iCope Long-term Conditions Service

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Since 2017, iCope Islington has been developing specific treatment pathways to work with people with long-term physical health conditions (LTCs) and persistent physical symptoms (PPS). It offers a specialist treatment pathway for patients with type 1 and type 2 diabetes, chronic obstructive pulmonary disease and breathlessness, chronic pain and coronary heart disease. In 2020, this will be extended to cover specific ‘medically unexplained’ syndromes (initially, irritable bowel syndrome). 

Patients with these conditions will be seen by clinicians who have received specialist training in working with patients with LTCs. The focus is on working with anxiety and depression symptoms that may have a negative impact on physical health management or on coping with the symptoms of physical illness and its management. Individuals with other long-term physical-health conditions may still be seen in the core service provided that they meet iCOPE’s general service referral criteria. 

The interventions offered to patients with LTCs include: 

  • brief cognitive behaviour therapy (typically around 12 sessions)
  • guided self-help (typically 6 sessions)
  • group interventions.

There is a chronic pain group run in collaboration with physiotherapy colleagues in the Whittington Community Musculoskeletal Team and a mindful eating group with the dietician team. The mindful eating group is aimed at any patients needing to watch their diet as part of their condition self-management. Psychological wellbeing practitioners also provide regular psychological input to the community pulmonary rehabilitation groups at the Whittington and the cardiac rehabilitation groups. 
 


Eligibility criteria

Inclusions

  • mild to severe anxiety or depression alongside one of our target physical health conditions [PHQ-9 (depression) ≥ 9/27 or GAD-7 (anxiety) ≥ 7/21]
  • able to attend regular outpatient appointments
  • able to engage in structured psychological treatment, i.e. not only looking for emotional support (if so, consider social prescribing/community linking).

Exclusions

Please note: iCOPE’s LTC service is not designed to meet the needs of patients who require secondary-care mental-health input and/or the support of an MDT (i.e. complex/co-morbid mental health problems, severe and enduring mental illness, personality disorder, etc), patients with substance abuse problems, and/or patients in acute crisis.

Patients with the following are also excluded:

  • severe/enduring mental illness (e.g. psychosis or bi-polar illness) or diagnosis of personality disorder
  • currently in crisis or recent history of this (past three months)
  • significant on-going self-harm or history of recurrent serious self-harm
  • chronic and complex anxiety and depression that has not responded to previous brief interventions
  • needs better served by clinical health psychology (e.g. regular inpatient attenders or when close MDT liaison or specialist health psychology skills are needed)
  • needs better served by a psychologist within a specialist community teams, for example, severe physical disability or social care needs (e.g. if the client is bedbound/housebound, requires multiple social care inputs/OT adjustments, or requires specialist home treatment such as oxygen therapy)
  • intractable problems with care coordination
  • high medical risk with poor physical health management that requires close medical monitoring or input, who might be at risk of hospitalisation or rapid deterioration in their medical condition(s).
  • at risk of falls or notable frailty (a falls risk assessment and intervention would need to be in place prior to assessment or treatment in iCOPE)
  • significant memory deficits or cognitive impairment (e.g. dementia, brain injury). 
  • functional impairments in activities of daily living due to their physical condition e.g. unable to cook, clean, manage personal hygiene (consider a social care or OT assessment or safeguarding referral)
  • active significant risk to self-related to problematic self-management of physical health problems (e.g. medication misuse, hoarding of medications or medication refusal).
  • co-existing socio-economic issues (e.g. benefits or acute housing crisis) prevents engagement.

How to refer

EMIS form

Referral methods: Email

A generic iCOPE referral form can be found in EMIS under
ISL global documents > Mental Health
and should be emailed to cim-tr.icope@nhs.net

 If you think that the patient should be seen by the LTC team, please make a note of this in their referral and specify their condition.

Please note: for referral to this service a person’s anxiety and depression should be clearly related to their LTC or they are struggling to self-manage. (If their anxiety or depression is not related to their LTC they will be reallocated to a clinician in the core iCOPE team.)

Self-referral

Patients may self-refer through the iCOPE website

Although we welcome self-referral, please do not encourage this for patients who do not meet our eligibility criteria as this is likely to lead to frustration when we are unable to offer treatment. We would also encourage GPs to make a referral on behalf of patients if they are unlikely to follow through with self-referral due to impaired motivation or potential stigma concerns. If you are unsure, contact us for an informal discussion before referral.
 


w: https://www.icope.nhs.uk/request-an-appointment/