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Psychological Therapies for Common Mental Health Problems – TALKWORKS (Devon Depression & Anxiety Service)

TALKWORKS (formally known as DAS) is the IAPT (Improving Access to Psychological Therapies) service provided by Devon Partnership NHS Trust

Scope

Common mental health problems covered in this information include depression and anxiety disorders such as generalised anxiety disorder, panic disorder, obsessive-compulsive disorder (called OCD for short) and post-traumatic stress disorder (called PTSD for short). Other common mental health problems include phobias about a specific thing (such as spiders) or situations (such as being embarrassed in front of other people).

Devon TALKWORKS - Inclusion criteria
  • Age: People age 18 and over. No upper age limit
  • Primary diagnosis: Depression &/or Anxiety disorders (generalised anxiety disorder, simple phobia, health anxiety, post-traumatic stress disorder, obsessive compulsive disorder, social phobia, panic disorder with or without agoraphobia). Bulimia, not underweight.
  • Risk: We accept people who have suicidal thinking &/or mild self-harm or neglect, and are emotionally stable enough to benefit from therapy
  • Co-occurring problems: We accept people who have a primary anxiety &/or depression problem who have co-occurring problems as long as they are able to benefit from psychological therapy for anxiety &/or depression. Problems include: post-detox or post-stabilisation alcohol or drug use problems, learning difficulties, long term physical health conditions,
  • Prioritisation:
    • Perinatal women
    • Veterans who are presenting with anxiety and depression

Out of scope

TALKWORKS is well equipped to provide evidence-based psychological therapy for people with primary anxiety &/or depression in a primary care context. TALKWORKS does not provide general / emotional support. It is not a specialist mental health service and is staffed by psychological therapists only.

TALKWOKRS cannot work with:

Risk of suicide:

  • People with current risk of suicide indicated by either/or
    • Suicidal ideation, with evidence of intent &/or plans
    • Recent suicide attempt or self-harm event

Risk of harm to others:

  • Presenting current risk of harm to others.
  • Involvement in safeguarding actions will not exclude if risk reduced and person well engaged. On probation will not exclude if assessed low risk

Risk of neglect:

  • Current self-neglect impacting on daily life

Risk of harm from others:

  • Living in an abusive or unstable home environment, as psychological therapy is unlikely to meet their needs

Diagnosis:

  • Bipolar disorder, psychosis, uncontrolled substance use disorder, or personality disorder having an impact on therapy.

Severity & complexity:

  • We are unable to accept people:
  • Currently receiving care from specialist mental health services
  • In a current mental health crisis or distress
  • With a history of recurrent treatment failure &/or recurrent lack of engagement with treatment services
  • With multiple life problems having an impact on everyday functioning which reduces ability to engage in therapy
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Mild, moderate and severe mental health problems
  • The terms mild, moderate and severe are used in this information to describe different levels of mental health problems.
  • A mild mental health problem is when a person has a small number of symptoms that have a limited effect on their daily life.
  • A moderate mental health problem is when a person has more symptoms that can make their daily life much more difficult than usual.
  • A severe mental health problem is when a person has many symptoms that can make their daily life extremely difficult.
  • A person may experience different levels at different times.
Depression
  • The main symptoms are feeling 'low' and losing pleasure in things that were once enjoyable. These symptoms may be combined with others, such as feeling tearful, irritable or tired most of the time, changes in appetite, and problems with sleep, concentration and memory. People with depression typically have lots of negative thoughts and feelings of guilt and worthlessness; they often criticise themselves and lack confidence. They may also experience reduced activity and avoidance of social contacts.
Generalised anxiety disorder
  • The main symptoms are having a number of different worries that are excessive and out of proportion to a particular situation, and having difficulty in controlling one's worries. A person with generalised anxiety disorder may also feel irritable and have physical symptoms such as restlessness, feeling easily tired, and having tense muscles. They may also have trouble concentrating or sleeping. They may experience avoidance of places, things or thoughts which trigger the anxiety.
Panic disorder
  • The main symptoms are having unexpected and recurring panic attacks, and also worrying about having another panic attack. One of the symptoms of a panic attack is an increased heart rate. A panic attack may happen because of a particular situation (something that the person fears or wants to avoid), or it may have no obvious cause. People who have panic attacks often change their behaviour as a consequence of the attack, which may develop into phobias such as agoraphobia (a fear of being in places or situations that are difficult to escape from). They may experience avoidance of places, things or thoughts which trigger the anxiety.
Obsessive-compulsive disorder
  • The main symptoms are having thoughts, images or impulses that keep coming into the mind and are difficult to get rid of (called obsessions), and a strong feeling that the person must carry out or repeat certain physical acts or mental processes (called compulsions). Common obsessions include being afraid of dirt and germs, worrying that something is not safe (such as an electrical appliance), wanting to have things in a particular order, and thoughts and fears of harming someone else. Common compulsions include excessive washing and cleaning, checking things repeatedly, keeping objects that other people might throw away, and repeating acts, words or numbers in a pattern.
Post-traumatic stress disorder
  • Psychological and physical symptoms that can sometimes follow particular threatening or distressing events. One of the most common symptoms of PTSD is having repeated and intrusive distressing memories of the event. There may also be a feeling of reliving the event through flashbacks or nightmares. There can also be physical reactions, such as shaking and sweating. They may experience avoidance of places, things or thoughts which trigger the anxiety.

