about MUS and sought recommendations for further development of such training.

Design Mixed-methods design comprising a web-based questionnaire survey and an expert consultation workshop.

Setting Nineteen foundation schools in England, Wales and Northern Ireland

Participants Questionnaire administered via email to 155 foundation training programme directors (FTPDs) attached to the 19 foundation schools, followed by an expert consultation workshop attended by 13 medical educationalists, FTPDs and junior doctors.

Results The 53/155 (34.2%) FTPDs responding to the questionnaire represented 15 of the 19 foundation schools, but only 6/53 (11%) reported any current formal teaching about MUS within their programmes. However, most recognised the importance of providing such teaching, suggesting 2–3 hours per year. All those attending the expert consultation workshop recommended case-based discussions, role-play and the use of videos to illustrate positive and negative examples of doctor–patient interactions as educational methods of choice. Educational sessions should cover the skills needed to provide appropriate explanations for patients’ symptoms as well as avoid unnecessary investigations, and providing information about suitable treatment options.

Conclusions There is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.

Full free at:

http://dx.doi.org/10.1136/bmjopen-2016-014720
 
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Dx Revision Watch

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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(From an earlier post in this thread)

In Scotland, "Persistent physical symptoms" is being used, on this site at least, where the term, "long-term conditions (LTCs)" is used in England.

http://www.nes.scot.nhs.uk/educatio...ogical-interventions-and-physical-health.aspx

NHS Education for Scotland
Quality Education for a Healthier Scotland

Psychological Interventions and Physical Health

NES Psychology directorate has been developing a programme of work aimed at addressing the training needs of the NHS Scotland workforce in relation to psychological interventions in physical health care...

(...)

https://www.ucl.ac.uk/pals/research...ople_with_Persistent_Physical_Health_Problems

The Matrix (2015) A Guide to Delivering Evidence-Based Psychological Therapies in Scotland; Persistent Physical Symptoms

The Psychological Therapies 'Matrix' is a guide to planning and delivering evidence-based Psychological Therapies within NHS Boards in Scotland. The Matrix is published by NES, in partnership with the Scottish Government. It provides a summary of the information on the current evidence base for various therapeutic approaches, guidance on well functioning psychological therapies services and advice on important governance issues. The sub-section relating to the psychological management of persistent physical symptoms was updated in 2015.

Persistent Physical Symptoms refers to health problems that last a year or longer, impact on a person’s life, and may require ongoing care and support. The definition does not relate to any one condition, care group or age category. Common examples include diabetes, heart disease, chronic pain, arthritis, inflammatory bowel disease, asthma and chronic obstructive pulmonary disease (COPD).

The evidence tables for persistent physical symptoms can be found and downloaded in the link below:

http://www.nes.scot.nhs.uk/media/3500010/matrix_-_persisent_physical_symptomstablesfinal_1.pdf

The document in the PDF:

Psychosocial Interventions for People with Persistent Physical Symptoms

Introduction

Persistent Physical Symptoms, refers to health problems that last a year or longer, impact on a
person’s life, and may require ongoing care and support. The definition does not relate to any one
condition, care group or age category. Common examples include diabetes, heart disease, chronic pain,
arthritis, inflammatory bowel disease, asthma and chronic obstructive pulmonary disease (COPD).
Around 2 million people in Scotland have at least one such condition, and one in four adults over
16 years reported some form of long term illness, health problem or disability, and one in five have
chronic pain. These conditions become more common with age. By the age of 65, nearly two-thirds
of people will have developed Persistent Physical Symptoms, however, more people under the age of
65 years in Scotland have multiple conditions.

(...)

Asthma
Cancer
Cardiovascular disease (CVD)
Chronic fatigue syndrome (CFS)
Chronic kidney disease
Chronic obstructive pulmonary disease (COPD)
Chronic pain
Diabetes Type 1 and Type 2
Irritable bowel syndrome (IBS)
Multiple sclerosis (MS)
Osteoarthritis
Rheumatoid arthritis
Obesity/Weight loss interventions


The NHS Education for Scotland site has a separate page for MUS:

http://www.nes.scot.nhs.uk/educatio...chology/mus-long-term-conditions-toolkit.aspx

MUS - Long Term Conditions Toolkit

The term “medically unexplained symptoms” is used to describe a set of persistent physical symptoms (e.g. chest pain, dizziness, back pain) for which, after extensive investigation, there is no obvious underlying cause or diagnosis.

For those with persistent physical symptoms, the journey from symptom development to clear understanding and evidence-based treatment can be an arduous one. In an attempt to exclude more concerning underlying conditions, GPs often undertake a range of medical assessments and interventions. While necessary, these can cause patients to develop:
  • unwanted psychological and physical side effects, adding to distress and disability
  • beliefs about the nature and seriousness of their condition,
  • Additional pain, fatigue and other symptoms due to pharmacological interventions.
In the absence of a clear cause or diagnosis despite persisting symptoms, patients can become increasingly distressed, while fear of what may be generating symptoms often leads to avoidance of daily activities. Further investigations may also place the patient at risk of harm, for instance, due to infection from exploratory operations, and exceeding safe doses of radiation etc.
 
lilpink

lilpink

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lilpink

lilpink

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lilpink said:
Here's one to sign and share widely. Closes on the 26th. It would be good to show the WEP we appreciate the stance they have taken regarding 'MUS'. If you feel able to add a paragraph about the way the BPS school has affected you then please feel free.

http://www.groupcard.com/c/QACkpQAJPMw/Thank-You-Card-for-Women039s-Equality-Party

or tiny: https://tinyurl.com/ljurdhw
Click to expand...

It would be good to get a very full card of signatures by the deadline of Friday week. I'm surprised more haven't realized what a 'watershed' this is: a UK political party basically going to war on MUS on UK soil. Why more aren't rushing to thank them I have no idea! (Chaps welcome).
You don't have to be politically aligned with with the WEP (though why anyone wouldn't want equal rights for women I'm not sure).. this is simply a 'thankyou' for the recognition that MUS has no place as a spurious 'mental health' condition. Surely everyone who is so exercised by MUS on this forum would want to add their signature?
 
S

Sean

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Dx Revision Watch said:
These conditions become more common with age. By the age of 65, nearly two-thirds of people will have developed Persistent Physical Symptoms,...

Asthma
Cancer
Cardiovascular disease (CVD)
Chronic fatigue syndrome (CFS)
Chronic kidney disease
Chronic obstructive pulmonary disease (COPD)
Chronic pain
Diabetes Type 1 and Type 2
Irritable bowel syndrome (IBS)
Multiple sclerosis (MS)
Osteoarthritis
Rheumatoid arthritis
Obesity/Weight loss interventions
Click to expand...

Looks like nothing more than an employment generating scheme for psychology/psychiatry.
 
S

Sean

Senior Member
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@lilpink

Is that only for UK residents?

lilpink said:
You don't have to be politically aligned with with the WEP (though why anyone wouldn't want equal rights for women I'm not sure).
Click to expand...
At the risk of being branded a traitor to my sex, I regretfully have to report that some men don't. Quite a few of them, actually. Not the majority, but not a tiny minority either.

One or two women too. No idea how that works. :confused:
 
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