Looking back to see what’s ahead…
Andy MacFarlane, RMN
Director, Condition Management Partners
Introduction
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Variation in MH presentations
Aims of Condition Management
Description of a CMP service
Presentations of CMP customers
Evaluation & typical outcomes gradients
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Designing transition - PtW to WP framework
Marketing
Operations
Reflections
Variation in MH presentations –
drivers of service development
General Prison
Pop (1/4). Pop (3/4).
Severe &
enduring
Bipolar disorder
Psychosis/Schizophrenia
10%
10%
6%
36%
Common
Unipolar depressive disorders
Anxiety related disorder
Post-traumatic stress disorder
62%
15%
3%
45%
10%
3%
Sources: WHO + Justice dep’t
Aims of Condition Management
 Assist people to understand and manage their health condition via
learning CBT and increasing work-related functional activity
(education/training/volunteering/part-time work/full time work).
 Reduce psychological distress, improve mood, reduce anxiety,
overcome pain and fatigue, adapt to changes in level of functioning
(mental and/or physical).
 Improve self efficacy, shift locus-of-control from external to internal.
 It can be delivered as voluntary or mandatory activity under
employment programmes, but is limited to those with common
health conditions
CMP
 It is not a quick-fix/cure all (3 month – 2 year improvements
gradient)
 It is aimed at a common MH problems (and physical problems)
 It sees a high volume of throughput, and offers clinical expertise at
greatly reduced costing by co-locating clinical specialists within
existing employment services
 It is strictly time-limited, but it is also highly individualised for the
person
 Requires clinical expertise and rigorous following of methodology
(beware those selling snake oil…)
CMP
 Initial contact & one-to-one engagement interview
 CMP programme – 5 sessions – group based
 Biopsychosocial approach + Therapeutic Interventions - CBT, SFBT,
MI – all evidence-based interventions (RCT evidence & nice
guidelines)
 Differ from NHS/GP/IAPT – work-related focus (and outcomes)
 Offer employment adviser training in dealing with people who have
health problems, and also individual support with signposting and/or
liaison for customers with appropriate local health services
Health Conditions & Problems
 Common Mental health (depression, stress & anxiety)
 Musculoskeletal (neck, back, joint problems, RSI, arthritis,
trauma)
 Cardiopulmonary (CHD, Asthma, COPD, Heart attack,
hypertension, angina)
 Neurological (TIA, Stroke, Epilepsy, Parkinson's disease)
 Other (diabetes, chronic fatigue/ME, fibromyalgia)
 General lifestyle (obesity, smoking, poor exercise tolerance)
Evaluation Methods - quantitative
 Measures completed pre and post CMP group - also at 3 month &
2year follow-up:
CORE-OM (Barkham et al, 2005)
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Work and Social Adjustment Scale (Mundt et al, 2002)
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Intrinsic Motivation Scale (Hackman & Lawler, 1971)
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General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995)
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Employment status at 3 months and at 2 years
Psychological Distress
3 months to 2 year
Greater
psychological
distress
24
22
CORE-OM Score
20
Remained on
benefits
18
Steps to work
16
14
Returned To work
Lower
psychological
distress
12
10
Intervention
Perceived Disability and Occupational
Response 3 months to 2 year
Greater
perceived
disability
28
Perceived Disability Scores
26
Lower
perceived
disability
24
Remain on benefits
22
20
18
Steps to Work
16
14
Return To work
12
10
Intervention
Designing the Transition of a service
from NHS to WP Framework provision
 We put together an offer based on very stringent
budgetary constraints (unit costs are roughly a
quarter of same service commissioned by
DWP/NHS under PtW)
 Total co-location model reduced costs
 Flexible staffing model reduced costs
(both based on Australasian model of services)
Marketing… Meeting #1
 V. large prime, with V. deep pockets…
 “We need exactly what you are offering.
It's a perfect fit with our delivery model,
and we’d be only too happy to have you
aboard…”
 “All you need to do is find a way deliver it
at no cost to us whatsoever.”
Marketing… Meeting #2
 Smaller prime, much shallower pockets.
 We need exactly what you are offering it's
a perfect fit with our delivery model, and
we’d be happy to have you aboard…
 Here is an annual budget for the service…
Now please tell us how you can use it to
deliver whatever you think will work…
Operations… Meeting #1
 Costs double what we are used to paying front line staff!!
 Tell you what… You train our staff up, then they can just
do whatever it is you do for half the price…
(took a good year to train many of them to just differentiate
common MH condition customers – then high attrition of
staff meant we had to start again almost from scratch)
 Cost of experienced well trained health professional staff
who are qualified and experienced enough able to actually
deliver this stuff is what it is. Just the going rate we have
to pay to get staff.
Operations… Delivery
 Initial belief.. For those with health conditions, we can just continue
to do what we have always done with other customer groups and it
will work just as well for them, as it always does for everyone else…
 CMP know that’s not how it works… Barriers related to health are
complex and multi-faceted - and CMP say so.
 3 years later, everyone is beginning to realise that’s not how it works
(Separate health provision framework for employment related
services, anyone?)
 Framework doesn’t actually matter - outcomes can be achieved what matters is provision of right service for particular grouping of
needs, and getting the right mix of people in to do it.
Reflections on Framework/Services
 There are genuine opportunities to put together
innovative packages of outcome-based assistance and
support using partnership models of delivery.
 We need to access and pull together the pockets of
existing expertise (these models are not generally
available in mainstream health).
 We need to stick to replicating the evidence-based
methodologies – utility already tested, and proven.
 It can be done cost effectively, results can be achieved,
but it’s not that easy, and it cannot be done for nothing.