Delivering Contemporary CBT Interventions to Unemployed and Working Populations: Prevention, Retention, and Rehabilitation

This follow-on project is designed to provide four partner organisations with the knowledge and skills to deliver group-based psychological interventions based on the principles and practices of acceptance and commitment therapy (ACT). ACT is a modern form of cognitive-behavioural therapy, which provides clients with a combination of mindfulness and behavioural activation skills. The project follows-on from an earlier ESRC-funded research project, which demonstrated the effectiveness and efficiency of a brief group-based version of ACT for improving people's mental health, behavioural functioning, and life satisfaction. The project partners were closely involved in the design of this follow-on work, and include a local branch of Mind (a mental health charity), and staff support/ occupational health professionals from three separate NHS Trusts. In the first phase of the project, the Principal Investigator (PI; Dr. Paul Flaxman, City University London) will directly train several staff support psychologists, counsellors, and vocational rehabilitation specialists in how to deliver ACT in groups. These partners will then be supported and observed by the PI as they begin cascading ACT-based training down to their service users. The results and impact of the project will be communicated to a wider group of stakeholders at a feedback workshop held towards the end of the nine month project (this event will be co-facilitated by the PI and the project partners). The ultimate aims of the project are to: 1) enhance the project partners' staff and employment support service provision; 2) offer help to NHS employees experiencing common mental health problems; 3) improve the psychological well-being and behavioural functioning of individuals accessing local mental health and employment support services; and 4) provide much wider access to ACT interventions than has previously been possible.

Who will benefit?

The most immediate beneficiaries of this follow-on project will be the psychologists, counsellors, psychological well-being practitioners, and employment support specialists who will be trained to deliver ACT interventions by the Principal Investigator (Dr. Paul Flaxman, City University London). These various professionals are employed by the four project partners: a regional branch of the UK's leading mental health charity (Mind), and the staff support functions within three separate NHS Trusts.

These professionals will then be supported and observed by the PI as they cascade ACT interventions down to their own staff groups and service users. These service user beneficiaries include: 1) NHS managers who are reporting difficulties "switching off" from work during their leisure time; 2) NHS staff members who are experiencing a common mental health problem (and who are considered at risk of stress-related sickness absence); 3) NHS staff groups being exposed to ongoing and significant organisational change; and, 4) unemployed (and long term absent) individuals who are accessing psychological and vocational support services in the South East of England.

More indirect beneficiaries include providers of staff support and mental health services from around the UK, who will be invited to a feedback and dissemination workshop towards the end of this nine month project. This event will be co-hosted by the PI and the project partners, and will include input from a sample of the aforementioned service users.

How will they benefit?

The project partners will benefit by receiving training from an internationally recognised expert in delivering ACT interventions to heterogeneous groups of individuals (e.g., Flaxman & Bond, 2006; 2010b; 2010c). The partner teams will receive the equivalent of three full days of training in ACT, plus follow-up supervision and observation support from the PI as they begin offering ACT workshops to their own service users. In this way, it is expected that the project partners will develop sufficient expertise to continue independently delivering ACT interventions long after this project has been completed. A strong argument in favour of this continuation project is that it will enhance the project partners' current service provision.

The partners' service users will benefit by having unprecedented access to an empirically supported intervention that has been shown to provide clinically meaningful improvements in people's mental health (Flaxman & Bond, 2010c). The proposed follow-on activities include offering ACT-based training to general NHS staff groups, as well as targeting particular groups in need of more immediate support (e.g., those held on waiting lists for psychological services). There is clearly an urgent need to increase access to evidence-based psychological interventions. For example, a recent review estimated that around three-quarters of employees with a common mental health problem do not receive a recognised intervention (Seymour & Grove, 2005).

Timescales for Impact

As indicated in the attached workplan, the PI will begin training the project partner teams within the first few weeks of the project's proposed start date (3rd September 2012). As soon as they have completed the training, these professionals will be supported by the PI as they begin offering the training to service users. By the end of the nine month project, it is expected that all four project partner teams will have offered a complete ACT intervention to groups of staff and service users. The number of people trained will then continue to be monitored for a further 12 months to feed into the final impact report.

The dissemination workshop will be held in the final month of the project. This will allow the PI and his collaborators to evaluate the impact of the project, and prepare to publicise to a wider group of professional stakeholders and mental health service providers.