Taking the drama out of a crisis

Chris O’Keeffe admits she was a little sceptical when she and her team were first approached about an innovative programme to help improve outcomes for people with mental illness.

Janssen Healthcare Innovation (JHI) was keen to work with the trust to develop a programme based on German research. Ms O’Keeffe says she struggled to envisage the impact but soon found she had evidence of it – better compliance, fewer bed days, and greater service user and staff satisfaction.

“At first I looked at it and thought to myself that we were doing a lot of the things already; I wondered how it could make a difference. But now I’m almost evangelical about it. I love what we’re doing, and I love what it means to service users.”

‘Now I’m almost evangelical about it. I love what we’re doing, and I love what it means to service users’

Ms O’Keeffe is clinical lead with the Maintaining Adherence Programme (MAP), which is being piloted at South Essex Partnership University Foundation Trust (SEPT). The programme is the result of a joint working agreement between JHI, an entrepreneurial team within Janssen Pharmaceuticals, and the trust. The programme – now rechristened Care4Today Mental Health Solutions – aims to reduce the risk of relapse and non-compliance among people with diagnoses of three serious mental illnesses: schizophrenia, schizoaffective disorder, and bipolar affective disorder.

Mix of methods

A patient-focused, care management approach, the initiative uses a mixture of methods, including educational and technological, to engage with this group of service users and their families and carers.

At the heart of the programme are wellbeing activities, a structured psychoeducation course, and a telephone or text reminder service for service users.

The psychoeducation sessions are particularly important, says Ms O’Keeffe, explaining that, for example, the schizophrenia course involves 11 group sessions lasting up to two hours a time.

“Each course has six to eight people and two facilitators,” says Ms O’Keeffe, who is a registered mental health nurse by background. For schizophrenia, sessions start with an introduction to group work, then cover topics including symptoms, causes, and diagnosis to medication and side effects.

‘Participants are encouraged to look at signs they might be about to relapse’

In later sessions, participants (on an individual basis) are encouraged to look at signs they might be about to relapse, such as trouble sleeping, or an increase in symptoms such as auditory hallucinations, then draw up a plan for dealing with crisis.

Personal health goals

“It’s about doing something before it’s too late,” says Ms O’Keeffe. “It’s about empowering service users by looking at what they can do to prevent problems. Of course, you can’t prevent every crisis, so we also help patients draw up a crisis plan – covering things like who will feed their dog – so that they feel they have a voice when they are unwell.”

Service users are encouraged to share their relapse and crisis plans with their family, she adds, and carers also attend a course covering the same subjects.

There’s a lengthy session on recovery, shorter sessions on drugs and alcohol, including caffeine and nicotine, and participants are encouraged to develop personal health goals.

‘It’s good for the service user and their families, but it’s also good for the trust’s bottom line’

“Since June 2011 we’ve run 24 groups, and the impact has been great – I’m really thrilled about it,” she says. “It’s good for the service user and their families, but it’s also good for the trust’s bottom line; adherence – or lack of it – has costs, both personal and economic.”

The community-based programme has a significant technological element. Service users can, if they wish, sign up to receive text reminders about taking medication, and also receive a weekly call from a health professional just to check everything is fine.

Coffee and culture

The wellbeing programme involves social groups. These have a physical health aspect – there are walking groups, for example – but also address broader interests.

“We call it coffee and culture and we’re trying to progress people out into the community. It’s led by the service users and has involved things like a visit to the mayoral chambers.”

‘We call it coffee and culture and we’re trying to progress people out into the community’

Other important elements include shared decision-making between the dedicated adherence team and service users, and direct consultant access rather than traditional outpatient clinics.

Inpatient bed days reduction

Service users are measured for adherence and levels of satisfaction before the programme, and reviewed three months after. So far, the results have been impressive. The 18-month patient cohort saw inpatient bed days reduced by 58 per cent.

A validated patient-reported medication adherence rating scale changed from 5.35 to 8.02, indicating significantly improved adherence. Questionnaires were completed by 79 per cent of patients (50 out of 63) and satisfaction levels were very high, with 98 per cent saying they would recommend the service to family and friends.

Ian Smyth from Janssen Healthcare Innovation says the company is delighted with the results, and is particularly pleased that the trust has decided to roll the approach out to adult psychiatric patients across the region (so far it has been for service users in Southend only).

‘The trust has decided to roll the approach out to adult psychiatric patients across the region’

He explains the programme is based on the work of Dr Werner Kissling in Munich, and Janssen wanted to see if it would translate to the UK. “The health systems are very different: England has community-based teams, while Germany is more hospital based. We were pleased that SEPT agreed to try the programme because we know they have a reputation for innovation.”

Joint working

The relationship between the trust and the company has been extremely good, he says, and a joint project board is overseeing the work. Janssen also provided dedicated project management to support the SEPT team.

Buy-in from the trust’s senior management team was crucial, he adds – as was getting across the message that the aim of the initiative was to promote wider healthcare solutions rather than specific medications.

“At JHI we are committed to developing cutting-edge health solutions to modernise healthcare delivery and improve patient care, particularly in areas of significant need such as mental health,” he says.

‘We are committed to developing cutting-edge health solutions to modernise healthcare delivery and improve patient care’

The company is hugely encouraged by the results from the SEPT project, which show that – delivered consistently, with a high degree of fidelity to the pathway – there is a positive impact on adherence.

JHI is now seeking to form partnerships with other mental health organisations, hoping they will recognise the benefits of the programme: strong, evidence-based materials, a technology platform that reduces variation in programme delivery and implementation support that ensures integration with care pathways from a clinical, cultural and technological standpoint.

The programme certainly has support from Ms O’Keeffe. “I can’t speak about it highly enough. I love what we’re doing and I love my job,” she says.