Evaluation of Life Skills Pilot Programme

Report
Helping Men Live Life to the
Full
Liz Rafferty
WISH Programme Manager
Men and Depression
• 17 per 1000 for men 25 per 1000 for women
• Studies suggest that depression in men occurs as
often as in women but men are less likely to be
diagnosed with depression
• Men’s experience of depression is different to
women
• Men use different coping mechanisms - 3 x more
likely to be alcohol dependent and 2 x more likely
to be drug dependent
• Suicide is the most common cause of death in
young men under 35
Men and Help Seeking
• Reluctance by men to seek help in general whether
physical or for mental health issues
• Being in “therapy” is in conflict with traditional
attitudes to male role
• Men prefer less emotionally intrusive
interventions
• Men in most need of psychological help are least
likely to come forward
• Men respond similarly to therapy as women
Gender Sensitive Approach
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Pathways PCMHT in SW Glasgow
Short questionnaires 8 (31) practices x 100
71 returned
Youth Counselling Service & football complex
Nil returned
Made changes to publicity, groups available and
timings 32.1% (503) 2007 35.6% (659) 2010
Clinical Guidelines
Recommend CBT the main form of psychotherapy
offered
The Cognitive Behavioural Therapy
(CBT) Model
• What people believe
affects what they feel
• What people believe
affects what they do
• Name associated with
it is Aaron Beck.
Traditional CBT Model
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Expert practitioner
Face to face
1hr
Approximately 20 sessions
Clinic based
Access to CBT limited
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Few accredited/experts
Waiting lists in many areas
Scary to attend?
Embarrassing to attend?
Does the usual CBT model – 1:1, talking
about how we feel – fit how many men
want to work?
Issues about mental health
and men
• Stigma – label matters
• Access – location matters
• Focus – practical and here and now versus
emotions/past
• Choice – how you want/when you want to work
• Fit with life styles e.g. work/other commitments
• CBT can be delivered in different ways
Professor Chris Williams
Five Areas Approach
The Five Areas Model: impact of low mood
Life Situation, relationship, practical resources and
problems
Altered Thinking
Altered Feelings
Altered Physical
Symptoms
Altered
Behaviour
Evidence based ways
of delivering CBT
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Different sizes and shapes of CBT
Books (big/small) – can teach CBT
Online courses (cCBT)
DVD (LLTTF DVD)
With support:
– One to one support (telephone or email)
– Class based support
Other ways of accessing:
New www.llttf.com website (free)
Total registered users 136,434 Total Hits in in Nov 10 1,776,224
Who uses the site?
1,400
1,200
Count
1,000
800
600
400
200
0
SOMEONE
HEALTH
CARER/FRIEND VOLUNTARY
LOOKING FOR PRACTITIONER
PERSON
HELP FOR SELF
OTHER
The ratio of women to men using the site is 2/1
LLTTF Demographics
7%
5%1%
EMPLOYMENT
STATUS
8%
SCHOOL
EMPLOYED
STUDENT
9%
64%
6%
UNEMPLOYED
RETIRED
FULL TIME AT HOME
SELF - EMPLOYED
Are people receiving help?
• Only 32% of the individuals were currently seeing
a mental health practitioner
• 37% were taking medication for their mental
health difficulties
• Two thirds of the users are not receiving any
formal input from their health service
• Importantly, 24% of people who are definite
cases anxiety or depression are not seeing a
health care practitioner for help
Is LLTTF meeting unmet need?
Bar Chart
Depression or anxiety
case at HAD10
5,000
No case of anxiety or
depression
case of anxiety or
depression
Count
4,000
3,000
2,000
1,000
0
YES
NO
CURRENTLY SEEING SOMONE FOR MENTAL
HEALTH
The LLTTF Classes – easy,
accessible, effective, fun
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LLTTF – 8 sessions
1: Why do I feel so bad?
2: I can't be bothered doing anything
3. Why does everything always go wrong?
4: I'm not good enough: (low confidence)
5: How to fix almost everything
6: The things you do that mess you up
7: Are you strong enough to keep your temper?
