Mood, Anxiety and Personality

109 Pages·2017·2.56 MB·English

King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
Outcomes
Mood, Anxiety
and Personality
Clinical Academic Group
i
King’s Health Partners
King’s Health Partners brings together:
n three of the UK’s leading NHS Foundation Trusts
n a world-leading university for health research and education
n nearly 4.8 million patient contacts each year
n 40,000 staff
n nearly 30,000 students
n a combined annual turnover of more than £3.7 billion
n services provided across central and south London and beyond, including nine mental health and physical
healthcare hospitals and many community sites
n a comprehensive portfolio of high-quality clinical services with international recognition in cancer, diabetes,
mental health, regenerative medicine, transplantation, cardiac and clinical neurosciences
n a major trauma centre and two hyper-acute stroke units
King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
About King’s Health
Partners
King’s Health Partners Academic Health Sciences n increase the value of the care we provide and
Centre brings together one of the world’s the outcomes we achieve for our patients
top research-led universities, King’s College and service users
London, and three of London’s most prestigious
and highly-regarded NHS Foundation Trusts – n integrate care across local primary, secondary
Guy’s and St Thomas’, King’s College Hospital and social care services to make it easier for
and South London and Maudsley. people to get the care and support they need
Our partnership provides a powerful combination n improve the public health of our local
of complex clinical specialties that cover a wide community by tackling inequalities and
range of physical and mental health conditions supporting people to live healthy lives
and a breadth of research expertise that spans
disciplines from medicine and biomedical n bring together our collective strength
sciences to the social sciences and humanities. and expertise in a range of specialist areas
to deliver world-leading care, research
There are three parts to our mission: excellence and education.
in research, education and clinical care.
We are uniquely structured to deliver our mission
To support our mission, we are delivering for excellence. Our 21 Clinical Academic Groups
programmes of work to: (CAGs) bring together all the clinical services
and staff from the three trusts with the relevant
n join up mental and physical healthcare so that academic departments of King’s College London.
we treat the whole person, mind and body
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
Foreword
At King’s Health Partners, we are committed to The primary purpose of King’s Health Partners
improving outcomes for our patients and service is to improve health and wellbeing, locally and
users and achieving maximum value for money globally. We must deliver this goal in a challenging
in everything we do. We believe that being open economic environment with rising demand for,
and transparent about the care and outcomes we and costs of, healthcare. We will only achieve
deliver results in a culture of improvement across sustainable health improvement if we strive always
our partnership. This is why we are publishing to increase value. We define value in terms of
a series of outcomes books that will help patients, outcomes that matter to patients, over the full
service users, carers, referring clinicians and cycle of care, divided by the cost of producing
commissioners to make better-informed decisions, those outcomes. By publishing outcomes
Professor John
and our staff to drive up the quality of the care books, we have more information to support us
Moxham, Director
we provide. The books report key outcomes for measuring the value of the healthcare we provide.
of Clinical Strategy
treatments provided by our 21 clinical academic
groups (CAGs). CAGs form the building blocks of Our goal is to increase the depth and breadth
our Academic Health Sciences Centre. By bringing of reporting each year. Books will be updated
together our clinical and academic staff across regularly to demonstrate progress against our
teaching, training and research, we can use their mission to achieve world-class research, education
combined expertise to achieve better outcomes and clinical care. We hope you find these data
for our patients and service users. valuable. Please send comments and suggestions
to us at [email protected].
Our books are designed for a clinical and lay For more information please visit our website
audience and contain a summary of patient at www.kingshealthpartners.org.
volumes and measures (e.g. length of stay,
Professor John Moxham, Director of Clinical
re-admissions, patient experience), clinical
Strategy, King’s Health Partners
outcomes, educational activities, technological
and research innovations and publications. August 2017
They also focus on other important measures,
such as staff satisfaction and wellbeing.
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
A word from the
CAG Leadership
The Mood, Anxiety and Personality (MAP) CAG key partners in the community to promote health
brings together many centres of excellence in the and wellbeing.
South London and the Maudsley NHS Foundation
Trust (SLaM) and the Institute of Psychiatry, This book showcases our achievements since 2010
Psychology and Neurosciences (IoPPN). Together we and the activities under way to weave education
are developing a real partnership between those and training, research and clinical services into
working at the forefront of research, education and integrated delivery units whose performance is
patient care. By harnessing the ‘virtuous’ synergistic judged against metrics spanning the tripartite
interaction between these three domains, we aim agenda. We hope that it shows the quality of the
to translate research findings into clinical delivery care we deliver and serves as a useful benchmark
without delay, resulting in better mental health for future reports charting our progress.
for both our local population and those who are
referred to us nationally and internationally. In July 2016, the MAP CAG was merged
with specialist services previously within the
Increasing numbers of the population have Psychological Medicine CAG. The new CAG is
both a physical and a mental health long term named Psychological Medicine and Integrated
condition. A key focus for the MAP team over Care CAG and we have been building an
the next five years will be to consider how integrated approach over our first year.
healthcare delivery might be centred on the
whole person, with fully-integrated physical Prof Allan Young, CAG Lead
and mental healthcare. The CAG workforce is and Academic Director
our greatest asset and they will thrive if valued,
Dr Hugh Jones, CAG Lead and Clinical Director
supported and educated to consider the whole
system, unconstrained by traditional healthcare Mr Steve Davidson, Service Director
boundaries. We also need to collaborate with
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
The value of
partnership at King’s
Health Partners
King’s Health Partners aims to create a centre
Integrating mental
where world-class research, education and clinical
practice (the ‘tripartite mission’) are brought
and physical health
together for the benefit of patients.
