Intensive Support Programme

Developing a therapeutic service across the acute care pathway, based at Woodhaven, that engaged me between 2004 and 2012 came to an abrupt halt in July 2012 with the closure of the Unit as part of the re-organisation of services in the Trust. This also put an end, when first raised in 2010, to plans to secure funding to evaluate the model properly across two hospitals in the Trust (Southampton and Woodhaven) that were using it.

However, the approach was recognised as valuable as a response to reduced bed capacity and the Intensive Support Programme (ISP) is a project to embed it in acute services across the Trust which I am leading (August 2012 – February 2013). The intention is to publish the evaluation of the project. The rationale for the project follows.

In order to maintain quality of service with less resources, we need to engage our service users in active partnership with psychological as well as medical treatment. This will often mean giving a different message to service users from the one they are used to. This will be hard at first – but much easier to take on board if the same message comes from everyone.
It is a message of hope; they will be helped to understand and do something for themselves about their situation, their distress.
It is also a tough message. Without their active participation, there is a limit to what we can do.
Risk will remain a reality – but without active, positive, risk taking that develops responsibility, the service can in fact perpetuate risk.
We need everyone in the service to be a partner in therapy oriented treatment. We need them to understand the approach; to support it in their interactions with service users. Everyone, including therapists, encourages people to follow their medical treatment plans and to take their medication as prescribed. We need the same universal commitment to psychological treatment so that it becomes integral to care.

Implementation Stages.

1. Training will be offered to all acute staff to start this new direction for the Acute Services: By introducing the simple but radical ideas on which it is based – ideas which have informed a service on a small scale, and been evaluated and published.
   • By introducing the skills of creating a collaborative, partnership, relationship with service users that underpins this way of working.
   • By introducing the programmes that are designed to support service users in approaching their mental health in the new way – with the opportunity to learn more and participate in their delivery in the future if that is of interest to the individual.
   • By allowing space for discussion of the initiatives - its challenges, its strengths and the support that you will need to help make it a reality.
2. Training in emotion focused formulation for all acute service psychologists and other therapists.
3. Recruitment of an assistant to help the lead psychologist to develop the psychological approach, group and individual in the four participating teams across the Trust.
4. Development of ISP care plans and virtual team data collection, including evaluation data (Mental Health Confidence Scale) in order to embed the approach into MDT care review, CPA and nursing practice.
5. Data collection and writing up for publication.

A training programme with a similar model is being delivered to Step 2 and 3 IAPT practitioners in Hampshire (i-talk) to enable Step 2 to identify and manage interactions with people presenting with complex trauma, and at Step 3 to assess this group for motivation and treat if appropriate (i.e. incipient personality disorder, not requiring Step 4).