Knowledge into Action: Improving Mental Health of Stroke Survivors

1. Knowledge into Action: Improving Mental Health of Stroke Survivors “Community of Practice” Meeting February 2010 Maddy Halliday, Director Scotland, The Stroke Association

2. Knowledge into Action: Improving Mental Health of Stroke Survivors Meeting Aims: • To initiate a community of practice and develop a shared understanding of how it will work • Identify the knowledge-practice gaps the community will address • Plan next steps to apply knowledge to practice in these areas.

3. Mental Health and Stroke Meeting Programme 22 Feb. 2011 Meeting Programme 1.00-1.10 Introductions – getting to know each other 1.10-1.25 Background to meeting host and mental health and stroke (Maddy Halliday) 1.25-1.30 Questions 1.30-2.00 Knowledge into Action Through Communities of Practice (Ann Wales) Knowledge into Practice Gaps (Annette Thain)

4. Mental Health and Stroke Meeting Programme 22 Feb. 2011 Meeting Programme cont. 2.00-2.45 Prioritisation Exercise – 2 facilitated working groups 2.45 – 3.10 Break and refreshments 3.10- 3.50 Planning next steps )Annette Thain Working as a Community of Practice) and all 3.50- 4.00 Closing remarks – Maddy, Ann, all

5. Welcome and Introductions • Please turn to your neighbour on the right. • Please introduce yourself: share your name, where you live/work and the reason you are at the meeting. • Then I will invite each person in turn to introduce their colleague to the group!

6. Presentation Overview • Background on the meeting host: The Scottish Stroke Knowledge into Practice (SSKIP) Community • Background on mental health and stroke in Scotland: • the challenge • context • improvement opportunities

7. Scottish Stroke Knowledge into Practice (SSKIP) community This meeting today and future work is being hosted and supported through SSKIP, which is an initiative established and led by The Stroke Association in Scotland and NHS Education Scotland.

8. Scottish Stroke Knowledge into Practice (SSKIP) community cont. SSKIP Aim: To support improved quality of life and well being of stroke survivors and their unpaid carers.

9. Scottish Stroke Knowledge into Practice (SSKIP) community cont. SSKIP Objectives: • To facilitate improvements in rehabilitation and continuing care for stroke survivors (e.g. exercise after stroke, return to work; vision problems; mental health....) • To facilitate improvements to support provided to unpaid carers of stroke survivors. • To support effective involvement and influence of stroke survivors and carers (collective advocacy) • To facilitate effective networking and collaboration between all stakeholders

10. SSKIP: Activities

11. SSKIP: Website • Many of SSKIP’s activities will be supported by a SSKIP website, using a web resource provided by NHS Education Scotland. • The website will provide an easy access “portal” to a wide range of information on stroke and will also host the online aspect of a variety of special interest groups and communities of practice.

12. SSKIP: Website cont. • The website has been developed and will be launched for piloting in April 2011. • All papers and information relating to our work today and future work on mental health and stroke, will be available on the SSKIP website from April.

13. SSKIP: Special Interest Groups and Community of Practice • SSKIP is helping to set up and support a range of new special interest groups and communities of practice on priority stroke topics e.g. • arts and stroke • mental health and stroke • return to work after stroke

14. SSKIP: Special Interest Groups and Community of Practice cont. SSKIP will also provide a “hosting” facility for existing stroke topic networks which pre-date SSKIP e.g. • exercise after stroke • vision and stroke

15. SSKIP: Supporting Organisations In addition to the lead support provided by The Stroke Association and NHS Education Scotland, a wide range of other organisations are involved in setting up SSKIP and will be active in its future:

16. SSKIP: Supporting Organisations cont. • Care Organisations: Institute of Research in Social Services (IRISS), Social Care and Social Work Improvement Scotland (SCWIS previously Care Commission), Scottish Care

17. SSKIP: Supporting Organisations cont. • Professional Bodies – College of Occupational Therapists; Royal College of Physiotherapists, Scottish Stroke Research Network, and others • Voluntary Organisations – CHSS, WRVS and others

18. Mental Health and Stroke: The Challenge • Stroke is caused by a blockage in the blood vessels in the brain or bleeding in the brain. • It is most commonly linked to cardio-vascular problems (e.g. high blood pressure or heart disease) but also has other causes (e.g. malformation of blood vessels in the brain) • Risk of stroke increases with age but maintaining good cardio vascular health can significantly reduce the risk of stroke in many people.

19. Mental Health and Stroke: The Challenge cont. • Stroke is the third most common cause of death in Scotland. • 13,000 people have a stroke each year in Scotland, two thirds of whom will survive. • Stroke is the major cause of complex adult disability in Scotland as a result of brain damage. • There are an estimated 110,000 people living with the consequences of stroke in Scotland.

