As an occupational therapist by trade, Alex Roger knows the benefits of supporting patients to recover at home better than most. “When people are left in their own environment, there’s much more opportunity for them to thrive again than there is if you take all of that away and you put them in a clinical space,” she says. “We’re all a product of our environment, from the families we’ve grown up in, the communities we’re part of … Our social network isn’t just about immediate family and friends, it’s your neighbours, the local shop you go to, knowing the shape of the trees near your house.
“If you remove someone from all of that familiarity, all of that softness, all of that support … they are never going to recover [as well as] they will do if they’re around that supportive environment.”
That ethos is at the core of the IAPT (improving access to psychological therapies) and primary care services, where Roger works as the operational lead at South West London and St George’s Mental Health NHS Trust. It’s a broad remit that covers Wandsworth, Sutton and Merton boroughs, with a team of more than 180 psychologists, nurses, wellbeing practitioners, occupational therapists and more.
With one in four people experiencing some form of mental illness over the course of a year, the IAPT initiative was introduced in 2008 by NHS England, aiming to improve the public’s access to talking therapies, particularly for those suffering from anxiety and depression. IAPT groups will cover subjects such as mood management, overcoming worry, mindfulness, depression, social phobia, and stress. In August 2019 alone, more than 2,000 people were referred to IAPT services across Roger’s three boroughs (including self referrals, which is possible via the services’ website).
“It’s great to see the impact you’re making,” says Roger about the service. “This is about early intervention … Rather than people waiting to get a clinical diagnosis, we’re trying to get in before that point and say: ‘OK, you’re slipping down the road a bit, we’ve got this workshop you can attend – we’ve got some really simple tools you can adopt that should support you.’”
Rising targets from NHS England (by January 2020, the team will need to have contact with 22% of people living with a mental health condition across the three boroughs), has meant diversifying the team’s offering. Less formal wellbeing workshops, offering help with self-confidence and assertiveness, sleep, self-care and relaxation, for example, are run in collaboration with local charities and other organisations, in venues as diverse as food banks, mosques, Citizens Advice offices, and libraries. There are also out-of-hours clinics, with extended opening hours, to make them as accessible as possible. The feedback so far has been very positive, with users praising the “extremely useful information and techniques”, and in some cases, describing attending as a “life-changing experience”.
Early intervention is something care coordinator Rachel Kitts understands the importance of. She’s part of the first episode psychosis team for Sutton and Merton, providing bespoke support to outpatients for up to two years. “It’s quite an assertive role,” she says. “The research shows the more intervention that’s provided at an early stage of psychosis, the better the outcome.” A typical day might involve meeting five or six clients, talking through their treatment plans and their progress. “If someone is too paranoid to leave the home, then I might ask the recovery support worker to do some graded exposure to get back on to public transport, for example,” she says.
She has worked at the NHS for 30 years but says this has been the most hopeful job she’s had. She has seen patients with psychosis triggered by taking drugs, or by stress, or by family genetics – so many of these people are doing amazingly well and have gone on to achieve professional qualifications and personal goals. “If they engage with us and take medication and have psychology and do something within their day – because often their function stops because of the psychosis – they get better. And that for me has been the thing that drives me,” she adds.
Associate clinical director (ACD) for Wandsworth, Jo Turner, one of three ACDs overseeing consultants that work in community services, agrees that the relationships you develop with patients and their families is one of the best things about the job. “I’ve known patients who spent years going in and out of crises,” says Turner, who also works as a clinical psychiatrist. “[They have] sometimes spent long periods in hospital, but are now living independently and working as peer supporters, helping others.”
It’s a busy role, that can be “stressful but never dull”, and Turner enjoys the variety. She’ll meet with the team to discuss patients that are relapsing or are in crisis, work in the outpatient clinic, supervise juniors, and speak to GPs at a surgery aligned with the team, something she describes as “great for collaborative working”. Making patient pathways as user-friendly as possible is always front of mind, and the service is about to embark on a community transformation programme. “The aim is to avoid unnecessary repetition of assessments, reducing delays in accessing treatment and minimising inconsistencies between the five boroughs (Kingston, Richmond, Merton, Sutton and Wandsworth),” she says. Prioritising staff wellbeing will also play a part, with workloads reviewed and a focus on creating posts “which are both rewarding and sustainable”, she adds.
For Roger, whose work and team continues to expand, the benefit of working in community services is “being able to affect change. Being at the forefront of the mental health agenda, driving forward services to be much more proactive in how they support communities rather than a reactive jerk that comes with the crisis end. If we get this right, we can help to really make a difference”.
Find out more at swlstg.nhs.uk
