The North London NHS Foundation Trust (NLFT, a merger of BEH and CANDI) NHS Talking Therapies has a long-term health conditions (LTC) pathway for adults with depression, anxiety and co-morbid LTCs.

This pathway is part of NLFT NHS Talking Therapies psychological therapies; it is a dedicated arm of the main service with the same referral processes and eligibility criteria.

Information about this LTC pathway is provided below and on the NLFT NHS Talking Therapies website.

The NLFT NHS Talking Therapies LTC pathway is for adults who:

• meet existing service eligibility criteria
• have problems with depression and anxiety that co-occur with specific long-term physical health conditions, as listed on the physical health problems page of NLFT NHS Talking Therapies' website
• can attend regular outpatient appointments face-to-face or remotely (via video or phone) and can actively engage in structured psychological treatment.

Adults who are seeking practical or emotional support should not be directed to this service, instead consider social prescribing or community-based peer support for living with LTCs.

What is offered?

Adapted cognitive-behavioural interventions are offered to treat depression and anxiety disorders associated with NLFT NHS Talking Therapies LTC pathway conditions.

Depression and anxiety disorders that NLFT NHS Talking Therapies clinicians work with are listed on the psychological therapies page.

All interventions aim to reduce symptoms of depression and anxiety, improve quality of life and promote health-related self-management. Where appropriate, interventions include physical activity promotion.  

Interventions are time-limited, goal-focused and delivered by clinicians with specialist training in adapting cognitive behavioural therapy. They include:

• one-to-one cognitive behaviour therapy (typically 12 sessions)
• guided self-help (typically six sessions)
• cognitive-behavioural group interventions.

Adults with LTCs that are outside of the listed LTC pathway conditions may still be seen in the core NLFT NHS Talking Therapies service if general service eligibility criteria are met. Please note: the NLFT NHS Talking Therapies LTC pathway is not designed for or recommended in the following circumstances:

• there are intractable problems with care coordination and/or an adult's needs may be better addressed by clinical health psychology or specialist psychologists located in community or hospital-based teams
  • for example, in cases where an adult is bedbound/housebound and requires social care input, occupational therapy adjustments, or specialist home-based treatment then a community-team approach involving a community team psychologist may be more appropriate
  • alternatively, adults who require frequent and intensive hospital-based treatments or who are regular inpatient attenders may benefit from close multi-disciplinary liaison and specialist health psychology interventions
• high medical risk is identified for adults with poor physical health management who require close medical monitoring or input due to risk of hospitalisation or rapid deterioration in their LTCs
• notable frailty or high risk of falls is identified
  • a falls risk assessment and intervention would need to be in place prior to assessment or treatment in NLFT NHS Talking Therapies
• needs include significant memory deficits or cognitive impairment (e.g. dementia, brain injury) that may be better met by specialist services
• needs include significant functional impairments in activities of daily living due to LTCs that have not been addressed
  • if ability to cook, clean, manage personal hygiene is severely impacted, then consider adult social care or occupational therapy assessment in the first instance
• significant and active risk to self directly related to problematic LTC self-management is identified (e.g. medication misuse, hoarding of medications or medication refusal)
  • in such cases, consider referral to crisis services or seek advice by contacting NLFT NHS Talking Therapies, Camden primary care mental health network or Islington practice-based mental health service prior to making a referral.

Visit NLFT NHS Talking Therapies psychological therapies service for all relevant service downloads.

Eligibility Criteria

Inclusions

• adults (17.5 years and older) with:
  • anxiety disorders
  • depression
  • or primary insomnia at all levels of severity (mild, moderate, or severe) who wish to engage with a structured psychological intervention.
• people who have EUPD traits or where the personality disorder problems are mild (e.g. the person has a historical diagnosis, but their presentation has since changed), if the focus of the work is around anxiety or depression.
• harmful or hazardous drinkers and/or recreational drug users presenting with anxiety or depression, if they are able to attend sessions on a regular basis and are motivated to limit/reduce their substance use and do not need additional support to reduce this.
• mild learning disabilities and/or are neurodiverse if the focus of the work is anxiety or depression and the person is able to engage with a structured psychological intervention.
• problems relating to anger may be seen in NHS TT if this is associated with anxiety or depression rather an underlying personality disorder.

See Downloads for a full list of inclusion criteria.

Exclusions

• people requiring multi-disciplinary team (MDT) input/care coordination
• people who require secondary care (specialist) mental health services 
• people presenting with active suicidal risk or risk to others (they will generally be referred to Crisis Response Teams)
• people who are currently receiving talking therapy elsewhere
• people who have had previous treatment in the service
• those presenting with PTSD to multiple incidents of trauma (typically four or more)
• people with complex emotional needs and/or a current diagnosis of a personality disorder. This includes Emotionally Unstable Personality Disorder, sometimes referred to as borderline personality disorder (BPD)
• people with severe substance misuse problems (e.g. dependent alcohol problems) where that needs to be the focus of the intervention
• diagnostic criteria for an eating disorder
• diagnosis of bipolar disorder (exceptions apply)
• diagnosis of psychosis (exceptions apply)

See Downloads for a full list of exclusion criteria.

How to Refer

Locations

Camden Talking Therapies

Islington Talking Therapies