Living Life to the Full – Can it reach people currently not engaged in the Clinical Services

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Home / Case Studies / Living Life to the Full – Can it reach people currently not engaged in the Clinical Services

Liz Rafferty

START Lead

Submitted Date: 06/04/2011

Review Date: 08/05/2009

Overview

An online life skills resource which aims to empower users by providing information to help cope with problems, such as low mood and anxiety.

Local Area

National

Care Setting

Care Group

Evidence Base for Practice

The Living Life to the Full website offers an additional avenue to an evidenced based psychological intervention as advocated within many recent guidelines and policies. Web based and computerised interventions are also gathering a body of evidence to support them being used within stepped care approaches.

de Graf, E., Gerhards, S., Evers, S., Arntz, A., Riper, H., Severens, J., Widdershoven, G., Metsemakers, J., Huibers, M. (2008). Clinical and cost-effectiveness of computerized cognitive behavioural therapy for depression in primary care: design of a randomized trial. Biomed Central Journals, 8:224, p4.

Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S., Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, Vol 37 (09), 1217-1228.

Hunt , S ., Howells, E., Stapleton, B (2006). The Addition of a Computerised Cognitive Behavioural Therapy Programme, to Stepped Care, Primary Care Mental Health Service. The Journal of Primary Care Mental Health Service. 9, 2, 34-38.

NHS Education Scotland (NES) (2007). Increasing the Availability of Evidence-Based Psychological Therapies in Scotland.
http://www.nes.scot.nhs.uk/mentalhealth/publications/documents/NESPhase1TrainingPlan.doc

National Institute of Clinical Excellence (NICE) (2005). Guidance on the use of computerised cognitive behavioural therapy for anxiety and depression. Technology Appraisal Guideline No. 51 (Review). http://www.nice.org.uk/pdf/51_CCBT_Full_guideline.pdf

Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D., Goldberg, D., Mann, A., Tylee, A., Marks, I., Gray, J. (2004). Clinical effectiveness of computerised cognitive behavioural therapy for anxiety and depression in primary care. British Journal of Psychiatry, 185, 46-54.

SIGN (2008). Draft Non-pharmacological management of mild to moderate depression a national guideline. Edinburgh SIGN.

Quality assurance/impact of practice

An audit of a sample of all persons who had registered with LLTTF between 16 January 2006 and 15 January 2007 was conducted in order to describe the population accessing the website. People were excluded if they failed to log on to the website once registered. Duplicates were eliminated in order of date registered - only the first date is being included. Only persons accessing the website for personal use where included (86.1% - 10689 of 12413 registrants.

Overall 65.4 % of users are female and 69.6 % between 17– 44 years of age. Only 1.6% was > 65 years of age. Of persons using the website for personal use, 79.6% (8504) experienced either clinically significant anxiety or depression using a cut-off of 10 for each on the HADS. Of these cases, 55.3% were not seeing anyone for mental health treatment, and similarly 52.8% were not currently taking any medication for psychiatric purposes. Overall, 25% were using self-help books and 54.3% described using other resources (not including video, tape, internet and self-help groups), with only 8.7% not using any other resources.

Living Life to the Full has also been awarded BACP Counselling and Psychotherapy Awards, 2007 in the Excellence in the Practice of Counselling and Psychotherapy category.

Practice Summary

Living Life to the Full (LLTTF) www.llttf.com is a freely accessibly online life skills resource which aims to empower users by providing information to help cope with problems such as low mood and anxiety. The course is based on the Overcoming Depression & Low Mood: A Five Areas Approach book, a style of Cognitive Behavioural Therapy (CBT), which has been shown to be effective in treating depression. The course is devised using written modules accompanied by audio from a trained CBT therapist. It has It also incorporates abridged “TV modules” to allow a comprehensive learning style. The website also has a very active forum, useful contacts page and allows practitioners to set up supported learning with patients.

Practice Detail

The website was a follow on from the START Project. It was a 3 year project and was part of the Scottish Executive’s “Doing Well by People with Depression Initiative”.

The aim of the START Project was to provide multiple ways of accessing CBT self-help for those facing mild to moderate depression and anxiety. The team achieved this by working closely with Depression Alliance Scotland and local Primary Care Mental Health Teams. The team delivered the interventions in a variety of ways, such as one to one self-help clinics; using workbooks or CD Rom, telephone and group sessions, college courses or website delivery.

And it was from this foundation that that the website and its resources were developed and progressed further.

The Main Aspects of the Website are:

All users must complete a mandatory registration. Once registered thy are able to access their “My Living Life to the Full” which allows users to follow their progress in the course and access all areas of the website such as the Forum, and tools to monitor their mood. (HADS and PHQ9). It also has a record of all the modules started and completed as well providing recommendations for possible future modules.

As supported self help has been shown to be the most effective way to deliver self help for low mood (Gellatly et al, 2007). Practitioners can set up an agreed link with a patient using the website and are able to view progress in the course modules, follow mood scales and to respond to any queries.

Registration is mandatory and records the mental health status using the Hospital Anxiety and Depression Scale (Zigmund & Snaith, 1983).

Challenges

Our major challenge was to ensure the adequate use of the website and to improve its functionality. Therefore LLTTF had a re-launch in September 2007 (original launch 2005) with improvements in its navigation and further developments in learning resources such as the Living Life to the Full TV. We have also ensured our resource is in keeping with the recent evidence which indicates that self help is more effective when supported therefore we have developed the site to allow practitioners to monitor and support patients.

Other issues we have overcome have been increasing awareness of this resource in both the general population. Therefore we have advertised the site in local newspapers and attended academic conferences, national events and health care conferences.

Additional Comments

Importantly we present data that as well as providing an opportunity to offer computerized CBT to people already within the NHS, there is also an opportunity to provide access to people not currently engaged in clinical services. We are currently exploring ways of offering support for users via various methods.