20. Mental Health and Stroke: The Challenge cont. • All stroke survivors are at increased risk of subsequent stroke. • At least half of stroke survivors will experience one or more permanent or long term impairment due to brain damage - e.g. movement, vision, thinking, feeling, communication. • About a third of stroke survivors will experience mental health difficulties, including depression and anxiety. (See Psychological Effects of Stroke published by The Stroke Association). http://www.stroke.org.uk/information/our_publications/factsheets/index.html

21. Mental Health and Stroke: The Challenge cont. Many stroke survivors say that despite their mental health difficulties, they struggle to get the support they need. (See Stroke Association UK Needs Survey Dec. 2010) http://www.stroke.org.uk/information/our_publications/other_material/index.html

22. Mental Health and Stroke: The Challenge cont. Research, consultation and feedback on mental health and stroke indicates there are significant challenges in terms of: • awareness and engagement • evidence of effective interventions • prevention – especially thinking problems (e.g. vascular dementia) • diagnosis, treatment and continuing support • resources (for research, treatment and support)

23. Stroke and Mental Health in Scotland: Context • In reviewing national policy on both stroke and mental health in Scotland there is little or no specific reference to stroke and mental health issues. • Although there is guidance on good practice from the Scottish Intercollegiate Guidance Network (SIGN) and there are some local specialist stroke mental health services.

24. Stroke and Mental Health in Scotland: Context cont. • Scottish Stroke Action Plan published 2009 - has no specific action for mental health problems following stroke http://www.scotland.gov.uk/Publications/2009/06/29102453/0 • Quality Improvement Scotland’s Clinical Standards for Stroke in an Acute Setting do not specifically mention mental health problems. http://www.nhshealthquality.org/nhsqis/6354.html

25. Stroke and Mental Health in Scotland: Context cont. The Scottish Intercollegiate Guidelines (SIGN) on Management and rehabilitation of people with stroke (No. 118, 2010) does include guidance on managing stroke patients with mood and emotional difficulties http://www.sign.ac.uk/guidelines/fulltext/118/index.html

26. Stroke and Mental Health in Scotland: Context cont. • Some NHS Boards and Stroke Managed Clinical Networks (MCNs) have established specialist stroke psychology services. • Several colleagues involved in these services are here today!

27. Stroke and Mental Health in Scotland: Context cont. • Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011 – does not mention stroke specifically although several sections are relevant to stroke and mental http://www.scotland.gov.uk/Topics/Health/health/mental-health/mhi • The Scottish Govt. Delivering for Mental Health (2006) sets out a range of actions which seek to improve mental health car for everyone with a mental health problem. This should benefit stroke survivors but stroke is not specifically mentioned (although dementia is). http://www.scotland.gov.uk/Topics/Health/health/mental-health/servicespolicy

28. Stroke and Mental Health in Scotland: Context cont. The government’s Mental Health Collaborative is supporting implementation mental health policy, with a focus on dementia care, depression, access to psychological therapies to and other issues. Improvements in these areas should assist stroke survivors but again, stroke is not mentioned. http://www.improvingnhsscotland.scot.nhs.uk/programmes/mental-health/Pages/About.aspx

29. Stroke and Mental Health in Scotland: Context cont. There is an NHS Scotland target for access to mental health services (HEAT target): 'Deliver faster access to mental health services by delivering 18 weeks referral to treatment for Psychological therapies from December 2014‘

30. Stroke and Mental Health in Scotland: Context cont. • The Government has funded a Psychological Interventions Team based within NHS Education Scotland which supports delivery of the HEAT target and other work on mental health, including evidence on therapies http://www.nes.scot.nhs.uk/disciplines/psychology • There is also a new Pan-Scotland Community Mental Health Service for People with Sensory Impairments . ..these developments may be beneficial to stroke survivors......

31. Stroke and Mental Health: useful developments outside Scotland The Dept. of Health for England’s Stroke Improvement Programme has extensive new guidance on psychological support following stroke including current knowledge: http://www.improvement.nhs.uk/stroke/NationalProjects1011/Psychologicaltherapy/tabid/177/Default.aspx

32. Stroke and Mental Health: useful developments outside Scotland The Royal College of Physicians and The British Psychological Society provide professional guidance and training on mental health after stroke: • Psychology concise guide for Stroke (2008) http://www.rcplondon.ac.uk/node/483 • Training in Psychological Coping Strategies Post Stroke http://www.bps.org.uk/bps-learning-centre/find-cpd/find-cpd_home.cfm?eventPageUUID=68710260-9B62-8C96-23AC-96ED9CD27763

33. Mental Health and Stroke in Scotland: Improvement Opportunities

34. Mental Health and Stroke in Scotland: Improvement Opportunities Prior to this meeting you all collectively identified a variety of improvement opportunities for mental health and stroke, which we are going to discuss in more detail soon.

35. Mental Health and Stroke in Scotland: Improvement Opportunities In future, once we have established this proposed mental health and stroke community of practice we can also consider how we might work together on some other activities to complement our practice improvement focus......

36. Mental Health and Stroke in Scotland: Improvement Opportunities For example we could..... .....Press for explicit reference to stroke and mental health issues in both stroke and mental health national policies and guidance in Scotland as this would help to increase awareness and engagement.

37. Mental Health and Stroke in Scotland: Improvement Opportunities ...and we could.... Support sharing of information on good practice in relation to stroke and mental health. We could do this through the SSKIP website.

38. Mental Health and Stroke in Scotland: Improvement Opportunities ...and we could..... Identify knowledge gaps in mental health and stroke and facilitate new research, collaborating with colleagues in the Organisation of Psychological Research in Stroke and others. http://www.bps.org.uk/dcp/useful-links/opsyris.cfm http://wfnr.co.uk/docs/special_psyris.html

39. Conclusion • Thank you for listening • Any questions before we move onto the rest of meeting .....?

40. Stroke helpline Website 0845 3033 100 www.stroke.org.uk