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Type and Title of Submission


Title:

'Living with changeable moods' : a psychoeducation program for older people with bi-polar disorder.

Description:

A nine week psychoeducation program was developed to support older people who live with Bipolar disorder. Running alongside this is an ongoing monthly support group for those who have attended the course to offer support and self management of changeable moods

Category:

Clinical

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG38 - Bipolar disorder

Category(s) that most closely reflects the nature of the submission:

Service development

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

The aim of the group is to help prevent the need for admissions, lessen the disruption caused by mood changes and strengthen people's ability to cope with changing moods.

Objectives

1. To up skill the staff and enable them to deliver the intervention. 2. To set up a 9 week psycho-education program to support older people who live with Bi-Polar disorder. To set up an ongoing monthly support group for those who have attended the course to offer support and self management of changeable moods. 3. To explore the potential for rolling out across other services for older people within the organisation

Context

The impact of severe mood changes can be profound, leading to people requiring in-patient admissions at times of crisis. It was identified that no specific intervention existed for older people with bi-polar disorder. Through a process of group learning and group support, people are able to form a self supporting network through which they learn about triggers to mood changes, warning signs and develop strategies to enhance wellness and continue living in the community. Adaptations to the model of psychoeducation were needed making the program address specific issues commonly arising in old age such as loss, bereavement, social isolation and age related physical changes. The program is based on research demonstrating the efficacy of psychoeducation for people who experience bipolar disorder (Colom and Lam 2005; Grabski et al 2007). The intervention has been shown to be clinically effective in randomized control trials and has recently been subjected to a systematic review (Beyon 2008). Outcomes include an increase in client awareness of changes in mood, greater understanding of why changes occur, relapse prevention and an increase in maintaining a healthy lifestyle as a protective factor against mood changes (Colom et al 2003; Otto et al 2003). The program aims to prevent relapses and enhance a person's wellbeing and ability to manage changing moods. The courses follows the structure of the Barcelona Program (Basco 2006; Colom and Vieta 2006). The staff facilitator drew on her clinical experience of working with older people to adapt the pace and the focus of the sessions ensuring that the course addresses experiences living with bipolar in relation to factors which accompany aging.

Methods

1. The project was developed over 6 months. An action learning process was used to support the nurse developing the program. The Lecturer Practitioner provided theoretical and clinical research material. The program was developed in collaboration with the multi-professional team and through discussion with those who would receive the service. The team leader had already established an ongoing practice development process. This provided the infrastructure which supported the development of practice and initiatives from individuals within the team. 2. Resources were collated and the overall structure of the program was prepared. Topics include: understanding mood changes, using a mood diary, recognising triggers, strategies to stay well, problem solving and managing a change in mood, involving your family and others, strengthening wellness through community activities. Community mental health teams and outpatient clinics were made aware of the intervention and made referrals to the group. Clinicians were invited to a presentation about the program. The first group ran in ( November 2006) and the ongoing support group was established in January 2007. A second group ran from March to April 2007. The monthly support group started in June 2008. 3. The nurse presented the program to other clinical staff providing day services across the county. This was done through an in-house educational program running to support day services staff in adapting to New Ways of Working and developing day services. (Department of Health 2007). By presenting her work, other staff now wish to establish similar programs and enable the intervention to be available across the whole county. The initiative is currently only delivered in one part of West Sussex. The program will be developed across West Sussex as part of the Older Persons Mental Health Directorate action plan for 2008/9. This could also be spread to two other sectors within the Trust covering East Sussex.

Results and evaluation

The outcomes of this group have not been formally or empirically evaluated. Ongoing evaluation and reflection on practice has occurred throughout. Practitioners evaluated the group through team supervision and peer review of the process and content. Service users evaluated the course at the end and were asked to identify what changes had occurred as a result. Participants have told us that they have a better idea of what can trigger off an episode of being unwell and have dealt with situations more positively; e.g. becoming more assertive, identifying anniversaries or times in the year that are more difficult to manage. Three of the first group participants used to be regularly admitted to hospital but have managed to avoid admissions since attending the group and support sessions. The total number of people who have undergone the program is nine. There was initially some concern that there would be insufficient numbers for a group. However, once clinical staff were aware of the program the numbers of referral increased. When compared to other parts of the county, a larger number of people with bi-polar are being supported where the group exists. This indicates that the program offers a new service which was not in place before. A total of nine people have attended the program and the majority of these have maintained contact through the support group. It is thought that this may be important in relapse prevention and early recognition of changes which may have led to an admission in the past.

Key learning points

1. Following feedback from service users who attended the first group, adaptations to the program were made. The service users recommended that the program strengthened the focus on staying well and valued the opportunity to share experiences, thoughts and coping strategies with others by continuing to meet on a regular basis. They also advised that the monthly support meetings could be used to follow up some of the themes in the program. They have requested speakers about medication, relaxation techniques and the relationship between food and mood, cognitive behaviourial therapy and the benefits of complementary therapies . 2. The nurse presented the program to other clinical staff that provide day services in other parts of the county. This was done through an in-house educational program which was running to support day services staff in adapting to New Ways of Working and developing day services. (Department of Health 2007). By presenting her work, other staff now wish to establish similar programs and enable the intervention to be available across the whole county. 3. It is hoped that the role of a service user as a co-facilitator of the psychoeducation program can develop. Striving towards greater service user involvement in the facilitation of the program opens up other possibilities such as joint authorship and co-presentation of the program.

Contact Details

Name:Wendy Harlow
Job Title:NICE & SCIE Implementation Facilitator
Organisation:Sussex Partnership NHS Foundation Trust
Address:Aldrington House, 35 New Church Road
Town:Hove
County:East Sussex
Postcode:BN3 4AG
Phone:01273716585
Email:wendy.harlow@sussexpartnership.nhs.uk

 

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This page was last updated: 29 September 2008

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.