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A project led by researchers from the NIHR Applied Research Collaboration (ARC) North East and North Cumbria and the regional ‘Deep End’ GP network will evaluate a new pilot to place clinical psychologists within general practices serving some of the most disadvantaged communities in the North East and North Cumbria.

The pilot intervention is called ‘MINDED’, which represents the working title of ‘Mental health IN the Deep EnD’, and it is being trialled across four Deep End practices in Gateshead, Newcastle, Sunderland and South Tyneside.

‘Deep End’ practices are those which work within some of the most deprived communities in the country, and the North East and North Cumbria area has developed its own Deep End Network of GP practices – where up to 96 percent of registered patients live in the most deprived areas.

Pilot shaped by GPs’ concerns

The MINDED pilot was shaped by concerns raised by Deep End GPs and practice staff in the region as part of an earlier piece of research work, where they identified mental health problems such as anxiety and depression, as amongst the most fundamental issues facing patients.

Mental ill-health concerns take up a third of GP appointments and research suggests many GPs’ high workloads prevent them from providing good-quality mental health care. This issue is even more pronounced in areas of severe socioeconomic deprivation.

Alongside this, the risks of diagnosing poverty-related distress as mental illness are a concern for GPs working in areas of deprivation, as this may lead to inappropriate treatment.

Deep End primary care staff said they needed more time and support to help patients with mental ill health, whilst also protecting their own mental wellbeing. As a result, the MINDED pilot was developed to address this need.

Through the MINDED intervention, patients with common mental health problems will be offered 30-minute consultations with a clinical psychologist based in a GP practice, who can conduct a thorough assessment and provide patients with time to explore their problems and start to identify solutions.

MINDED offers something different because it employs clinical psychologists who can work directly with patients with more complex needs, within a GP setting.

The clinical psychologists are trained in a range of interventions, including those that promote autonomy and mental wellbeing, minimise social exclusion and inequalities. They also will link with other professionals to help patients engage in activities such as employment, education and leisure.

The scheme aims to improve the quality of primary mental health care in the most disadvantaged communities, and improve outcomes for patients most in need.

The MINDED pilot intervention is fully funded by the North East and North Cumbria (NENC) Deep End Network through the regional Integrated Care System (ICS) for the North East and North Cumbria.

Researchers from the NIHR ARC North East and North Cumbria and Fuse, the Centre for Translational Research in Public Health, will monitor and evaluate the pilot as it is embedded, and explore how best to measure its impact.

The evaluation has been funded through the NIHR Three Research Schools Mental Health Practice Evaluation Scheme.

Exploring GPs’ and patients’ experiences

Dr Sarah Sowden from Newcastle University is leading the research work.

She said: “Our evaluation will aim to explore the feasibility and acceptability, for patients and GPs, of embedding clinical psychologists in general practice in areas of severe socioeconomic deprivation. The study will also explore – with patients and GPs – meaningful and measurable health and wellbeing outcomes from the MINDED consultations.

“The study represents the first rigorous evaluation of the feasibility and acceptability of embedding a clinical psychologist in primary care practices in areas of severe socioeconomic deprivation.”

Dr Sameena Hassan is a local GP and the Joint Clinical Lead for the Deep End network in the North East and North Cumbria. Dr Hassan is also practice co-lead for the evaluation.

She said: “We hope that this pilot will provide valuable learning for GPs interested in expanding their core practice team to include an in-house clinical psychologist and enhance the finite resource we have. The evaluation will be key in helping us to establish whether embedding a clinical psychologist is feasible, acceptable and of value to primary care patients and practitioners in areas of socioeconomic deprivation.”

The research will include work around:

• GPs’ willingness to refer and patients’ willingness to take up referrals to MINDED consultations.
• Patient and GP experiences and opinions of the intervention.
• Potential quantitative outcomes to inform a larger-scale evaluation of the impact of the provision of clinical psychologists in primary care on patients’ mental health and wellbeing.

Findings will:

• Act as a model for other areas of the country facing similar challenges.
• Identify outcomes for a full evaluation of primary care embedded clinical psychology appointments.
• Help general practices make informed decisions on using funding available.

The study will also identify relevant quantitative outcomes that can be investigated in a future evaluation of effectiveness.

You can find out more in this project summary.

Or get in touch with Principal Investigator Dr Sarah Sowden – [email protected]