Books on prescription: information resource or treatment

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• Books on prescription information resource or
  treatment?

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• Project team
• Helen Snooks Regional Director, AWARD
  Swansea University joint lead
• Keith Lloyd School of Medicine, Swansea
  University joint lead
• Alison Porter AWARD, Swansea University
• Angela Evans AWARD, Swansea University
• Julie Peconi AWARD, Swansea University
• Ian Russell IMSCaR, University of Wales, Bangor
• Commissioner Welsh Assembly Government
  (Community, Primary Care and Health Services
  Policy Division)

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• Background
• Bibliotherapy is the use of self help books to
  treat medical conditions
• Guidelines from a UK government agency (NICE)
  recommend bibliotherapy based on Cognitive
  Behavioural Therapy for panic, general anxiety
  disorders, mild depression and eating disorders.
• Books on prescription is one model of
  bibliotherapy family doctors or other health
  professionals give patients a prescription for
  books, which they then collect from a public
  library

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• Book Prescription Wales (BPW)
• BPW is a bibliotherapy scheme introduced in 2005
  for people with mild to moderate mental health
  problems
• BPW set up by the Welsh Assembly Government and
  run as a partnership with Local Health Boards
  (LHBs), libraries and prescribers
• Prescribers include family doctors, primary care
  nurses and counsellors, social workers in mental
  health teams etc
• Set list of 31 titles covering issues such as
  depression, anorexia, bereavement, anger
  management, obsessive compulsive disorders, and
  low self-esteem

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• Mind over Mood
• Dennis Greenberger and Christine Padesky
• Guilford Press, New York
• This popular workbook shows readers how to
  improve their lives using cognitive therapy one
  of the most effective and widely practised forms
  of psychotherapy. The books is designed to be
  used alone or in conjunction with professional
  treatment. Step by step worksheets teach specific
  skills that have helped thousands of people
  conquer depression, panic attacks, anxiety,
  anger, guilt, shame, low self-esteem, eating
  disorders, substance abuse and relationship
  problems. Readers learn to use mood
  questionnaires to identify, rate and track
  changes in feelings change the thoughts that
  contribute to problems follow step-by-step
  strategies to improve moods and take action to
  improve daily living and relationships.

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• Study objective
• To describe implementation and experiences of
  delivering and using BPW
• Presentation objective
• To examine whether policy makers shared an
  understanding of the nature of the BPW scheme
  with those who were involved in implementing it

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• Methods
• Documentary evidence on project set up and
  borrowing rates
• Postal surveys to LHBs 95 response rate
  (21/22)
• Postal surveys to CMHTs 69 response rate
  (44/64)
• Postal surveys to prison medical staff 50
  response rate (2/4)
• Telephone survey of all GP practices 66
  response rate (327/497)
• Group interview with NHS Direct Wales staff
• 20 in-depth telephone interviews with prescribers
• 2 focus groups with library managers
• 1 focus group with front desk library staff

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• Results

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• BPW as treatment
• Bibliotherapyis a means of introducing a new
  effective form of psychological treatment into
  the primary care context
• WAG Decision Report, December 2004
• Bibliotherapy is structured and takes place over
  a limited time period, with monitoring and review
  by the professional
• Professional manages/controls the bibliotherapy
• Bibliotherapy is used alone as part of staged
  intervention
• Limited to the 31 books on the WAG list
• Books only available with a prescription

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• Structured and monitored?
• Its another way of saying theres information
  out there, go and look at it and come back if you
  need to.
• Practice Nurse, Mid and West Wales
• If people are unable to verbalise, they can read
  the information and then work out whether or not
  their situation relates to it.
• Community Mental Health Team worker, North
  Wales

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• Health professional in control?
• This is a really good alternative. It puts GPs
  in charge rather than put people in secondary
  care.
• Community Mental Health Team Co-ordinator
• Patients get to take responsibility for their
  own improvement, and do their own share of the
  work. Its a move away from the Ill sort you
  out model.
• Practice counsellor, South Wales

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• Bibliotherapy used on its own?
• Its not instead of, its as well as.
• Community Psychiatric Nurse, Mid and West Wales
• For me, it makes sense of the work I am doing.
  It gives clients a bit more confidence, so that
  they realise that not all that I am saying is
  bull.
• Senior Psychiatric Nurse in a CMHT North Wales

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• Limited to the 31 books on the WAG list?
• In a locally extended scheme weve used
  clinicians to vet the books that we are using in
  the extended scheme
• Library manager A1
• Were using the bibliotherapy scheme to promote
  the sort of range of materials that weve got
  available in libraries for other things, like
  information on physical ailments
• Library manager A3

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• Books available only with a prescription?
• We still issue more of the titles, through
  people browsing and finding them themselves, than
  actually on prescription.
• Library manager B1
• We did, in fact, send out lists to various
  people, voluntary groups and so on and so forth
  to make them available, and they have actually
  referred people to us in an informal way.
• Library manager A11

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• BPW as a health information resource
• Im a great believer in informationIt used to
  be that we just told people to take this tablet
  and that was it. But now there is a focus on
  informed choice. They need all the information
  available.
• Female CPN in a CMHT South Wales
• Staff have often been asked about various
  ailments, and look things up on the internet, you
  know now theyve got some authoritative material
  they can refer people to.
• Library manager

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• Discussion

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• The two models
• Are people aware of the two models?
• Are the two models running parallel or have they
  collided?

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• Some unresolved issues revealed
• Does BPW normalise a condition and its
  treatment, or medicalise a process which is a
  routine part of everyday life?
• What is an appropriate/acceptable level of risk
  in the use of bibliotherapy?

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• Lessons about policy implementation
• Things do not always work out on the ground in
  the way which policy makers envisage.
• If you want to evaluate the effectiveness of an
  intervention, be very wary of all the local
  variations which can arise.

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• Study limitations
• Study took place in first months of BPW - issues
  may be teething problems
• No views of patients have been recorded

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• Full study report available from
  www.awardresearch.org.uk