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Storyboard Entry Form 2014 Main author: Professor Ian Jones Email: [email protected] Telephone: 02920 688 399 1. Storyboard title: Bipolar Education Programme Cymru (BEP-Cymru): the development and delivery of a psychoeducation programme for bipolar disorder in Wales. 2. Brief outline of context: Where work was done – Wales and beyond Unit/department – Collaboration between the Cardiff and Vale University Health Board (UHB), Betsi Cadwaladr UHB and Cardiff University Staff/client groups – BEP-Cymru was developed by psychiatrists and community psychiatric nurses (CPNs) from Cardiff and Vale UHB and Betsi Cadwaladr UHB. It has been driven forward throughout Wales by a steering group made up of psychologists, CPNs, psychiatrists and user representatives. This ambitious project has been delivering psychoeducation to patients across Wales in both a group format and via a novel web-based delivery called BeatingBipolar.org. 3. Brief outline of problem: Problem - Medications are effective for bipolar disorder but NICE guidelines suggest they should always be combined with psychosocial interventions for maximum effect. Simple and effective interventions, such as psychoeducation should be made available in Wales. The lack of structured psychoeducational interventions for bipolar disorder within the NHS in Wales is a major issue for mental health professionals, many of whom would like to be able to deliver these interventions but find it difficult because of a focus on the management of severe crises. How tackled – This project provides two psychoeducational interventions for patients and a programme of clinician training on psychoeducation approaches. The patient interventions are (1) a 10 week course of group psychoeducation sessions and (2) a course of 8 interactive on-line psychoeducation modules (www.beatingbipolar.org). We have so far delivered 36 courses to 396 people across Wales covering all health board regions. Courses have been delivered in Aberdare, Bangor, Barry, Brecon, Caernarfon, Cardiff, Carmarthen, Denbigh, Llangefni, Llandudno, Newport, Pontypridd, Port Talbot, Swansea and Wrexham. Further 3250 people have accessed Beating Bipolar on-line. We delivered high quality training in bipolar psychoeducation to mental health staff so that this approach could reach as many patients and families as possible. At least 11 NHS trusts in England (e.g. Leicester, Devon, Oxford, Hereford, West London, Tees Esk and Wear, Brent, Sussex), 3 trusts in Northern Ireland (Northern Health and Social Care Trust, South Eastern Trust, Belfast Trust) and 2 in Scotland (NHS Forth Valley, NHS Greater Glasgow and Clyde) have delivered our programme. The BEP-C programme has also been delivered in New Zealand, and we have given BEPCymru training to over 60 psychiatrists in Turkey. How it affected patient/client care – Participants in both interventions have an improved awareness of their disorder, a better understanding of treatments and an ability to implement self-management techniques. Our psychoeducation training packages for clinicians are benefiting the NHS across the United Kingdom. 4. Assessment of problem and analysis of its causes: Problem – A lack of formal structured psychoeducation treatments for patients with bipolar disorder in Wales (despite NICE recommending that such interventions are effective, costeffective and should be widely available). Staff involvement – The programme has been developed by psychiatrists, CPNs and a project co-ordinator, along with considerable user input. We have been training mental health professionals to deliver psychoeducation approach across Wales. Cause of problem - Structured psychosocial interventions for bipolar disorder have not been a priority within the NHS despite the evidence for their effectiveness. Solutions/changes needed – Develop and deliver a comprehensive psychoeducation programme in Wales targeting patients and professionals. 5. Strategy for change: How the proposed change was implemented – We successfully applied for a £782k Big Lottery grant and implemented both group and online psychoeducation programmes in close collaboration with NHS services, Bipolar UK and user representatives. Clear client or staff group – Individuals with bipolar disorder, their families and mental health professionals who deliver care for bipolar patients across the NHS in Wales. How they disseminated the results of the analysis and plans for change to groups involved – We are raising awareness of these new interventions within our local Health Board and Boards across Wales through workshops, presentations and written reports to key clinical contacts. We have also developed two websites: www.ncmh.info/bepcymru and www.BeatingBipolar.org Timetable for change – Project has run over the past 4 1/2 years and we have plans to seek further funding to ensure continuation beyond the current grant ending in July 2014. 6. Measurement of improvement: A detailed qualitative analysis using standard thematic analysis techniques with 20 individuals following completion of the package showed that users felt benefits in terms of insight into their illness, health behaviour, personal routines and attitudes towards medication. Quantitative feedback from 240 individuals following completion of the programme indicated; 99% felt they had a good understanding of bipolar disorder, 97% would recommend the intervention to fellow-patients and 88% said they found group healthcare programmes such as this very helpful. 7. Effects of changes: Statement of the effects of the change – Patients have been positive about self-management capability. Clinicians feel this programme fills an important gap. How far these changes resolve the problem – We have clear evidence and feedback that BEP-C represents a valuable programme for patients, their families and professionals. How this improved care – Participants are more engaged with making decisions about their own care and with implementing self-management strategies. Clinicians are now using psychoeducational approaches. Problems encountered – The main focus of workload of mental health professional across Wales is on crisis management of severe mental illnesses and hence the take up of the programme by staff was not initially as widespread as we would have wished. However, over the period the programme has been running there has been considerable change observed with many staff around Wales now very active in referring clients to our service. We currently have a waiting list of 243 individuals. 8. Lessons learnt: Statement – We have learnt that there is a massive demand amongst service users for such approaches and when staff learn about our programme and experience their patients benefiting from attending our groups they give strong support. What would be done different next time – More intensive liaison with Health Board management to ensure more effective take up by mental health professionals. 9. Message for others: Psychoeducational approaches are very effective in engaging bipolar disorder sufferers with their illness and (as per NICE guidelines) should be offered alongside other treatments within the NHS in Wales. Clinicians in Wales are eager to have training in psychoeducational approaches so that they can deliver best possible care to their patients.