Group Psychoeducation is an evidence-based, NICE-approved (CG185, QS95) 21-week intervention for people with bipolar disorder.

Groups typically consist of 12-14 people with bipolar disorder and three facilitators; a clinician (e.g. community psychiatric nurse, occupational therapist or psychologist), a psychiatrist, and a peer facilitator with lived experience of bipolar disorder.

 EMAHSN worked with Nottinghamshire Healthcare NHS Foundation Trust to spread the intervention to other NHS mental health providers across the region:

• Northamptonshire Healthcare NHS Foundation Trust
• Derbyshire Healthcare NHS Foundation Trust
• Leicestershire Partnership NHS Trust
• Lincolnshire Partnership NHS Foundation Trust

The primary reason for implementation was that (prior to the project) no psychological interventions specific to bipolar disorder were routinely offered by NHS providers in the East Midlands outside of Nottinghamshire Healthcare NHS Foundation Trust - psychoeducation has been delivered since 2014. This followed the Trust’s participation in a randomised controlled trial of bipolar psychoeducation known as PARADES in 2009/10.

EMAHSN supported this project from April 2017 - December 2019.

Solutions / actions taken 

In establishing the project EMAHSN and staff from the Nottinghamshire Healthcare NHS Foundation Trust identified key decision makers within each ‘adopter’ NHS Trust. The roles of these individuals varied according to the configuration of each Trust’s service delivery model; in some cases, initial engagement was with the Research and Innovation Department, in others it was an interface with senior clinicians such as the Lead Nurse for Community Services or Deputy Medical Director.

Impacts and outcomes from the project 

• Improved function and recovery - This was measured through use of the Work and Social Adjustment Scale (WSAS) and Bipolar Recovery Questionnaire (BRQ) with the majority reporting a clinically significant improvement on at least one scale.
  
  
• Reduced relapse rates and demand on services -  Results showed that the proportion of patients receiving psychoeducation who had any relapse was 40% compared to 63% who received treatment as usual (TAU) Of these relapses 27% were major in the psychoeducation groups compared to 58% in TAU supporting the likelihood of significant potential savings from reducing costly inpatient spells. The total crisis team involvement was also lower for the psychoeducation group compared to TAU at 98 vs 167 days respectively. These findings should be treated with caution due to the small sample and non-randomised nature of the audit.
  
  
• Positive uptake and service user experience - The programme demonstrated a positive uptake and experience. Retention from enrolment to completion was 67%.
  
  
• Sustainability and funding - Three out of the four NHS Trusts that adopted psychoeducation are continuing to deliver it without external funding. To date, 19 bipolar psychoeducation courses have been initiated across the region since project launch and 236 people with bipolar disorder enrolled.
  
  

 Key learnings 

• Patient feedback was positive with most respondents valuing the course highly and likely to recommend it to others.
• Variation in delivery between trusts. Significant deviations from the original manual and model of delivery e.g. shortening the course, changing composition of delivery teams.This variation provided useful perspectives on how to make a service work in different settings given available resources and organisational contexts.
• A community of practice was important in sharing learning, experience and reinforcing the effectiveness of the intervention

Group Psychoeducation for people with Bipolar Disorder resources