Improving services locally3

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The Treatment and Experience of Depression in Rugby : 

The Treatment and Experience of Depression in Rugby

National Prevalence of Depression: 

National Prevalence of Depression Depression is a very common condition, which affects about 5% of people significantly at any one time, and 2-in-3 adults at some stage in their lives. In 1998 it was estimated that over 9 million Britons sought help from their GP for depression.

Access to Treatment: 

Access to Treatment Despite such prevalence …. around three-in-four people receive neither diagnosis nor treatment, depite the fact the research demonstrates anti-depressant medication and brief, structured forms of psychological therapy are reported as effective for 60-80% of those affected.

Treatment Options: 

Treatment Options

Recommended treatments for depression: 

Recommended treatments for depression Watchful waiting Guided self-help Short-term psychological treatments (e.g. CPN’s, Counsellors, Psychologists) Anti-depressants

Project Objectives: 

Project Objectives Rugby PPI were interested to explore: 1. The local prevalence of depression 2. Patient treatment preference 3. GP treatment preference 4. Locally available resources.

How does it all fit together?: 

How does it all fit together?

Project Activities: 

Project Activities 1. GP Survey 2. Public Survey

GP Focus Group Survey: 

GP Focus Group Survey Could you estimate the total number of patients you would expect to see in a year where depression would be one of the main diagnoses? Total: 3477 patients Or an average of 217 patients per GP per annum Or (with 51 GPs) we estimate over 11,000 patients per annum total which is 30% higher than extrapolated estimates of 8,500

GP Focus Group Survey: 

GP Focus Group Survey If more resources were available for the treatment of depression, are there any that you feel could make a significant impact on the quality of patient care/management?

Slide11: 

'More rapidly available psychology/counselling service'

Slide12: 

'Quicker access to psychology, availability of CBT'

Slide13: 

'Increase in counselling availability in primary care'

Slide14: 

'Better counselling services and psychological services'

Slide15: 

'Rapid access primary care counselling for mild depression and CMHT if moderate depression'

Slide16: 

'Improve secondary care - crisis team improvement, practice based counselling services, education i.e. diagnosis/therapeutic option'

Slide17: 

'Counselling /CBT'

Slide18: 

'More access to CBT, make online resources free (managed by NHS) and offer more training for GPs in CBT'

Slide19: 

'1st care counselling especially CBT and social care packages/counselling for mild depression with social issues'

Slide20: 

'Easy access to counsellors/CPN most depressed patients want 'somebody to talk to' and not medications'

Slide21: 

'A local accessible counselling service. A public education campaign to wean the public off the idea that antidepressant medication is the main answer for managing ordinary life stresses - unhappiness is not a medical illness'

Slide22: 

'More 'chat' therapy (not always readily available)'

Slide23: 

'More input from CPNs very important to be part of the mental health team, especially in moderate to mild depression, rather than counsellor removed from other mental health professionals'

Slide24: 

'Psychotherapy andamp; counselling should be more readily available'

Slide25: 

'More counsellors and psychotherapists'

Slide26: 

'Counsellor for support attached to GP surgery to be able to see a patient within 1 week. CPN service to offer appointment within 1-2 weeks'

GP Survey Conclusions: 

GP Survey Conclusions The findings supports the national trend of a significant prevalence of depression that cannot be treated with the psychological treatments that GPs would like to have access to for their patients.

Public Survey (n=95): 

Public Survey (n=95) 67 respondents (71%) reported that they had experienced long periods of low mood or feelings of not being able to cope, of which 32 (48%) reported being diagnosed with depression.

Public Survey (n=95): 

Public Survey (n=95) Of those respondents diagnosed with depression 30 (94%) were prescribed medication, of which 12 (40%) received a combination of talking therapy and medication

Slide30: 

How effective was the support and treatment?

Slide31: 

When asked 'what do you feel could be improved?', for those 16 given medication alone, two-thirds offered further comments (12) and three-quarters of these (9) focussed on the need and opportunity for greater support and/or opportunity to talk as illustrated by the verbatim comments below:   'Someone to talk to from the start' 'Counselling for longer periods of time' 'Maybe some sort of therapy'   'Talking about mother who died of XXXX but not spotted by Dr. XX'   'Better to have had talking therapies'   'Need to invest money NHS for talking therapies'   'GP to have time to listen'   'Time to talk'   'Treatment ongoing, not very effective needs more support'

Public Survey Conclusions: 

Public Survey Conclusions Overall, the picture provided by the public resonates with that provided by the GPs in suggesting a potentially higher than expected prevalence of depression in Rugby and significant support for enhanced access to talking therapies (i.e. psychological therapies).

Overall Survey Conclusions: 

Overall Survey Conclusions If the estimated higher prevalence of depression in Rugby is correct, the conclusions of this report cautions that the launch of the new Primary Care Mental Health Service developed by Rugby PCT may well be met with an overwhelming volume of referrals. It is therefore recommended that the PPI should closely monitor access, appropriate utilisation and clinical effectiveness of the new service over the first twelve months of provision.

Survey Follow-up [2007]: 

Survey Follow-up [2007] Service delivery developments since the study ended?

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