The right kind of help when you need it
Dr Paul Sigel – Primary Care Psychology
Where PCP Fits in the Pathway
Screening
Review prn, aim
for annually in
those with
chronic diseases
(no longer in
QOF)
Physical Health
Problem: Assess
mental health &
coping
Biopsychosocial
Assessment
Primary Care
Psychology
Pt wants
therapy
High
suicide risk
Crisis/
CMHT
Engagement
Issues
PCPCS
(Tavi)
PCP Service Model
Clinical Health Psychology: LTC & MUS
Primary Care Psychology
Treatment for patients in PbR clusters 5-7 & difficult to
engage
Condition-specific clinical health psychology
interventions;
Admission avoidance & condition management within
acute/community LTC pathways.
Complex presentations, including co-morbidity,
significant social problems & risk.
Neuropsychological assessment & Rx management.
Consultation, training & treatment planning to acute &
community MDTs
Treatments for mild- moderate autistic spectrum
disorder, eating problems, psycho-sexual problems.
Supervision and training
Supervision, training & clinical management
IAPT
Protocol-based treatments for common mental health problems for patients in PbR Clusters 1-4:
--mild, moderate and severe [but not complex] depression & disorders [panic, GAD, social anxiety, post-traumatic
stress disorder]
--mild to moderate-severe obsessive- compulsive disorder,
Protocol-based clinical health psychology interventions for physical health conditions, including long-term
conditions.
TREATMENT MODALITIES
Low –Intensity
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1:1 Telephone and Face to Face Therapy
Psycho- education & Skills Groups
Condition-specific interventions for LTC
High Intensity

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CBT for Common Mental Health Problems
Mindfulness-Based CBT for Depression
Interpersonal Therapy for Depression [IPT]
Couples Therapy
EMDR for PTSD
Condition-specific interventions for LTC
CBT for Chronic/ Complex Depression & Anxiety Disorders
PCP sees a disproportionately
high proportion of severe presentations
LARGE IAPT SERVICES IN AREAS OF SOCIAL DEPRIVATION HAVE
MORE SEVERE & CHRONIC/COMPLEX PATIENTS
100%
90%
80%
70%
60%
50%
% Clusters 5-8
40%
% Clusters 1-4
30%
20%
10%
0%
National IAPT
PbR Feasibility
Pilot
City & Hackney
HoNOS Pilot

IAPT services vary significantly in the proportion of patients with
chronic/complex anxiety or depression.

Most large IAPT services in areas of social-deprivation have high proportions
of more severe presentations. This includes the City & Hackney service.
Working with GP Practices
1. Seeing patients in Surgeries
2. Attending practice mtgs
3. Joint work with pts presenting with risk.
3. High Quality Primary Mental Health Care– Let us
know about patients requiring special management
through our rapid access pathways
Managing Long-Term Conditions:
Primary Care Psychology
Dr. Melanie Rendall
Long-term condition
pathways
• Gastroenterology (e.g., IBD; IBS)
• Dermatology (e.g., eczema; psoriasis; acne;
complex leg ulcers)
• ASD/Aspergers
• Cardiac
• Chronic Obstructive Pulmonary Disease
(COPD)
• Diabetes
• Older Adults (e.g., dementia)
• Women’s Health (e.g., gynaecological issues;
reproductive health; menopause;
endometriosis)
• Tinnitus/hyperacusis
Additional LTC services
• Adult Community Rehabilitation Team
(ACRT)
• Graham Stroke Unit (GSU)
• Pain management
• Sickle Cell & Thalassemia
• Admission avoidance (pilot project
completed)
Long term conditions & older
people in Hackney
• 71% stated that they, or a family member,
had a LTC
• 49% had multiple LTCs
• 25% of those with LTC endorsed
depression or other mental health issue
• 76% of those who were depressed had
LTC
• 44% were living alone
Long term conditions & older
people in Hackney
• Do we have any audit data about referral
numbers for older adults?
• If not, perhaps just a general reflection
about low numbers referred through GP
and mention that cohort which one would
presume might not be likely to self-refer
• Could comment on the admission
avoidance project and how sig number
were >70 - need to creatively target this
group????
Carers and mental health
• Up to 40% of carers experience
psychological distress or depression
(RCGP, 2007)
• Carers have an increased rate of physical
health problems (Carers UK, 2007)
• 51% of carers for someone with dementia
report don’t feel they get support to talk
about their needs (Carers Trust Report,
2013)
Carers and mental health
• Carers should be routinely screened for
depression and mental health problems as
they often ‘neglect’ their own well-being
(Clare Gerada, 2013)
• Recommended creating a register to help
those experiencing depression or
psychological problems
• Current best practice?