2 October 2024

Mary McNicholas, Consultant Psychologist, conducted a Quality Improvement Project as part of the Management Fundamentals course held at Imperial College Business School.

The focus of the project was to improve access to secondary care services in Community Mental Health Hubs (CMHH) in Harrow.  She developed a bitesize Dialectal Behavioural Therapy (DBT) programme and with other staff members from the Harrow Community Mental Health Team (CMHT) and initiated a Young Adults Intervention Skills programme (YAI). The programme is to improve access to Harrow Community Health Hubs for 18-24 year olds, and to reduce admission to acute (inpatient) services.

In previous years, there have been difficulties in reaching this age group. More young adults were being admitted and treated in impatient settings as opposed to community settings. In order to understand the needs of the young adults, the community mental health teams worked closely with the Young Adults in the community to understand the barriers they experienced accessing mental health support.

Based on this feedback, they worked on ways to provide early access to community services. To do this, a multi-disciplinary support group (MDT) was put together which improved communication between the psychology team and other staff groups. The teams came together to create an eight-week intervention programme for the young adults. The programme was based around the National Institute for Health and Care (NICE) guidelines and DBT framework too.

Over the eight-weeks, the programme covered topics such as managing emotions and distress tolerance, mindfulness with virtual reality and using what is known as the ‘tree of life’ to set life goals. Behaviours to improve quality of life were introduced. This included social prescribing, employment specialists, and occupational therapy. The last week focused on personalising the service for young adults in a one-on-one setting based on their individual needs. To measure the helpfulness of the programme, the CHMT used a 5-point Likert scale based on questionnaires and surveys filled out by the young adults.

The programme received a lot of positive feedback from the young adults. On week two of the programme, one young adult mentioned that the tree of life session made them realise that “I have more good stuff in my life than I thought”. The new pathway provided a streamlined, integrated service for young adults, reducing the need for acute services. They also improved response times and the time taken to see a psychologist.

The intervention promotes collaborative working across multidisciplinary teams and third-sector agencies, demonstrating significant improvements in young adults' mental health outcomes.

On completion of the programme, 60% of young adults have been discharged to their GP, 20% have been discharged to family therapy, 15% discharged to psychology sessions and 5% discharged to the hub.

The success of the YAI programme has shown to be significant in improving young adults’ health. However, to continue improving the intervention, Pharmacy and Volunteering disciplines will join the intervention driven programme.