More effective treatment for people with mental health problems and long-term conditions
What did we do?
We developed training resources from a successful trial of collaborative care for people with long-term conditions and anxiety or depression. We delivered it to a range of staff from several organisations who are now using this approach in practice.
How did we do it?
This work built on the success of the COllaborative INterventions for CIrculation and DEpression (COINCIDE) trial (published in the BMJ and the focus of a BMJ editorial) by developing the COINCIDE treatment model within Increasing Access to Psychological Therapy (IAPT) services to manage people with common mental health problems and long-term conditions.
The COINCIDE trial demonstrated that both depression and anxiety were significantly reduced in patients in the collaborative care arm compared with those in the usual care arm. The trial also demonstrated that patients who received collaborative care reported improved self-management behaviours and they believed their care to be more patient-centred.
What sets COINCIDE apart from comparable trials of collaborative care is that a population with high levels of mental and physical multimorbidity from deprived areas was recruited. The mean age of the sample was 58.5 years (adults of working age), but only a quarter of them were in work. Moreover, in addition to diabetes or heart disease, the population had a mean of 6.2 other long-term conditions and much more severe forms of depression and anxiety than anticipated. In every sense the trial population in COINCIDE was representative of people with multimorbidity who ordinarily do not make it into clinical trials and whose mental health is often overlooked.
In partnership with Mental Health Matters, Inclusion Matters and South Staffordshire and Shropshire NHS Foundation Trust (who all provide IAPT services), the COINCIDE training was adapted and rolled out to six different IAPT services, with Psychological Wellbeing Practitioners (PWPs) given the skills and materials to implement the model within routine practice.
Between November 2014 and March 2015 training was delivered to 42 PWPs. The focus was on educating PWPs to work together with primary care professionals to improve physical and psychological health and support self-management for people with long-term conditions (coronary heart disease and/or diabetes). The training was based on the intervention tested in the trial but adapted to be relevant to PWPs with responsibilities for managing depression and anxiety in people with cardiovascular and respiratory diseases. The care model is based on collaborative care liaison between health professionals to improve patient experience and outcomes. PWPs were provided with a training manual specifically designed for the intervention, highlighting:
- Psychological intervention dependent on patient preferences
- Medication management
- Frequency and duration of the intervention
- Guidance on collaborative working between patients, mental health professionals and GP and/or practice nurse.
Key outputs and impacts:
- The intervention has been spread to six IAPT services and 42 PWPs across the North West
- Dedicated training manuals for PWPs and patients have been developed
- Published paper in BMJ titled ‘Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease’, which has an Altmetric score of 88, putting the paper in the top 5% of papers ever scored by this measure. The BMJ also produced an editorial about the trial.
- We are currently working to develop the COINCIDE training resources as an online training package to be made available from our website
- Positive links have been made with Health Education North West and the Psychological Professions Network (PPN). As part of these discussions the PPN is to promote the online COINCIDE training courses as an evidence-based approach to managing depression and long-term conditions.