Mr. Daniel Flynn & Dr. Mary Kells - National Office for Suicide ...

Daniel Flynn &
Dr Mary Kells
Cork ISA Mental Health Services
HSE South
Who are we?
The Road to Endeavour
Development and Evaluation
of programmes
for those affected by chronic self harm
Daniel Flynn Principal Psychology Manager
and
Mary Kells A/Senior Clinical Psychologist
Cork ISA Mental Health Services
NOSP Forum
10 th of September, 2012
Who do we work with?
Individuals who present with chronic suicidal ideation and recurrent
self harm within the context of borderline personality disorder (BPD)
• Key features:
Who we work with?
Family members and friends
• Often feel overwhelmed and traumatised by the
behaviours that frequently accompany BPD
– Extreme difficulty regulating
• Behaviour
• Emotion
• Interpersonal relationships
• Self and maintaining consistent identity
• Thought processes in response to crisis (zoning out)
• highly stressful and chaotic interactions (transactional
nature of relationships).
• At high risk of emotional burn out

Why we introduced the programmes?
• Reach Out-Action on Suicide Prevention (2005- 2014)
(Health Service Executive, 2005)
• A Vision for Change: The Irish expert group on mental
health policy (Department of Health and Children, 2006)
• National Suicide Research Foundation Reports (National
Registry of Deliberate Self Harm in Ireland, 2002-2011).
• Evidence based practice – International research
What do the programmes involve?
Endeavour Programme
Dialectical behaviour therapy (DBT)
• Talking treatment, based on learning principles
• Balances acceptance and change
• Structured treatment
• Practice based evidence – local lived experience
• Principle driven, not protocol driven
What do the programmes involve?
Components
Endeavour Programme
Dialectical behaviour therapy (DBT)
Group skills training
Individual therapy
Phone coaching
Consultation team meeting
Structuring the environment
What do the programmes involve?
Endeavour Family Connections (FC)
• A group treatment programme for family members and
significant others of people with a diagnosis of Borderline
Personality Disorder (BPD).
• Designed to meet 3 needs of family members:
Education
Skills Training
Peer Support
How did we evaluate the
Endeavour Programme ?
• Pilot study on effectiveness of standard DBT
How effective was the Endeavour
Programme?
• 5 standardised measures evaluating change in:
• 12 participants
• 12 month intervention with 6 month follow up
• Battery of assessment measures completed at 8 weekly
intervals
– Borderline Symptomology
– Depression
– Anxiety
– Hopelessness
– Perceived Quality of life
• Frequency of service utilisation (Inpatient admission and Emergency
Department visits)

How effective was the Endeavour
Programme?
Borderline Symptom Checklist (BSL 23)
Mean Scores (n=12)
How effective was the Endeavour
Programme?
Beck Depression Inventory II
Mean (n=12)
BSL Scores
60
50
40
30
20
10
0
Pre
Treat
ment
Mod
1
Mod2 Mod3 Mod4 Mod5
End
of
Treat
ment
6 mth
follo
w up
Series1 51.2 41.6 39.4 35.1Time
40.3 30.5 15.8 13.1
BDI Scores
60
50
40
30
20
10
0
Pre
Treatm Mod 1 Mod2 Mod3 Mod4 Mod5
ent
End of
Treatm
ent
6 mth
follow
up
Series1 35.0 29.6 24.3 20.4
Time
22.2 18.9 14.5 11.9
BAI Scores
How effective was the Endeavour
Programme?
30
25
20
15
10
5
0
Pre
Mod
Treat
1
ment
Beck Anxiety Inventory
Mean (n=12)
Mod
2
Mod
3
Mod
4
Mod
5
End
of
Treat
ment
6
mth
follo
w up
Series1 25.3 25.8 20.4 20.7 Time 21.1 21.5 14.6 12.8
How effective was the Endeavour
Programme?
Beck Hopelessness Scale
BHS Score
14
12
10
8
6
4
2
0
Mean (n=12)
Pre
Treat Mod 1 Mod2 Mod3 Mod4 Mod5
ment
End
of
Treat
ment
6 mth
follow
up
Series1 11.9 8.8 9.6 6.3 Time 7.2 7.9 4.9 4.1
QOL
How effective was the Endeavour
Programme?
5
4
3
2
1
0
Quality of Life (WHOBREF Q1)
Mean (N=12)
Pre
Trea Mod Mod Mod Mod Mod
tmen
t
1 2 3 4 5
End
of
Trea
tmen
t
6
Mont
h
follo
w up
Series1 2.8 2.8 3.9 3.6 Time 3.3 3.6 3.8 4
How effective was the Endeavour
Programme?
Hospitalisation days
Number of Bed days
250
200
150
100
50
0
207
45 1
Sept '09 - Sept
'10 Sept '10 - Sept
'11 Sept'11- Nov.
Years
11
n=12

How effective was the Endeavour
Programme?
Bed day costs
(based on a conservative estimate of €700.00 per day)
How effective was the Endeavour
Programme?
Emergency Department Presentations (n=6)
160000
140000
€144,900
50
45
40
49
Cost in Euro
120000
100000
80000
60000
40000
€31,500
Number of contacts
35
30
25
20
15
10
20000
0
Sept '09 -
Sept '10 Sept '10 -
Sept '11
Year
Nov ,11
€700
Sept'11-
Present
n=12
5
0
Sept '09 - Sept '10
Year
6
Sept '10 - Sept '11
How did we evaluate the
Endeavour Family Connections
(FC)?
• Results from first year of a 3 year study
• Comparing participants who had 3 session education
group (n=6) with 12 session Family Connections
programme (n=15)
• Battery of 5 assessment measures (pre, post and follow
up)
Endeavour Family Connections
(FC)
• FC group
– Burden, Grief and Depression levels decreased
significantly
– Mastery levels increased significantly
• Control Group
– Perceived Burden levels decreased significantly
– No significant changes in Grief, Depression and
Mastery levels
What next?
Endeavour Programme
• Funding from the National Office for Suicide Prevention
granted (June 2011) to support:
– continuation of research on Endeavour Programme
– expansion of programmes- training for new teams ISA wide.
• Pilot early intervention programme (U&ME) for people
with poor coping at risk of self harm (North Lee)
Area
Number of
Staff Trained
and
delivering
DBT
Number of
DBT places
at present
Number of
DBT places
from October
2012
Cork ISA DBT Programmes
North
Lee
South
Lee
West
Cork
North
Cork
Cork
ISA
8 4 4 5 21
16 7 6 9 38
24 7 8 9 48

What next?
Endeavour Family Connections
What next?
Web page development
North Lee:
• FC programme (plus psychoeducation control) has run twice. Third
phase planned: January 2013
• Research study ongoing
ISA wide:
• Anticipate that FC will be available across the ISA when staff have
sufficiently established the DBT programmes in each area.
www.dbtcork.ie Go live date: 14 th September 2012
Content:
• information and resource materials for service users, family
members and professionals
• Initially North Lee programme information
• information on all Cork ISA services in next 12 months
• Additional national DBT teams to add information as services
develop
Philosophy
Creating a life worth living
• What’s in a name?
Endeavour- dictionary definition:
“An earnest attempt at achieve something”
“An enterprise or directed activity”