Organisation name: Cumbria Partnership NHS Foundation Trust, Department of Psychotherapy and Itinerant Therapeutic Community (ITC) Contact name:Dr Mike Rigby Job title:Clinical Lead, Consultant Psychiatrist in Psychotherapy Email: mike.rigby@cumbria.nhs.uk Telephone contact: 01228 603134
Any links to web pages or
sites giving further information about your initiative?
itc4u.org (unfortunately only
the home page can be viewed as the site is password protected for use only of
service user members and staff of the therapeutic community).
This project started life in North Cumbria in March 2005 as one of the pilots in the Department of Health National Programme for the Development of Services for People with Personality Disorders. It is now in transition to being commissioned locally to serve the whole of Cumbria. It offers a comprehensive blend of outreach work, staff training, formal psychotherapies, and a ‘mini' therapeutic community with a dedicated website, to help service users (SUs) with personality disorders and related complex mental health problems.
Our SUs frequently present in crisis, at high risk to themselves and sometimes to others, and may be difficult to engage in treatment. The anxieties raised by their problems often draw many professionals into contact with them from a whole range of services including mental and acute health and social services, general practice, police and probation. However, this care is often poorly-coordinated and communication between professionals may be compromised reflecting and sometimes compounding SUs' difficulties. Geography further exacerbates these problems: Cumbria is vast but sparsely populated with widely-spaced urban and rural communities.
The problem of offering meaningful treatment, while also providing safety between face to face sessions, was particularly acute for those SUs seen in our 'democratic analytic' therapeutic community. It meets two days each week, the work requiring SUs to take considerable responsibility for each other's difficulties, effectively running the unit in conjunction with staff members as part of their treatment.
What was needed was a 'service user led network of out of hours care', but this could not take the form seen in urban therapeutic communities (which might involve direct support) because of the distances involved. The solution was 'P2P'*, an internet-based support network, jointly developed by the pilot service, NIMHE NW and Xenzone Internet Technologies.
P2P enshrines therapeutic community principles and its format and conditions of use ensure a safe group response as an alternative to use of the professional network. However, while ostensibly a support network it also extends the learning opportunities available to members. A number of service user only support boards are in operation including a real time chatroom. The latter is for use both in a crisis or if particularly difficult problems can be foreseen. The site is operated and moderated by elected SU members of the community who employ a sophisticated system of feedback in order that online exchanges which raise significant concerns are communicated to staff members.
Service users provide training in use of the site for new members of the community as part of their induction. A low cost scheme (£10 for a computer, keyboard and monitor) is provided by the trust's IT department for those service users who do not have personal access to the internet.
The site has been successful in containing difficulties in the times outside the treatment programme allowing highly challenging and cost effective work to proceed unimpeded during the therapeutic days.
The service received a BT Health Insider Award in October 2009 winning in the category ‘Best use of IM & T to Promote Patient Safety'
What have been the benefits for individual service users (and others) accessing your project?
In the first year of operation of the service:
- Suicide attempts fell by 69%
- Self-harm incidents fell by 48%
- Admissions to Casualty fell by 80%
- Admissions to psychiatric hospital fell by 50%
- Days our service users spent as inpatients in psychiatric hospital fell by 90%
- Contact with the police fell by 70%.
These outcomes are the outward manifestations of improved capacities of service users to reflect on their own behaviour and to be better able to manage disturbing feelings and impulses, both in themselves and through better relationships with peers, carers and professionals.
Are you considering any future developments in response to the ‘Personalisation' agenda?
The service pioneered the employment of an ‘expert by experience' (XBX), a service user who had completed treatment and worked generically with staff members in the therapeutic community and department. Our first XBX was particularly active in developing the website. We now employ three consultant service users, all of whom have been members of the programme, who are active within the TC, department and Trust working generically as clinicians, teaching, involved in data collection and promotion of the work of the department. We would like to further develop these roles. In addition, we would like to develop the website to allow interaction between visitors to the website, who may be curious about the programme and wish to know more, and our service users.