Reasons to implement this service
Rapid Access
Due to the time limited, brief nature of these interventions, throughput is higher than for other types of intervention, resulting in smaller or no waiting lists
Patients learning New Skills
The interventions are designed to provide patients with lifelong skills to detect and react appropriately to patterns of negative thinking thus lessening the likelihood of repeated episodes of distress.
Evidenced Based Treatment
The National Institute for Clinical Excellence cites Cognitive Behavioural Therapy ( CBT), upon which these interventions are based, as one of the appropriate treatments/interventions for depressive symptoms
The approaches recommended in this guide are derived from CBT but are not full CBT; however the data collected during the Doing Well Programme suggests that these 'adapted' treatments can be effective and have been well received by patients with mild to moderate psychological problems.
Appropriate Level of treatment (secondary care treatment often not required)
Not only does this service reduce the stigma associated with attending secondary mental health services (and potentially therefore reducing DNAs), the care is delivered close to the patient's home and does not over-medicalise the condition.
Frees up GP time
An increasing number of consultations ( WHO estimate that this is around one in three consultations) have a mental health component, usually depression/anxiety. People who present with such symptoms tend to have multiple visits to their GP which impacts on GP time available overall. During the Doing Well Programme some of the pilot sites asked participating GPs the question "What action would you have taken if the self-help service had not been available". The results are shown in figure 1 below
Figure 1
NHS Dumfries & Galloway, NHS Borders and NHS Grampian asked referring GPs to indicate how they would have referred the patient had the new services not been available.
NB - Responses received were not mutually exclusive.
It can be clearly seen that access to the supported self-help services made a significant saving to both GP time from repeated consultations with the patient and referral to secondary services.
It should be noted however that self-help approaches do not suit everyone particularly those that are feeling suicidal and in this case referral to a specialist care service should be made. Consideration may be given to the individual's willingness to work in this way and their levels of motivation, concentration and energy at that time. Where self help is unsuitable, alternative approaches should be offered that are better matched to the patient's needs.
Evaluation Report
Evaluation Report (click on the link to access the report)
The Doing Well By People with Depression Programme was subject to an independent evaluation conducted by a consortium led by the Scottish Development Centre for Mental Health and various Scottish universities. The resulting report highlighted a number of key considerations and recommendations for policy, service and practice development. In addition, the report contains data on various aspects of the programme, which is a valuable step towards measuring what works in mental health services.