TALKWORKS is a planned treatment service and does not operate an emergency or out of hours service. If you think you need urgent help either contact your GP or call 111, or attend your nearest Emergency Department in a crisis.

TALKWORKS does not provide general / emotional support

Risk assessment & management with TALKWORKS.

TALKWORKS is well equipped to provide psychological therapy for people with primary anxiety &/or depression in a primary care context. It is staffed by psychological therapists only. TALKWORKS can work with patients whose risk can be safely managed by psychological therapy and primary care interventions.

Devon Partnership Trust - Depression-Anxiety-Service-decision Tree for-GPs & other referrers

Risk assessment & management requires clinical judgement

These descriptions & examples are intended to support communication & decision making

Very low risk:

  • Considered to have no history or warning signs indicative of risk

Low risk:

  • Considered to have no current/recent behaviour indicative of risk but history and/or warning signs indicate the possible presence of risk. No special risk prevention measures or plan required (E.G. may have thoughts of harm to self or others but no intent or plans. May have self-harmed in the past. Not currently in adverse environment, no other risk factors)

Medium Risk:

  • Considered to have significant risk. The history and current condition indicate the presence of risk to self or others which is a significant issue at present and a risk management plan is required as part of the persons care (E.G. may have thoughts of harm to self or others and there is evidence of plans and/or intent. May have self-harmed in the past. In an adverse environment such as domestic abuse relationship or other risk factors).

Patient presents with depression and/or anxiety of less than 2 week duration.

  • No or very low risk

GPs identify, assess, actively monitor and provide self-help information

Person presents with depression and/or anxiety:

  • Generalised Anxiety Disorder
  • Simple Phobia
  • Health Anxiety
  • Post Traumatic Stress Disorder
  • Obsessive Compulsive Disorder
  • Social Phobia
  • Panic Disorder (with or without agoraphobia)
  • Bulimia, Binge-eating disorder (normal weight, no health problems)
    • Motivated
    • Very Low Risk

Please hand out leaflet.

Patients can Self-referral to DAS by contacting the nearest service to where they live or completing the online self-referral form.

Person presents with depression and/or anxiety:

  • Generalised Anxiety Disorder
  • Simple Phobia
  • Health Anxiety
  • Post Traumatic Stress Disorder
  • Obsessive Compulsive Disorder
  • Social Phobia Panic Disorder (with or without agoraphobia)
  • Bulimia, Binge-eating disorder (normal weight, no health problems)
    • Low motivation
    • Low Risk
  • History of mental illness
  • Veterans
  • Pregnant women

GPs - Written referral required to DAS via letter, fax, email.

Person presents with depression and/or anxiety with any of these features of risk or complexity:

  • Unclear presentation
  • Medium or greater current risk to self or others
  • Currently accessing other mental health services
  • Repeated treatment failure
  • Significant repeated and serious self-harming
  • Multiple life problems having an impact on everyday functioning which reduces ability to engage in therapy

NOT FOR TALKWORKS, please refer to DRSS (email: cab.helpdesk@nhs.net) or Crisis Resolution service as appropriate

Person presents with any of the following disorders, whether or not depression or anxiety are present:

  • Current psychotic features
  • Bi-polar disorder/cyclothymia
  • Primary drug/alcohol problems
  • Anorexia or other eating disorder where BMI is not in normal range
  • Severe personality disorder

NOT FOR TALKWORKS, please refer to DRSS (email: cab.helpdesk@nhs.net) or Crisis Resolution service as appropriate.

Referral Forms

The team at TALKWORKS have added a Healthcare Professional referral form to their website. This is to enable GPs and healthcare professionals to send referrals to the service on behalf of a patient.

If you are working with a patient who is experiencing a common mental health problem, and is anxious about contacting TALKWORKS, you can send a referral on their behalf by filling in the Healthcare Professional referral form here.

Patients are still able to self-refer to TALKWORKS as normal.

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