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Jacqui Howard

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  • 1. THE ROLE OF IAPT SERVICES INSUICIDE PREVENTIONJacqui Howard andTracey Murden17 May 2013
  • 2. Policy frameworkWhat do Increasing Access to PsychologicalTherapies (IAPT) services do?Role of IAPT services in: preventing suicide identifying and responding to riskContents
  • 3. Policy frameworkHM Government (2011) No health without mental health More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health Fewer people will suffer avoidable harmDH (2011)Talking therapies: A four year plan of action Complete roll out of IAPT services for adults Improve access for older people and black & minority ethnic communities Stand-alone programme for children and young people.DH (2012) Preventing suicide in England Reduce risk of suicide in key high risk groups Tailor approaches to improve mental health in specific groupsNHS Outcomes framework 2013-14 Treating and caring for people in a safe environment and protecting themfrom avoidable harm
  • 4. Preventing suicide in England 2012Relevant pointers for IAPT services……. Those who work with men in different settings, especiallyprimary care, need to be particularly alert to the signs ofsuicidal behaviour. Accessible, high quality mental health services are fundamentalto reducing the suicide risk in people of all ages with mentalhealth problems. Depression is one of the most important risk factors for suicide.
  • 5. What do Increasing Access to PsychologicalTherapies (IAPT) services do?IAPT services:Provide primary care based talking therapies services that offer arange of treatments for depression and anxiety disorders approvedby NICEAre organised through a stepped care approach (least intrusiveinterventions first)Are delivered by trained therapists: Step 2- Psychological Wellbeing Practitioners (guided self help) Step 3- High Intensity Therapists, including cognitive behaviouraltherapists; counsellors; interpersonal psychotherapists; briefpsychodynamic psychotherapists.Monitor outcomes at each session
  • 6. What does Inclusion Matters Liverpool do?….Covers Liverpool City (Population: 465.7 thousand; 95 GP practices)Provides primary care psychological therapies (IAPT) services fordepression and anxiety, combined with alcohol interventionsNow has over 100 trained therapists working at Step 2 and Step 3 levels ofinterventionWorks closely with a range of community and social inclusion agencies,including the wider mental health system.
  • 7. Role in preventing suicide
  • 8. High risk groups who are priorities for prevention of suicide:young and middle aged men; people in care of mental health services; people with ahistory of self harm; people in contact with the criminal justice system; &specific occupational groups, including doctors and nurses.Profile of people engaging with the service
  • 9. The early identification and prompt effective treatment for depression has amajor role to play in preventing suicide across the whole populationTreating depression
  • 10. Treating depressionDuring my darkest days of depression, I began mysessions with IML. With stress and anxiety havingtaken over my life, Mike listened carefully to my fearsand feelings… his understanding, care and compassionwere a lifeline… I still use the techniques (wedeveloped) and the dark days are slowly lifting…
  • 11. Initial assessment (usually by telephone)Step 2 : Low intensity interventionStep 3: High intensity intervention……….continuallyIdentifying and responding to risk:When do we assess risk?
  • 12. Standardised measures: Patient Health Questionnaire(PHQ-9)Q 2: “Feeling down, depressed, or hopeless”Q9: “Thoughts that you would be better off dead or ofhurting yourself in some way”How do we assess suicide risk?
  • 13. • Ask directly:“ Have you got thoughts of killing yourself?”“ Have you got a plan?”• Explore specifics:“ Why, how, when……..?”How do we assess suicide risk?
  • 14. Reasons for dying• Loss• Hopelessness• Crisis• Mental stateReasons for living• Hope• Future plans• Other people• FearExplore…….
  • 15. Previous self harm/suicide attemptsHistory of mental illnessAlcohol/substance misuseRisk factors
  • 16. Family/friendsFormal support network- e.g.ProfessionalsInformal support network-e.g. Church, community groupsPetsSupport factors
  • 17.  Recognising warning signs that a suicide crisis may beapproaching Identifying coping strategies that can be used byperson to soothe emotions and avert crisis Using family and friends that can be contacted todistract from suicidal thoughts and urges withoutdiscussing these Contacting friends and family who may help resolve acrisis and with whom suicidal thoughts can bediscussed Contacting emergency / crisis services Reducing access to lethal means (disabling suicideplan)As the plan is developed, write each step down onpaper so that the person can take this homeSafety plan (‘crisis response plan’): six steps
  • 18. We document the following: (on an electronic clinical record /information system) suicide risk assessment management plan (including future monitoring of risk) communications with person’s GP and other agencies involved; forexample, psychiatry emergency/crisis care follow up arrangements.We have a direct referral pathway with the local access/ crisisresponse home treatment teamDocumentation and follow up
  • 19. Increased training of own staff and other care givers(e.g. ASIST)Training and education for the communityHealth Promotion and awareness to improve thepsychological and emotional wellbeing of thecommunityIAPT: further possibilities for prevention
  • 20. Anyquestions?