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Tackling adult anxiety in Sheffield

A Lead Psychological Wellbeing Practitioner explains what the Steel City is doing to tackle mental health care for pensioners:

Ten million people in the UK are aged over 65 and yet older adults are under-represented in Improving Access to Psychological Therapies (IAPT).

Only 6.5% access IAPT nationally, and just 6% in Sheffield where the service exceeds 12,000 people entering treatment each year. Data indicates that, once referred, a greater proportion of older adults complete treatment and achieve better outcomes.

Launched in 2008, Sheffield IAPT service is integrated into primary care with psychological wellbeing practitioners, cognitive behavioural therapists and counsellors based in 85 GP practices across Sheffield.

Offering a wide range of National Institute for Clinical Excellence recommended evidence-based treatments, Sheffield IAPT aims to increase access to under-represented groups to promote equality and offer effective, evidence-based interventions to meet the needs of diverse patient populations.

Generalised anxiety disorder (GAD) is a common disorder in older adults, with prevalence rates estimated between 3.4% and 6.3%. NICE recommends pharmacotherapy, cognitive behavioural therapy (CBT) or applied relaxation to treat GAD in adults (NICE, 2011).

Older adults are found to prefer psychological therapy over medication for the treatment of anxiety conditions. Currently, one-to-one CBT is offered to older adults presenting with symptoms of GAD in Sheffield IAPT. Research suggests there is no difference between group and one-to-one treatment for GAD in older adults; furthermore, the benefits of group therapy include reduced social isolation and shared empathy, which are relevant for older adults given reductions in mental wellbeing associated with loneliness.

The IAPT service worked with Sheffield Older Adult Community Mental Health Team (OACMHT) and the University of Sheffield in designing and evaluating a group treatment for GAD for older adults to increase access and treatment choice.

The group was termed the Older Adults Overcoming Worry Group and it ran for two hours a week for 12 weeks. The group was based on a treatment protocol used in IAPT for the one-to-one treatment of GAD. The treatment protocol had encouraging results, with continued improvements after treatment with working age adults in group and individual settings, and older adults individually. Older adults with GAD who accessed Sheffield OACMHT and IAPT were offered the group for treatment of GAD to help understand, manage and reduce symptoms.

A total of three Overcoming Worry Groups were set up, representing 37 participants, 28 patients from IAPT and nine from OACHMT. Patients were asked to complete outcome measures at three time points: at the beginning of the group, at the end, and at an eight-week follow-up. Patients and facilitators completed short interviews at the end of treatment and many patients described their treatment as an enjoyable and social experience.

Almost half described coping better than expected with group-based treatment. Data indicated that attending the group made a big difference in reducing anxiety symptoms, with a 70% recovery rate.

In summary, the protocol shows real promise as a treatment for GAD in older age.

Dr Shonagh Scott, Principal Clinical Psychologist, and Dr Manreesh Bains, Senior Clinical Psychologist, of Sheffield OACMHT, said in their feedback: “The group has highlighted the importance for clients of having a group facilitator who has knowledge and expertise in the specific challenges of later life and who are able to draw on a wealth of clinical experience to illustrate concepts within the model with older adult-specific examples.”

It was a really good opportunity to shadow and learn ways of adapting groups to meet the needs of older adults. I realised the importance of ensuring materials and case examples were specific to this patient group. Facilitators were warm and empathic; the group was delivered at a good pace, which facilitated conversations and learning.

The research study and working in collaboration has provided older adults in Sheffield with an opportunity to participate in an effective treatment for GAD and contributed to the evidence-base for the effectiveness of GAD group-based treatments for older adults. This development is very important for improving access and contributing to an evidence base and also providing a group therapy option for older adults, which has many other benefits for this patient population such as the reduction in social isolation.

Sheffield IAPT and OACHMT will continue to work together to improve access and treatment choice for older adults. This will enable them to enhance referral pathways and supervision structures for staff, contributing to better quality care and patient experience.

The IAPT service, OACMHT and others will continue to work to achieve objectives set out in the Five Year Forward View for Mental Health.

Heather Stonebank

Heather Stonebank is Lead Psychological Wellbeing Practitioner for Sheffield Improving Access to Psychological Therapies Service (IAPT), a role in which she provides clinical leadership for the PWP workforce.

Heather has 11 years’ experience of working in mental health services within Sheffield Health and Social Care NHS Foundation Trust, working as part of Sheffield’s drug and alcohol team and on an acute mental health ward.
In October 2016 she was recruited into the Yorkshire and the Humber Clinical Network, NHS England, on secondment as a Lead PWP Clinical Advisor.

She is also co-chair of the British Association for Behavioural and Cognitive Psychotherapies Low Intensity Special Interest Group.

Heather has a keen interest in research to inform guidelines and clinical practice, is a member of the Northern Practice Research Network and has been involved in several research studies which have reached publication.

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4 comments

  1. James says:

    I’ve recently developed an interest in the role of being a Psychological Wellbeing Practitioner and wanted to find out more from you considering that my Dad fell across your blog post on the NHS England website the other day. I’m aware of the route into PWP training, however I’m just wondering if you would recommend anywhere where I could consider looking at getting experience with people who have mental health problems? I’m currently studying BsC Psychology at The University of Sheffield so I’m close to the city centre and hospitals and walk in centres.

    • Heather Stonebank says:

      Hi James – thank you for your message, that’s great to hear you are interested in the PWP role. I would be more than happy to have a chat over the phone and discuss the role and relevant work experience. I think you have sent an email, so I will reply today.

      Best Wishes

      Heather

  2. Kassander says:

    1) “Data indicates that, once referred, a greater proportion of older adults complete treatment and achieve better outcomes.”

    “better” than what, please?

    2) ” based in 85 GP practices across Sheffield.”

    What % 0f GP practices, and of registered patients, please?

    • Anonymous says:

      Hi Kassander, thank you for reading the blog and your questions.

      In answer to your questions:

      1)Older people achieve good outcomes from IAPT treatment, sometimes better than people under 65. In 2014/15 56% of over-65’s showed reliable recovery after receiving psychological therapies compared with 42% of working age adults.

      2)Sheffield IAPT are based in all GP practices in Sheffield and we have a self-referral team too.

      Hope this information is helpful, any other questions, please let me know.

      Best Wishes

      Heather