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The NICE guidelines for the management of depression, anxiety (panic disorder and generalised anxiety disorder) and Obsessive-Compulsive Disorder (OCD) recommend using a stepped care model approach to treatment. The steps and the interventions required vary across these conditions but the principle is that patients receive the least burdensome and most effective treatment necessary for their recovery.
Within stepped care, the progression of patients from Step 1 interventions through to a higher intervention is based on a mixture of increased need and past experience of treatment. It is expected that many patients will have had access to lower step treatments prior to receiving treatments from higher steps. For example, many patients with moderate/severe depression will benefit from brief psychological interventions and this may reduce the burden of more intensive treatment on the patient, the service providers and commissionersThis project aimed to develop a pathway map of STEP 2-4 psychological therapy services within the Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) area, which may assist the policy making process.
To achieve this, PenCHORD worked with a wide range of mental health organisations, including both commissioners and providers, and sought to address the following key questions:
What is the current pathway for the provision of STEP 2-4 psychological therapies (including counselling) in NEW Devon CCG?
What is the current patient flow through the pathway for providing STEP 2-4 psychological therapies (including counselling) in NEW Devon CCG?
Can a consensual pathway map of services between the key stakeholders be developed as a basis for future planning of mental health services?
The aims of the project were to:
Work closely with providers (e.g. Devon Partnership Trust, Livewell Southwest, other small providers and voluntary organisations) and commissioners to develop a pathway map of the current system through which STEP 2-4 psychological therapies (including counselling) are provided to patients within the NEW Devon and Plymouth areas.
Through dialogue with and between stakeholders, ensure the pathway map provides a consensual basis for understanding and planning of service provision across the area.
Using existing process maps of the care pathways for psychological therapies from Devon Partnership Trust and 3rd sector providers, as well as organised process mapping sessions as appropriate, we produced a conceptual model of the system for the provision of STEP 2-4 psychological therapies.
The Mental Health Commissioning Support Manager for NEW Devon CCG acted as the central point of contact for liaising between the partners, organising team meetings and requesting data from the various providers and systems required for the completion of the project. The collaborators were responsible for collating, anonymising and linking all data before it was distributed to PenCHORD.
The following outputs are envisaged from the project:
Process map of current service pathways
Presentation of findings and written report
Potential journal publication(s)
Following on from this project the model could be used to look at a range of planning questions (e.g. how can the efficient provision of psychological therapies be achieved in NEW Devon CCG under the current structure for the provision of services?).
Conceptual model, discrete event simulation or system dynamics could be used to provide sensitivity and ‘what-if’ scenario analysis to investigate how referrals may optimally be distributed to minimise waiting list times and avoid patients being ‘lost in the system’.