This post was originally published on this site

@PAVOMH

Becka Williams, Project Manager, SilverCloud CBT

Last month I was pleased to accept an invitation to attend a Mental Health Partnership Board meeting at our Llandrindod offices, as it gave me the chance to find out more about the new online Cognitive Behavioural Therapy offering in Powys. It is called SilverCloud

Becka Williams, the Project Manager overseeing roll out of this new service across the county, gave us some background, an update on project progress and outlined plans for future development.It was an interesting session to learn more about the new service, as individual representatives attend this quarterly partnership meeting. The reps are people who either have used, or care for somebody who has used, mental health services in Powys. Their role is to make sure user/carer voice is included in the planning of services, and here they were able to voice some immediate thoughts about online CBT.

Joy Garfitt, Assistant Director of Mental Health Services for Powys Teaching Health Board, began by explaining that CBT is a therapy that can help us think differently, particularly if we have unhelpful thoughts.

Background

Some regular readers may remember that we wrote about an earlier provision of online CBT in Powys, which was called Beating the Blues. This 3 year pilot scheme was spearheaded by a European funded project called Mastermind, but unfortunately engagement with this model was not brilliant. Out of 543 referrals to Beating the Blues, only 100 people completed the full course. Many disengaged with the process and some did not even start after being referred. Mastermind’s key aim, however, was to implement online therapies in rural areas across Europe, rather than to monitor the effectiveness of the actual CBT programme. But the project was invaluable in that many lessons were taken from this early work to help inform a new improved provision of online CBT in Powys.

In fact, many benefits of online CBT were identified directly as a result of the Mastermind scheme:

  • Online CBT provides care closer to home – anytime, anywhere. 
  • It reduces the number of unnecessary appointments. 
  • It gives almost immediate access to therapy for people. 
  • It reduces the travel time of people using services, carers and healthcare professionals. 
  • It supports Prudent Healthcare – an approach at the heart of A Healthier Wales, the Welsh Government’s long-term plan for health and care. 

The Welsh Government is now providing funding to continue and upscale online CBT not just in Powys but across the length and breadth of Wales. Powys Teaching Health Board is leading on the roll-out of SilverCloud across the country, starting with Powys. The aim is to:

  • Increase options available to people experiencing mild / moderate anxiety and / or depression. 
  • Reduce waiting lists / times by improving quicker access to therapies. 
  • Improve equality of access to mental health care across both urban and rural areas.

Project progress 


SilverCloud online CBT went live in Powys on 1 May 2018. There are now 8 programmes available, including Space from Anxiety & Depression, Space from Stress and Space from Chronic Pain. Since the launch about 300 people have been referred to the programme, which can be accessed on smartphones and tablets as well as computers. Referrers can be GPs, Occupational Therapists, staff in the Community Mental Health, Local Primary Care and Long Term Conditions teams. In future people will be able to refer themselves onto the programme.At this point in the meeting the individual reps began asking questions about managing risk. What happens if someone is considering self-harming? If it’s midnight? If someone is extremely lonely and this is all they have been offered to deal with their depression or anxiety? Joy described the online CBT as “adding another tool in the box for people�. It might not be right for those wanting face-to-face talking therapy, but others may prefer to do it privately. It is not aimed at people experiencing severe and enduring mental health issues. If someone has complex needs they will be referred to a different service. They may still access SilverCloud CBT but as an additional therapy to enhance what is already being done by mental health practitioners working to provide care in primary (via GP services) and secondary (via Community Mental Health) teams.

From day one when people register on SilverCloud, they have access to all the programmes for 12 months. Staff closely monitor their engagement with the platform for 3 months, but people can provide feedback for the whole period. Risk alerts are set in place, so that if anyone expresses an intention to self-harm they are contacted straight away and referred to a health care professional as appropriate. The service is monitored between 9am – 5pm during the week, but details of support / help out-of-hours are provided. Online CBT is not designed as an emergency response service.

People can write in journals as part of the programme, and choose to share (or not) the content with the online CBT co-ordinator. Some online content, such as the Mindfulness videos, can be downloaded onto a computer for future use. If access to an online device is not available people can use computers with privacy screens at their local libraries and further options will be available at Job Centres ultimately. Regular online reviews take place with the co-ordinator, and phone conversations are also possible. The whole process is confidential unless policies around safeguarding issues and / or criminal intent are set in motion.



Future development

Work is currently underway to further develop some of the strands of the online CBT, including:

  • A combination of online CBT and face-to-face counselling, known as ‘blended’ counselling. The health board will be working with third sector organisations to provide additional support to some people using SilverCloud CBT. 
  • The self-referral model for those who do not see their GP or access any other help. This will be the first time in Powys that open access is given to such a service and should be available in the New Year. 

Whilst Welsh translation of relevant forms and help pages has already taken place, the platform as a whole now needs to be translated. The design and roll-out of an All-Wales SilverCloud online CBT platform is then the key next step.

And, importantly, Becka is very keen to receive feedback from people who have used SilverCloud CBT, to help inform future development of the online provision in Powys and further afield.

If you have used SilverCloud online CBT and would like to let us know what you think, you can email us at mentalhealth@pavo.org.uk Alternatively contact Becca Williams directly at becka.williams@wales.nhs.uk

And what are your thoughts on online CBT generally? Let us know in the comments box below.



Feedback about SilverCloud CBT 

I found SilverCloud very easy to use and was surprised at how well developed and 
researched the platform was. 
I have found SilverCloud hugely useful in teaching me ways to improve my mental health and managing stressful situations. I am excited to continue using the skills I’ve learnt. 
I have been feeling more positive since taking part in this programme. I have been able to do simple things like taking the bus and going for a walk alone a lot more easily than about a month ago.