Mood disorder care innovations

The Mersey Care Mood Clinic

Why is the clinic taking a different approach to tackling mood disorders?

Mood problems are often assumed to be best described as a diagnosis of depression. This diagnosis then directs clinicians to follow the National Institute for Health and Care Excellence (NICE) guideline for treating depression. Very often, this treatment takes place in primary care, directed by your GP.

However, for some people, this approach doesn’t lead to improvement in their condition, and it is difficult to know what to do next.

In these circumstances, patients should be able to access a secondary care, specialist service – for example, be referred to see a psychiatrist. But this is currently difficult to achieve.

There are some clinical services set up for people with treatment-resistant depression, but they are not consistently available across England. In addition, the idea of treatment-resistant depression tends to focus on whether medical treatments (such as medications) worked or didn’t help, and these clinics usually focus on people with an existing diagnosis of depression or recurrent depression.

Recently, the idea of treatment-resistant depression has been expanded to a newer, broader concept of difficult-to-treat depression (or DTD). Using this approach, we consider any and all factors (be they psychological, social or medical) that impact on someone’s mood and may be preventing them to get better irrespective of their established diagnosis.

For this reason, people seen in the Mersey Care Mood Clinic might be offered a range of treatment options to consider such as addressing social or personal problems, finding psychological or talking therapies that might help, or considering different medications. It all depends on what the assessment, using the DTD approach, reveals alongside what the patient’s previous experiences and current treatment preferences are.

The aim is to prevent people being “stuck” with mood difficulties that don’t improve and to make access to specialist assessment and treatment easier by removing barriers between primary (GPs) and secondary care (mental health teams).

How does it work?

We offer an outpatient team assessment to patients over 18 who have been referred by their GP or mental health team because they meet the following criteria below.

• At least two adequate, evidence-based interventions for depression already
• Have difficulties that have persisted for longer than six months after receiving treatment
• They can provide informed consent and have a desire to try different approaches to treatment
• They can tolerate a series of assessments over an extended period of time.

Patients who have an existing mental illness or diagnosis and are otherwise stable such as bipolar affective disorder, personality disorder, recurrent depressive disorder, psychotic-spectrum, anxiety and trauma disorders will not be excluded from accessing the Mersey Care Mood Clinic.  The clinic team will work with any healthcare professionals already involved in the care of people with existing or long-term mental illness to ensure any proposed intervention plans don’t conflict with any established treatment.

Patients will usually be offered a number of treatment options that are tailored to their individual needs and goals.

Treatment plans will vary depending upon the patient’s needs, but the mood clinic aims to employ innovative treatments and new technologies to support patients. The results of assessments and treatments will be anonymised and stored in a confidential data registry, held at Mersey Care NHS Foundation Trust. This data will be used to help inform future research and treatments to improve care.

How have service users and carers been involved in the development of the clinic?

The voice of service users and carers has been at the heart of the development of the clinic. This has taken place through workshops and smaller focus groups with M-RIC service user and carer representatives and public advisors.

Examples of patient and public involvement and engagement activities 

• Mood clinic engagement workshop: considering how we gather information from service users
• Consultation event on improving services and treatment for people with mood disorders
• The co-production of the mood clinic assessment forms