NCMH response to: Inquiry into the impact of the Covid-19 outbreak, and its management, on health and social care in Wales

The Health, Social Care and Sport Committee is undertaking an inquiry into the impact of the Covid-19 outbreak, and its management, on health and social care in Wales. The inquiry will consider the impact of the outbreak, and its management, on health and social care services in Wales. As part of this, the Committee will examine the response by the Welsh Government and relevant public bodies, as well as considering the impact on staff, patients and others receiving care or treatment in both clinical settings and the community. It will also consider the Wales response in the wider, UK context.

About Bipolar

Bipolar disorder, formally known as manic depression, is a serious mental health condition in which people experience episodes of low mood (clinical depression) and high mood (mania or hypomania). Around three in every 100 people will experience an episode of bipolar disorder at some point in their life. It can have a devastating impact, not only on the person with the condition but their family and wider society. Whilst there are a number of effective treatments for bipolar disorder, including both medication and psychological interventions, poor treatment adherence and other factors can adversely affect long-term outcomes, resulting in episodes of mania and depression, poor employment records, and lowered self-esteem.

Psychoeducation interventions have been shown to be effective in maximising the benefits of self-management approaches and optimizing treatment concordance, leading to reduced relapse rates, improved clinical outcomes and therefore considerable downstream financial savings. Medications are known to be effective in treating bipolar disorder, but NICE and other guidelines suggest they should always be combined with psychosocial interventions for maximum effect and patients are typically keen to explore non-pharmacological approaches. Simple and effective interventions, such as group psychoeducation that can empower patients to have more control over their illness, represent an excellent addition to the treatments they are currently receiving in Wales.

Bipolar Education Programme Cymru (BEPC)

The Bipolar Education Programme Cymru (BEPC), is a group “psychoeducation” programme that aims to improve the quality of life for people with lived experience of Bipolar Disorder. It offers peer support and trustworthy information and allows the co-production of effective self-management and coping strategies. BEPC is an intervention with a strong evidence base and is part of the Matrics Cymru with its level of evidence rated at the highest level - A. The intervention involves 10 weekly facilitated group sessions of 2 hrs to groups of between 6 and 12 people, with a further session targeted at friends and family. The course enables individuals to better manage their condition by understanding the symptoms of bipolar disorder, identifying their triggers and monitoring their mood to help them stay as well as possible.

BEPC was developed with funding from the Big Lottery (£870,000) as a partnership between those with lived experience of bipolar disorder, representatives from the charity Bipolar UK, and academic and clinical staff from Cardiff and Vale University Health Board and Cardiff University. BEPC has been delivered in over 70 cohorts to over 700 people and to over 100 of their friends and family across Wales, with outstanding feedback. It has been embraced by Bipolar UK, the leading third-sector organisation supporting people with the condition, and has won the British Medical Journal (BMJ) Award for Innovation in Healthcare. In addition to Wales we have trained staff to deliver BEPC in over 20 NHS trusts across the UK, as well as health providers abroad, including in New Zealand, Australia, and Turkey.

Impact of the COVID-19 pandemic on BEPC

BEPC involves face-to-face facilitated group sessions with up to 12 participants and 2 facilitators. It has been necessary to stop these face-to-face sessions during the covid-19 outbreak and subsequent Wales lockdown.

The BEPC team at the National Centre for Mental Health, Cardiff University however, recognised that this time of lockdown could be a trigger for a bipolar episode with people being out of their normal routine, unable to get out for as much exercise and possibly not having the same level of support from family and friends. In addition, mental health services were also affected by the outbreak.

In order to provide some support for the individuals who have previously been through the face-to-face BEPC programme, a series of ‘virtual’ BEPC booster sessions have been undertaken. These booster sessions, held via zoom, include up to 6 participants and two clinical facilitators and an additional facilitator with lived experience of bipolar disorder. Each group has 2 sessions in which aspects of the face-to-face BEPC programme are reviewed and discussed as a group. Invitations to these groups were sent to all previous BEPC participants, for which the BEPC team has contact details. To date eight groups have taken place, with 38 participants. The feedback we have received from those who have taken part is very positive; participants have stated it was comforting and reassuring to have the opportunity to share their concerns with others who have bipolar disorder in a safe and supportive environment, that it was good to revisit those topics covered in the course (and for individuals to recognise that they are managing their mental health in the best way they can) and that the provision of care provided virtually was acceptable and welcomed.

In addition to the booster sessions, for those already familiar with the BEPC programme, a series of webinars were presented, to provide some of the BEPC content to individuals not familiar with the BEPC programme. These webinars were collaboration between NCMH and ‘Bipolar UK’ the leading bipolar charity in the UK. The content was presented by the BEPC team from NCMH, with representatives from Bipolar UK introducing the webinars and assisting the BEPC team answering questions at the end of each webinar. Three one hour webinars were presented weekly starting on the 22^nd July. The webinars covered three main areas: ‘what is bipolar?’, ‘approaches to bipolar’ and ‘self-management’. Each webinar included a range of information presentations, lived experience interviews and question and answers. An average of 86 people attended each session. Evaluation of the webinars is underway, to date 29 questionnaires have been returned. Across the 3 sessions on average 76% of respondents found the webinars helpful or very helpful. 86% would like to attend further webinars if they are hosted. The BEPC team are planning to host further webinars in the autumn.