Projects

The aim of this research project is to evaluate a pilot intervention to embed clinical psychologists within general practices serving disadvantaged communities in the North East and North Cumbria – called the MINDED pilot.

‘MINDED’ represents the project’s working title of ‘Mental Health IN the Deep EnD‘.

Through the MINDED pilot, patients with common mental health problems are offered 30-minute consultations with a member of an in-house psychology team 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 is being piloted across six Deep End practices in Gateshead, Newcastle, Sunderland and South Tyneside.

Background

The North East and North Cumbria (NENC) region has developed a Deep End Network of GP practices where up to 96 percent of registered patients live in the most deprived neighbourhoods in the country.

The NENC has the third highest rate of common mental conditions in England, and previous research with Deep End practice staff identified mental health problems, such as anxiety and depression, as one of the most fundamental issues facing patients.

Mental ill-health issues take up around one 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 – while also protecting their own mental wellbeing. The MINDED intervention has been developed to address this need.

It aims to improve the quality of primary care mental health care in the most disadvantaged communities and improve outcomes for patients in most need, and funding is being provided by the NHS to employ mental health professionals directly.

How will the pilot work?

Clinical psychologists provide interventions that address both mental distress and social exclusion and their advanced training means they are able to act independently, helping to both improve care and reduce pressure on GPs.

In the MINDED intervention, patients with common mental health problems are offered 30-minute consultations with a clinical psychologist or member of an in-house psychology team located in the GP practice – to conduct a thorough assessment and provide patients with time to explore their problems and start to identify solutions.

Where appropriate, patients are signposted to further sources of support. Patients can also arrange further MINDED appointments to continue to explore and refine their treatment and support options.

How will the evaluation of the project, work?

The evaluation will aim to explore the feasibility and acceptability, for patients and GPs, of embedding an in-house psychology team 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 and the feasibility and acceptability of data collection methods. The research will explore:

• GPs’ willingness to engage and patients’ willingness to take part in 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.

This pilot study will provide valuable learning for GPs interested in expanding their practice team to include an in-practice clinical psychologist.

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

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

What is different about this work?

The proposed study represents the first rigorous evaluation of the feasibility and acceptability of embedding a psychology team in primary care practices in areas of severe socioeconomic deprivation. The study will also identify relevant quantitative outcomes that can be investigated in a future evaluation of effectiveness.

MINDED is novel because it employs professionals who are extensively trained and equipped to accept patients with more complex needs, in comparison to most existing staff or services currently providing psychological intervention and support within primary care (for example Improving Access to Psychological Therapies services and mental health support workers).

The members of the team 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 study will establish whether embedding an in-house psychology team is feasible, acceptable and of value to primary care patients and practitioners in areas of socioeconomic deprivation. This study will address this need by determining how the intervention impacts on patients and practitioners in areas of socioeconomic deprivation in terms of access, choice and satisfaction with mental health care provision.

Findings will:

• Inform the wider local service transformation agenda currently being developed through the North-East Community Transformation Programmes.
• 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 through the Additional Reimbursable Roles Scheme (ARRS).

To find out more about the study, please contact:

Dr Jayne Jeffries, Research Associate, Newcastle University – [email protected]