What do learners need to score on the mental health tools to be eligible?
In the DfE E Adult Education | Mental Health research phase 2 (2016/17), we use people's self-assessment scores on PHQ9, GAD7 and SWEMWBS as:
- Broad indicators of problems linked to mild to moderate mental health problems that the person says they would like to learn how to manage/manage better
- Eligibility to be included in the research (people who are not eligible receive the initial guidance offer and signposting to your mainstream offer and/or other kinds of services
- To measure self-assessed changes in their mental health that may result from learning.
Generally speaking, this means the CLMH learning offer should be made to people who have mild to moderate mental health problems and would most likely meet the criteria for treatment by their GP including choice whether to be rreferred to IAPT services.
|PHQ9 score||may mean the person has|
|0 - 4||No mental health problems|
|5 - 9||Mild mental health problems / depression|
|10 - 14||Moderate mental health problems / depression|
|15 - 19||Moderately severe mental health problems / depression|
|20 - 27||Severe mental health problems / depression|
|GAD7 score||may mean the person has|
|0 - 4||No mental health problems|
|5 - 10||Mild mental health problems / anxiety|
|11 - 15||Moderately severe mental health problems / anxiety|
|16 - 21||Severe mental health problems / anxiety|
NICE guidelines recommend that people who score 10 or more on PHQ 9 and/or those who score 8 or more on GAD7 would benefit from CBT/referral to the IAPT service.
Your local IAPT service will follow the national NICE guidelines to decide who they will normally see/help, i.e. people with a score of 10 or more on PHQ9 and people with a score of 8 or more on GAD 7. People who score 20 or more on PHQ9 and 16 or more on GAD7 and individuals who have some other concomitant mental health conditions will usually (but not always) be referred to secondary mental health services for more intensive or different kinds of support.
We know that there is often also some local variation in which scores lead to referral/access to IAPT. This local variation can be criteria set by local commissioners or local mental health services and may depend on waiting list times and the availability and capacity of local services.
The decision as to whether or not someone is accepted for IAPT services is never based solely on someone's score on the self-assessment scales. it is always also based on a clinical assessment of the person and their (his)tory. GPs and mental health services use a wider range of scales to help detect and measure changes in people with other mental health conditions. We have no intention of using any of these as research tools, and you must not get drawn into using them. We are not in the business of diagnosing mental health problems.
Our educational assessment carried out with the learner is similar but we cannot afford to have lots of people accepted onto the research courses who do not meet the criteria for the research, but, it is worth noting that:
- There is also some evidence that people in social groups that IAPT fails to reach may have lower scores, e.g. PHQ9 is less good at picking up latent depression and/or improvement in some groups like older people. That's one of the reasons why some IAPT services are beginning to use SWEMWBS as well for this group.
- Many deaf people with a PHQ 9 score of 7 probably have latent depression, and IAPT would normally/hopefully see them, even if their hearing peers are not usually accepted with scores below 10.
- Subthreshold depression is increasingly recognised as causing considerable morbidity and human and economic costs, and it is more common in people with a history of major depression, whcih is a particualr known risk factor for future major depression
We (community learning services/providers/practitioners) do not have the necessary professional training, knowledge, skills or authority to make clinical assessments. That's a good thing, and we should never attempt to do so (even if a member of your staff also holds qualifications in a profession that is allied to medicine). If you have the necessary local partnership relationships, you may be able to offer to refer someone for assessment for access to mental health services.
Eligibility to join the research in phase 2
For phase 2, we must strictly apply the research criteria for who can/cannot join the research. Those people whose PHQ9 and/or GAD 7 scores are in the green or amber ranges above are eligible to join the research. If someone scores anything for questions 8 and/or 9 on PHQ9 you need to assess them further first to see if they need mental health first aid/urgent/emergency help.
What to do when someone scores (anything) on question 8 or 9 on PHQ9
Questions 8 and 9 on PHQ9 ask:
"8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way"
Many people with mild to moderate mental health problems think about killing themselves, so it will nto be unusual for people who are eligible to join this research to score on questions 8 and/or 9 on PHQ9. If someone scores 1 or more on either or both of the final 2 questions on PHQ9, you must not ignore it. Mental health first aid or emergency referral/help may be needed. You should check that you and the learner understand exactly what the person is saying / the importance of what the person has said about how they have been feeling. Ask if it is how they feel now (at that moment). If they say they would still score on eitheror both questions, you should suggest to the person that they might want to see their GP for help or ask if they would like you to speak to/refer them to a local partner agency for assessment/help.
Remember this is a choice. People have approached you voluntarily. You cannot force people to act on your advice or signposting. If you are concerned that there is imminent danger that they may do serious harm to themselves or others, then you need to follow the Mental Health First Aid protocol /call 999/use your safeguarding procedures as appropriate to help keep them (and/or others) safe
What we (community learning) offer and are qualified to provide is education - adult learning, including information, advice and guidance about local adult education opportunities. We are qualified to work with the person to help them decide if learning is right for them, and if it is, what kind of learning, where and when and whether the CLMH courses would suit and help them to better manage their mild to moderate mental health problems and to progress from learning.
As part of this process, we need to make it clear to potential learners that this is a research project. We do not know yet if it works (although Learn2B in Northants has had impressive results for many years).
If someone wants to sign up for this offer we need to check during the initial guidance session that they meet the criteria (by asking them to complete PHQ9, GAD 7 and SWEMWBS) in order to be included and that they agree to sign a consent and provide responses to PHQ9, GAD7, SWEMWBS and soem other questions about their circumstances and progression:
- at the start of their first class
- every 2 weeks during their course
- each time they attend a top-up/refresher learning experience
There is no SWEMWBS 'score' that learners need to fall within to be involved in the project because SWEMWBS is designed to provide a population wellbeing measure.
Before you start asking learners to complete PHQ9 and/or GAD7 scores you must complete training in how to use the tools, support learners to complete them, submit accurately completed results online for your local records and our research external evaluators. We will cover this in detail at the all-research sites training on 27/28 September and you must review the resources and the recording of the training webinar on 8.7.15 about how to use the tools and the alternate formats that are available at: http://bit.ly/CLMHP_3on1