8: 10 things you can do to help
you feel happier straight away
The WISH Programme and
associated projects
• Training : 3 Health Board areas
DAS: National delivery of LLTTFi
• AWARE: Northern Ireland LLTTF classes
Successfully working in partnership to build
capacity in local communities
DAS supporting LLTTFi
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Commenced in November 09
High quality cCBT site
Open referral across Scotland
Supported DAS support worker
6 sessions
Interactive
Activity summary of sessions
LLTTFi Session
Data
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96 participants
28 (29%) Male
68 (71%) Female
40 (42%) have completed course
Outcomes
Mean score
Shift in PHQ9 and GAD7 mean score for each
module for those completing LLTTFi
14
12
10
8
6
4
2
0
Mean PHQ9
Mean GAD7
1
2
3
4
Module number
5
6
Improvements in PHQ 9 & GAD 7
• Of those who complete all 6 modules 13
(86.7) achieved a 50% or more reduction
which is widely accepted as a measure of
clinical recovery
• Improvements are still evident in those who
complete 1-4 modules
Completion Rates for Men
• Number of men registering for LLTTFi are
no different from those taking up other
services BUT:
• 65% of men complete all six modules
compared to 51% of women
• 78% of men complete 3 or more modules
compared to 67% of women.
Comparison of Mean PHQ 9 for
Men and Women
Feedback from Men
• “The course is helping me think things
through and I’m coping better. I’m better
able to catch and stop negative thoughts”
(Student, 22yrs)
• “The online course with the follow up
phone calls is genius! It has helped me so
much and helped me get back to work”
(Teacher, 40yrs)
• The anxiety session was a real eye opener
for me. Thanks for your support it has been
a great resource. (Social Worker, 46yrs)
AWARE Evaluation
Dr Katrina Collins
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24 Men who have attended the LLTTF
Classes
Completed both pre and post evaluation
measures
Selected from different Health Boards across
Northern Ireland
Aware Defeat Depression
The 12-item General Health
Questionnaire - GHQ-12
1. Able to concentrate
2. Lost much sleep
3. Playing a useful part
4. Capable of making decisions
5. Under stress
6. Could not overcome difficulties
7. Enjoy normal activities
8. Can face up to problems
9. Feeling unhappy and depressed
10. Losing confidence
11. Thinking of self as worthless
12. Feeling reasonably happy
INSTRUCTIONS
We should like to
know if you have any
health problems and
how your health is at
the moment.
We want to know
about present and
recent complaints, not
those you had in the
past.
GHQ scores at the beginning
GHQ scores at the end
Summary of Results
• 13% in ‘Happy’ category at start
compared to 74% at end
• 69.6% in ‘Depressed’ category at the
start compared to 8.6% at end
• 17.4% in ‘Not Depressed’ at the start
and this percentage remained at 17.4
% at end
Aware Defeat Depression
Attendance rates
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n= 24 men
50% of the 24 men attended all sessions
29.1% attended all but one session
8.3% missed two sessions
Two men dropped out of the programme at
session 2
Participant feedback at end of
programme
Rated scores 1 (very poor) -7 (excellent)
Average was 6.4
100% would recommend the course to
a friend
Aware Defeat Depression
Understanding of stress and
low mood
Your ability to understand how low mood and stress affect you
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Your ability to plan activities to boost how you feel
Your ability to respond positively to your negative thinking
Your ability to plan ways to boost your confidence
Your ability to overcome practical problems in your life
Your ability to overcome unhelpful behaviours in your life that are
worsening how you feel
– Your ability to overcome problems of anger and irritability in your life
– Your ability to do things that make you feel happier and healthier
• Statistically significant increase in knowledge and understanding
about stress and low mood
Aware Defeat Depression
Participants Comments
• “Highly useful and good to meet others with
similar problems”
• “I have an understanding of factors that lead to
depression and ways to cope with it made me feel
better about myself”
• “This has led to a dramatic change on my outlook
in life and seeing a way forward and being
positive”
• “This has given me hope and the ability to change
and become more self-confident”
Additional Feedback
• What did you dislike about LLTTF?
“Stress caused by being out of my comfort
zone but had to be done”
• What would you like more of?
“More on temper and anger management”
Next steps
• Considering men only classes
• LLTTF online - ? Advertise for a men-only
“book club”
• Advertise LLTTFi with men in mind
• Partner with organisations working with
men
• Go where men are. Consider other settings
e.g. prison/younger people
Any questions?
www.llttf.com

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