We want to make sure that the lessons from The mind and body are inseparable,
research are used swiftly, effectively and and mental and physical health conditions
systematically to achieve better patient outcomes, are often connected.
improve public health and join up health and
care services for people with physical and The average life expectancy for someone with
mental health problems. a long-term mental health illness is much shorter
than for someone without, often due in part
By working together in this way, integrating to smoking, obesity, diabetes or alcohol misuse.
care across different organisations and sectors, Likewise, many people with long-term physical
we can not only improve the health of the people health conditions suffer from depression or
we care for, but we can also achieve better other mental health conditions.
value for money.
Despite this, health services separate care into
physical and mental and often fail to share
patient information.
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
At King’s Health Partners, we are working to n linking IT systems across our partner trusts
overcome these barriers by treating the whole so that clinicians have access to a person’s
person. We are committed to caring for vulnerable physical and mental care records
patients with both physical and mental ill health in
an integrated manner with better, faster diagnosis n investing in innovative programmes such
and treatment because we know that addressing as IMPARTS (Integrated Mental and Physical
mental ill health improves physical health Healthcare: Research, Training and Services)
outcomes and vice versa. and 3DfD (3 Dimensions of care for Diabetes)
Right across our partnership, we are committed n recognising the importance of employee
to joining up and delivering excellent mental mental and physical health and wellbeing.
and physical healthcare, research and education
so that we treat the whole person, by:
Public health
n screening all patients with chronic physical
diseases for mental health conditions, and Public health is one of our biggest challenges.
using the learning from this to improve At the root of much of the ill health in south
the care we provide London is a high incidence of smoking, alcohol
abuse and obesity. With our health and social
n improving our understanding of the physical care partners, we are developing strategies to
health needs of people with severe mental tackle these public health priorities. We are also
ill health developing plans for a new Institute for Urban
Population Health, a collaboration with local
n addressing the traditional distinctions partners to bring about transformational change
between the mind and body in research to health in local communities. We want to
and education, allowing us to train students achieve a measurable improvement and impact
and staff to deliver more integrated care on health gain and local management of physical
and mental health problems through new
n better organising and expanding current evidence based interventions.
training provision for physical and
psychiatric comorbidity
Alcohol strategy – key aims
n working with our local commissioners to find
new ways of paying for integrated services n developing appropriate resources for
clinical staff and patients
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
n developing and implementing training for smoking interventions, outcomes of
allstaff on harmful drinking, supporting early interventions, user satisfaction, prevalence of
identification and intervention smoking, cost-effectiveness of interventions.
n establishing ourselves as a centre of
Informatics
excellence for integrated research, training
and practice in the management and
prevention of alcohol misuse Informatics is at the heart of our plans to join
up care, research and education. Data is one
n attracting funding for future alcohol clinical, of our most important assets at King’s Health
training and research initiatives Partners. We are proud of our ability to control
information systems for the purpose of data
n monitoring the impact of the strategy creation, curation and analysis, with strong
on indicators of alcohol-related harm. and transparent information governance
processes throughout. This control enables our
exploration of the relationship between clinical
Tobacco strategy – key aims and biological data, extending at one end to
clinical decision support embedded in electronic
n supporting all clinical sites to be smoke-free medical records (EMRs), sharing of clinical data to
enhance care and outcomes, through to research
n developing an informatics structure for recruitment and participation, with strong patient
routinely and systematically recording engagement throughout. We have developed
smoking status a clear strategy and action plan to maintain and
develop leadership in the field of informatics.
n support, referrals and treatment uptake
for smoking cessation across the partnership Systems have been developed to enable electronic
healthcare records to be shared across our
n co-producing clinical care pathway partner organisations and with other healthcare
for nicotine dependence treatment organisations. Our work includes the award-
winning ‘MyHealthLocker’ programme, the Clinical
n developing and implementing training Record Interactive Search (CRIS) and King’s Health
packages for smoking cessation interventions Partners Online. We are working with patients
for all our healthcare professionals to make electronic patient information available
in an anonymised format between partner
n monitoring the impact of our smoking trusts, primary care and social care. Together
cessation strategy in relation to knowledge we have a powerful information resource for
and uptake of skills by staff, uptake of both practitioners and researchers.
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
Contents
Introduction 08
CAG leadership 11
Our aims, ambitions, priorities 12
Our pathways and services 14
Key achievements demonstrating the tripartite mission 16
Which outcomes do we use? 21
Anxiety care pathway 28
Recurrent affective disorders 47
Personality disorders 72
Engagement, Assessment and Stabilisation 86
Education and training 94
Staff satisfaction 96
Research income for the CAG 100
Publications 102
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King’s Health Partners | Mood, Anxiety and Personality Clinical Academic Group
Introduction
The Mood, Anxiety and Personality (MAP) CAG Services are provided for people living in Croydon,
provides a large range of services for people with Lambeth, Lewisham and Southwark and for
mood, anxiety, personality and trauma disorders; patients from around the country who need
including depression and self harm. According specialist care. We provide assessment in the
to the Psychiatric Morbidity Survey in 2007, the community, and treatment where patients can
proportion of people aged 16–64 meeting the access talking therapies and social care for self-
criteria for at least one common mental disorder help and problem-solving to intensive day services.
(CMD) increased between 1993 and 2000, but We also provide inpatient and outpatient services
did not change between 2000 and 2007 (15.5% for people who need more intensive treatment
in 1993, 17.5% in 2000, 17.6% in 2007). The and support.
largest increase in rate of CMD between 1993
and 2007 was observed in women aged 45–64,
among whom the rate rose by about a fifth.
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