Shared learning database
Type and Title of Submission
A self directed anxiety support group for older peopleDescription:
We describe why we developed a structured anxiety management programme for over older people, how we planned and implemented it and some of the key outcomes which were apparent in the short termCategory:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG22 - AnxietyCategory(s) that most closely reflects the nature of the submission:
Description of submission
The aim is to provide a forum and a structured anxiety management programme which: - avoids social exclusion of older people with anxiety - facilitates clients' recovery - operates within a cohesive structure within which clients can work - works in partnership with other services, and - strengthens clients confidence in social networking and encourages links with community agencies to gives them access to local resources. - Operates within existing resourcesObjectives
1) Identify and provide appropriate resources such as facilitators, venue, refreshments and support materials 2) Identify appropriate and evidence based anxiety management course, 3) Develop protocols such as, operational policy, Facilitator skills assessment, description and programme of the group and evaluation/ monitoring criteria, referral and access criteria.Context
Anxiety and depression are highlighted as a priority area for older persons mental health (Lenze et al 2005; Age Concern 2007).The anxiety management intervention uses a theoretical and evidence base. Including use of a model of stress (Lazarus and Folkman) and an approach informed by Cognitive Behavioural principles to help clients understand and change their responses to Anxiety (Grant 2004). It includes challenging negative thoughts/beliefs and aims to help clients use problem solving (Dowrick et al 2000).The group uses principles of social learning aimed at individuals building their sense of self efficacy and self esteem (Bandura 1997). Using these approaches people are encouraged to build social networks and engage in activities outside mental health services to combat isolation (Phillipson 2001; Mind 2004). The facilitators of the group use a psycho-education approach to encourage self managed care (Gilbody 2008). Assessed need within the 65+ community for service users to learn techniques in self management of anxiety and depression and found that many older people do suffer from these problems but don't engage with programmes which have shown to be effective. Case loads suggested similarities in problems of clients. In addition, many relied heavily on medication and had regular contacts with primary care and mental health services. Rather than keep our clients in the 'sick' role with the experts, assisting them to recovery, it would be better to support and enable them in self-directed recovery. We encouraged clients to meet in small groups (4 to 8) where the facilitators were in the minority. The evidence suggests that sessions such as this can improve the quality of life of the individual and be cost effective in reducing clinical contacts with mental health workers and primary care. No additional funds were available for developing this service, two community psychiatric nurses (1 FTE) adapted their ways of working to implement the initiative.Methods
1) Two Psychiatric community nurses provided an eight week programme for 8 people using existing staff resources. Negotiated use of a room in a local day centre. Engaged multidisciplinary facilitators, e.g., Occupational therapists; service user consultants. Provided support materials such as information sheets produced nationally and locally and offered refreshments. 2) The course is an Anxiety and Depression Management Group which uses resources from various documents in the evidence base and which we named 'Can Do, Will Do' Wrote and agreed operational policy, facilitator skills assessment and evaluation/ audit programme for the intervention. 3) Reduced the number of clinical contacts with primary care and mental health staff.Results and evaluation
We monitored attendance, contacted and followed up anyone who failed to attend. We noted that on the whole mental health workers received less phone calls from clients attending our group. Evaluation forms were given out in the last session and the overall course discussed. As a result of this feed back changes were made to subsequent groups. We dropped the least popular item(s) and devoted more time to the areas that were felt to be most beneficial.Key learning points
We felt that crucial to the success of these groups was the concept of equality of experience. Having experienced anxiety and depression ourselves, we were able to emphasize our commonality. We were not 'the experts'. In this we recognize the concept of 'the expert patient', already recognized and adopted in many surgeries
View the supporting material
|Job Title:||NICE & SCIE Implementation Facilitator|
|Organisation:||Sussex Partnership NHS Foundation Trust|
|Address:||Aldrington House, 35, New Church Road|
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This page was last updated: 03 October 2008