Dr Kate Rhodes, Clinical Psychologist
Hywel Dda University Health Board
One in four Carmarthenshire residents have a chronic health condition. Many people with long-term conditions also have mental health problems, which can lead to significantly poorer outcomes and reduced quality of life. Research shows that poor physical and mental health increases costs to health and social care by at least 45% per person. Bridging physical and mental health is key to delivering a seamless approach to both prevention and statutory care.
‘A Healthier Wales’ Health & Social Care plan calls for services to “bring health and social care together in integrated services; to support and anticipate health needs, to prevent illness, and to reduce the impact of poor health; and improve physical and mental well-being.”
This project aimed to develop an innovative Clinical Health Psychology pathway within Carmarthenshire Integrated Services for people whose psychological difficulties were impeding on their self-management and increasing their social care needs.
The integration of psychology into health and social care teams aimed to :
Prevent the breakdown of care packages
Reduce the needs for costly care packages as a result of emotional distress, or challenging behaviour
Assist individuals in maintaining independence
To meet these goals a three pronged approach was taken, developing a pathway which included:
The referrals that we received for assessment and intervention were complex and broad in their presentations. This could prove challenging in respect of the input time needed by psychology for each service user and managing systems around these referrals. Good , regular supervision helped with this.
We were unable to engage 1 of the 3 Community Resource Teams within Carmarthenshire and think it is likely that this was because we had no physical presence in the Team. This could be overcome in future work by having a team member work from their offices occasionally.
To date we have provided training in assessment and low level interventions for anxiety and depression to 36 members of Carmarthenshire CRT’s . The feedback from this has been positive. Pre and post outcome measures show an increase in confidence by staff members to be able to asses for low level mental health difficulties and to work with their service users to provide interventions such as Sleep Hygiene, problem solving, goal setting, behavioural activation and onward mental health referral.
Graph 1: CRT Staff Confidence in Assessing for Anxiety and Depression Pre and Post Psychology Training.
Graph 2: CRT Staff Confidence in Providing Low Intensity Interventions for Anxiety and Depression Pre and Post Psychology Training
A cost analysis was conducted into 14 clinical cases where psychology provided input via the new integrated pathway.
It was found that 43% of cases (n=6) led to savings of £1.8k per week (£86K per year). For 2 of the cases costs were not reduced, but higher costs were avoided.
In one case through avoidance of hospital admission and in another through avoidance of a long term residential package. On the whole, the cases took up 100 hours of clinical psychology time equating to £2,984, resulting in an overall saving of £83k.
The project has demonstrated that Clinical Psychology can be a valuable addition to Adult Social Care services. We continue to offer input into Carmarthenshire CRT’s and to evaluate this work to build up our evidence base.
Core investment from the Health Board or integrated funding is required to make further savings, to ensure the sustainability of this working model and for further enhancement & innovation to meet strategic objectives.
Literature searches to date have found no literature relating to psychological issues/work in adult social care, we hope to write this work up for journal submission.
My Exemplar Experience
I have enjoyed and benefitted from the training events that being an Exemplar has opened up to me. It’s been a great experience.
“The psychologists have been a vital part of the Community Resource Team. Their addition to the team has provided opportunities for a range of disciplines to work jointly with them including District Nurses, OTs, Social Workers, Physiotherapists and Chronic Disease Management Nurses. Their expertise has been pivotal in our work with a number of highly complex cases, in which psychological approaches have been utilised to work towards building resilience and increasing levels of independence. The psychologists have also worked proactively with the team to increase our knowledge of psychological approaches and have delivered excellent training to the Social Work Team which was positively received. “
Angharad Jenkins, Team Manager, Social Work Team, Llanelli