Monday, 1 February 2016

Head of Psychology Service @nhsfife response to my request for update on Psychological Therapies in Fife

Today I received this letter by Email at 14.50 from the Head of Psychology Service, NHS Fife, in response to my request for an update on Psychological Therapies in Fife:

"Dear Chrys

Thank you for your enquiry regarding our provision of Psychological Therapies in Fife. In common with other health boards we have welcomed the HEAT target because it focuses attention on these services. The target remains a challenge but we continue to make progress. We are committed to developing sustainable services which meet the needs of children, young people and their families, as well as adults. We are also committed to developing services appropriate for individuals with a wide range of needs and preferences about how services are delivered, from individuals with relatively mild difficulties to those with significant, long term needs.

In response to your questions, I can provide the following information:

As stated in NHS Fife Board’s Integrated Performance Report for November 2015, our further progress with the psychological therapies HEAT target will require some increase in capacity. The plan to appoint 8 new therapists is based on the demand and capacity analysis we have completed. This is the amount of additional staffing we require to meet the waiting time target in a sustainable manner. All Boards were aware that Scottish Government funding to support the delivery of psychological therapies was planned for release in 2014/2015. We were delighted to receive confirmation on 12th January 2016 that the Government is going to provide £54m over the next 4 years to increase capacity across Scotland to meet this HEAT target. We await details of the amount of funding that Fife will receive and guidance on how we will be able to allocate the funds. Once this information is available we will be able to make decisions about recruitment.

Our latest return to Scottish Government shows that 75% of individuals starting treatment in December 2015 met the 18 week psychological therapies HEAT target compared with 67.6% in October 2015.

You have also enquired about the European initiative widening access to computerised CBT. This is the European Commission Mastermind project involving 10 EU and associated countries. Fife is one of four Scottish Board areas participating in Mastermind (the others are Shetland, Grampian and Lanarkshire); in Scotland the project is managed by NHS 24. It aims to investigate the barriers and facilitators to the roll-out of cCBT across a diverse range of cultures and communities. Beating the Blues is the name of the cCBT course used in Mastermind in Scotland. Its effectiveness is well-evidenced and the programme is recommended in NICE and SIGN guidelines for treatment of depression. Beating the Blues has been available for some time in Forth Valley and Tayside with good clinical outcomes. We were therefore very pleased that Fife was selected to become one of the pilot Boards in Scotland and the project is going very well indeed.

Since the project began in Fife in September 2014 we have received 845 referrals from GPs and hospital staff. Beating the Blues can be accessed by individuals at home or one of the libraries at the following sites: Dunfermline (Duloch); Lochgelly; Glenrothes (Glenwood); Dalgety Bay; Kirkcaldy (Templehall and The Galleries); Burntisland; Cupar; Cowdenbeath; Rosyth; Leven; Methil; Leslie; Cardenden; Markinch; Aberdour; Oakley; Valleyfield and Kincardine. Other sites can be added to the scheme if there is demand but so far these options are proving sufficient. Beating the Blues is an appropriate choice for some individuals as an alternative to referral to another NHS service/other agencies; in some cases NHS clinicians will provide some individual sessions as an adjunct to cCBT using a combined model of service delivery. Information about Mastermind can be found at http://www.mastermind-project.eu/services/guided-ccbt-for-treatment-of-depression; More detail about Beating the Blues is available at https://www.beatingtheblues.co.uk.  Information for people in Fife about referral to the programme is available on the Moodcafe website www.moodcafe.co.uk and in all GP practices.

In addition to rolling out Beating the Blues in Fife, we have been extending the range of psychoeducational and group therapy options available for adults with diverse needs. We are continually reviewing these programmes and make them as widely available as possible given available staff and accommodation. Groups/classes currently provided by the Psychology Service include:

