Nils Kolstrup Senior researcher, Norwegian Centre for Integrated Care and Telemedicine (NST) A plan for integrated stepped care in psychiatry in Northern Norway EHiN 2014, IKT-Norge og HOD

1. A plan for integrated stepped care in
psychiatry in Northern Norway
Nils Kolstrup

2. The message
•We already have technology that can change the way we conduct
mental health care in an area
•Challenges:
• How to integrate the technologies in a systematic way in a very complex
system
• Get authorities and health care workers to see the benefits of this new
approach
• Get health care workers to change the way they treat patients using the new
technologies
2

3. Mastermind Norway
Integrated stepped care in psychiatry

4. Mastermind EU
•9 countries, 13 regions, 23 partners in Europe
•5.000 patients
•Depression
•Computer based cognitive therapy
•Video based care
4

5. What do we want to achieve?
• Today the system is dysfunctional
• Long waiting lists
• Insufficient diagnostic procedures
• Treatment with drugs in stead of behavioural changes
• Patients becoming more ill while waiting
• Long cumbersome distances to get treatment
• Too many acute admissions that perhaps can be avoided
• Very little competence building in primary care and among the population in general
• We want to shorten the waiting lists, improve the diagnostic procedures, reduce the
unnecessary use of drugs, reduce unnecessary travels and increase competence among
therapists and the population.
• Are we crazy, or just megalomaniac?
5

6. Mastermind, Norway. Basic concept “The funnel”
Integration of Internet Based Cognitive Therapy (ICBT) and video in a
comprehensive stepped care system
GP and
patient
ICBT
Self help
ICBT
GP
Specia-list
and
patient
(video)
Specialist
patient
Self help
without support
General practitioner (GP)
follow up plus self help
GP assisted
by specialist
Specialist patient
policlinic or
Acute cases admittance
Admittance
Policlinic, video

7. Background. Why do we think we may be able to do this?
• Video experiences:
• Internal communication between District Psychiatric Clinics and University Hospital (DeVaVi)
• Communication between specialist and patient at primary health care (E-BUP)
• Video conferences between GPs and collaborators
• Other relevant experiences:
• Acute teams assisting GPs in treatment of acutely mentally ill patients
• Psychologist or psychiatrists advisory visits to GPs offices in elective treatment of patients
• Electronic communication between collaborators (FUNNKe)
• Standardized electronic diagnostic forms (ELSK)
• Since 2005 experience with the internet program MoodGYM, UiT The Arctic University of Norway
• Results Norwegian Research Council grant on the use of MoodGYM in general practice
• Administrative conditions:
• GPs are paid well for video conferences
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8. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Not interested Not depressed
Home
page
Screening
Depressed
ICBT
P
Better/attrition
Flow chart of the Norwegian plan for the CIP MASTERMIND project
8
Suicidal
take
contact

9. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Not interested Not depressed
Home
page
Screening
Depressed
ICBT
GP+
ICBT
GP no
ICBT
P
Better/attrition
Better or
attrition
P
Better/attrition
Flow chart of the Norwegian plan for the CIP MASTERMIND project
9
Suicidal
take
contact

10. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Home
page
Screening
Depressed
ICBT
GP+
ICBT
GP no
ICBT
Acutely ill Admittance
Video
pt. +
GP +
spec.
P
Waiting list
Not interested Not depressed
Better/attrition
Better or
attrition
P
Better/attrition
P
Specialist on
video with GP
and patient
Flow chart of the Norwegian plan for the CIP MASTERMIND project
10
Suicidal
take
contact

11. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Home
page
Screening
Depressed
ICBT
GP+
ICBT
GP no
ICBT
Acutely ill Admittance
Video
pt. +
GP +
spec.
Pt. home
Video +
spec.
Policlinic
treatment
P
Waiting list
Not interested Not depressed
Better/attrition
Better or
attrition
P
Better/attrition
P
Specialist on
video with GP
and patient
ICBT
Better/attrition
Flow chart of the Norwegian plan for the CIP MASTERMIND project
11
Suicidal
take
contact

12. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Home
page
Screening
Depressed
ICBT
No follow up
GP+
ICBT
GP no
ICBT
P
Follow up by GP
Acutely ill
Admittance
Admittance
Video
pt. +
GP +
spec.
Follow up by GP
and video
Pt. home
Video +
spec.
Video and
spesialist
Discharge
Policlinic
treatment
P
Waiting list
Not interested Not depressed
Better/attrition
Better or
attrition
Better/attrition
P
Specialist on
video with GP
and patient
ICBT
Better/attrition
Flow chart of the Norwegian plan for the CIP MASTERMIND project
12
Diagnostic
screening by
specialist
Diagnose
Suicidal
take
contact

13. Self help GP + patient GP+pt.+spec. Pt.+specalist Pt. in clinic Internal communication
Home
page
Screening
Depressed
ICBT
No follow up
GP+
ICBT
GP no
ICBT
P
Follow up by GP
Acutely ill
Admittance
Admittance
Video
pt. +
GP +
spec.
Follow up by GP
and video
Pt. home
Video +
spec.
Video and
spesialist
Discharge
Policlinic
treatment
P
Waiting list
Not interested Not depressed
Better/attrition
Better or
attrition
Better/attrition
P
Specialist on
video with GP
and patient
ICBT
Better/attrition
Video District
clinic and
central hospital
Video District
clinic and central
hospital
Flow chart of the Norwegian plan for the CIP MASTERMIND project
13
Diagnostic
screening by
specialist
Diagnose
Suicidal
take
contact

14. Basic concept “The funnel”
Integration of ICBT and video in a comprehensive stepped care system
GP and
patient
ICBT
Self help
ICBT
GP
Specia-list
and
patient
(video)
Speciali
st
patient
Self help
without support
General practitioner (GP)
follow up plus self help
GP assisted
by specialist
Specialist patient
policlinic or
Acute cases admittance
Admittance
Policlinic, video

15. The fantastic brave people that are on this project
• From Department South, General Psychiatric Clinic, University Hospital North-Norway:
• Geir Øyvind Stensland, Head of Department
• Didrik Kilvær, Psychiatric Nurse, Advisor
• Vemund Myrbak, Psychologist, Adviser/Psychologist with clinical specialty
• Morten Borgen, Advisor/project manager, Cognitive Behavioural Therapist
• Ove Lintvedt, PhD, Psychologist, computer engineer
• From Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway:
• Siri Bjørvik, Project leader
• Nils Kolstrup, Scientific project leader, senior advisor, researcher GP, PhD; NST and UIT – the arctic university of Norway
• Erlend Bønes, Senior advisor, Computer engineer
• Siv Hege Fagerheim, Ma, Psychiatric Nurse, Advisor
• Collaborators
• Mastermind partners
• UIT – the arctic university of Norway
• Institute of psychology
• General Practice Research Unit
• Others
• Check Ware
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16. The message
•We already have technology that can change the way we conduct
mental health care in an area
•Challenges:
• How to integrate the technologies in a systematic way in a very complex
system
• Get authorities and health care workers to see the benefits of this new
approach
• Get health care workers to change the way they treat patients using the new
technologies
16

17. Thanks for listening
Nils Kolstrup
Nils.Kolstrup@telemed.no
www.telemed.no
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