  1. Step on Stress - Currently in community venues in Dunfermline, Lochgelly, Kirkcaldy, Levenmouth with roll out to other areas of Fife planned for this year.  This 3 session course covers CBT techniques for managing the physical, emotional and cognitive impact of stress. There is a rolling programme of classes that accommodate large groups (50+) People can self refer (phone, email, via Moodcafe) or be referred by GP/psychologist/other professional.  Details on Moodcafe: www.moodcafe.co.uk/learn-to-deal-with-stress-at-a-local-class.aspx
  2. Self Esteem group – Available in NHS venues in Dunfermline. An 8 week CBT course for improving self esteem.  Non-diagnosis specific; 8-10 participants per course; referral through the Psychology service.
  3. Resources Group - Currently in the Day Hospitals in Dunfermline and Cupar, and about to start in Kirkcaldy.  Run by psychologists with Day Hospital staff. Aimed at people who are struggling to manage emotional dysregulation (often trauma-related). Incorporates a range of techniques including those from CBT, mindfulness, somatic trauma therapy, and DBT.  6 week course. 10-12 participants, referred via Day Hospital or Psychology. This Group has also been offered to people with addictions in partnership with First.
  4. Mindfulness Group - Currently in Kirkcaldy, about to start in NE Fife. This is a non-diagnosis specific CBT-based group introducing mindfulness techniques. 8-10 participants per course.
  5. We continue to work with the Express Group on group programmes assisting adults to overcome anxiety/agoraphobia through in vivo exposure. These have been offered in community locations in Kirkcaldy and are about to start in Dunfermline for first time, with the option of extending this to other areas of Fife if there is demand and the Express Group can support this.  Participants are identified by the Express Group or referred from Psychology.
  6. Within the forensic service the psychologists are working with nursing staff to deliver a range of group therapy programmes for inpatients and individuals in the community, focussing on the development of self-awareness and relationship skills. These are evidence-based programmes supported by the Forensic Network.
  7. The clinical health and physical rehabilitation teams offer an Acceptance and Commitment therapy 6 session group programme for individuals with long term physical health conditions; clinical health staff also work with the multidisciplinary teams in the Pain Service to deliver CBT-based pain management programmes.
  8. The older adult service is offering an 8 week psychoeducational group for carers of people with dementia to assist them to understand and cope with dementia in family members.
  9. Within the child psychology service we offer a 6 session group programme for parents of children/young people with ADHD; we also support the Incredible Years parenting programmes delivered across Fife by multi-disciplinary staff.

I hope that this information demonstrates the considerable effort we are making to extend the provision of evidence-based psychological therapies in Fife. 

Dr Katherine Cheshire

Head of Psychology Service NHS Fife

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I replied to this Email at 15.27 saying:

"Dear Katherine

Thank you for your comprehensive response.

I shall study the links which you have included.  To do with Mastermind and Beating the Blues.  I notice these are on the Moodcafe website which I am hoping is now up-to-date and accurate.  I didn't find it to be so in the past.

I note that there is forensic service group therapy but I don't see anything about psychological therapies available to acute inpatient psychiatric wards like Lomond and the IPCU at Stratheden, for non-forensic patients.  Please do correct me if I've got this wrong.  I notice that the Day Hospitals have groups.  However I think that inpatient care would benefit from clinical psychology input, on an equal basis to drug prescribing.  It may be easier to give depot injections of antipsychotics to distressed patients but it's not so easy if you're on the receiving end of it.

Can you please let me know what the process is for patients being discharged from Stratheden and the other acute inpatient wards in Kirkcaldy and Dunfermline, in respect of access to psychological therapies?  Is it only drug treatment for inpatients with no talking therapies?  I am concerned that anyone resisting psychiatric medications will have no other therapeutic input available to them.  In other words, drugs or nothing.

I and other members of my family would have appreciated access to psychological therapies when in a psychosis, altered mind state or emotional crisis/breakdown.  We did not like being coercively drugged with antipsychotics which took away our agency.  Even after managing to taper the drugs we still could not access CBT.  I am wondering why there is what amounts to discrimination towards people who have psychoses rather than neuroses?  Those of us who externalise our distress rather than internalise it.  

Scottish Government wrote about crisis houses and safe havens in the 2012-5 Mental Health Strategy, involving peers, people who are experts by virtue of their life experience, recovering from mental illness and psychiatric treatment.  I would like to see a safe haven in Fife for people like me who don't want to be forced with psychiatric drugs when having a life crisis or emotional breakdown.  We deserve to be treated respectfully and given every opportunity to retain our dignity and agency.  This is what I will be promoting and working for in 2016.  Now that my sons are in recovery, if not yet fully recovered from psychiatric treatment and having their agency taken away.

Yours sincerely,

Chrys


Chrys Muirhead
writer, activist, campaigner; community educator

ChrysMuirheadWrites.blogspot.co.uk
ChrysM-Associates.co.uk
@ChrysMuirhead



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