How the IMPARTS project inspired clinicians to integrate care

The IMPARTS project will effectively end October 2023 but the project has left a legacy that will continue to influence the way physical health clinicians care for their patients for years to come. We spoke to Candice Ebelthite to find out more. 

What was the IMPARTS project?   

The IMARTS project started as a small pilot in the rheumatology and liver reconstruction clinics in King’s College Hospital NHS Foundation Trust in 2012. It quickly became wildly popular and other teams decided that they wanted to use it too. Effectively what IMPARTS set out to do was to integrate mental healthcare into a physical healthcare setting. The project was driven by a desire to help people living with long term physical health conditions - like rheumatoid arthritis, diabetes, heart failure - who were more likely to have anxiety or depression related to their condition. This trend meant these patients were less likely to adhere to treatment plans, they were also more likely to struggle with their health going forward. So King’s Health Partners decided to try and integrate care by setting up this screening program, which became known as IMPARTS. 

What was your role with the IMPARTS project? 

I was a project manager so my role was predominantly supporting the implementation of IMPARTS in clinics that wanted to assess their patients' mental health alongside their physical health. Services that wanted to set up IMPARTS would meet with me and tell me about the condition they dealt with, and the kind of things they wanted to assess in their patients. We had some core (mandatory) questionnaires that everybody had to use such as the Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder (GAD) Questionnaire, as well as a Smoking Questionnaire, which was redeveloped by the Smoking Cessation Leads across both Trusts. The other questionnaires were dictated by the particular clinics and what they wanted to assess. For example, in trauma clinics, it could be something around PTSD, pain or appearance. In other clinics, it might be to do with sleep, fatigue or quality of life. We ultimately developed a library of around 230 questionnaires that people could use.   

We worked together with the clinical teams to find the questionnaires that would help the most and explored how they could manage any need that was identified out of those questionnaires. We asked would they be able to refer their patient to a psychologist or a psychiatrist? If not we asked, where could they refer them to? We co-developed a standard operating policy with the clinic, including all the questionnaires they would be using, best practice advisories, and Trust guidance around risk; built the screening link; trained the team in using the system; and helped them to start embedding screening as business as usual in their clinics.  

How did people respond to IMPARTS? 

Most of the time, people were enthusiastic. We always had loads of interest, even up to quite recently. One of the things I always noticed was how passionate people were about their patients. There's obviously always a lot of interest in the data gathered in terms of the research possibilities, but also a genuine desire to make a difference for their patients.  

Were there any moments throughout IMPARTS that you were particularly proud of? 

I'm proud of all the services that I've managed to help, especially the ones where IMPARTS was something very different to what they were used to. It's difficult for people who work in physical health teams to pick up something like this and run with it, suddenly asking their patients about their mental health. It doesn't necessarily come naturally to them, so when you work with a team who has managed to do that, it makes you proud. In some ways it changes the culture and the philosophy that people have - it's made people think a bit more about what holistic care and treatment is.  

Kathy Fan, a Professor of Maxillofacial surgery said something like ‘instead of just seeing a jaw or just seeing an arm or just seeing a broken leg, you see a person who's been profoundly affected by something, and that is going to have an impact on how well they recover and how they use services. It impacts the kind of the quality of life they will have’.   

If you can treat the entire person rather than having this mind body barrier, then you're doing a better thing in the long run for your patients, for the NHS as a whole as well. I think the fact that IMPARTS has tried to address this cultural, social, philosophical, intellectual barrier between mental and physical healthcare is a massive thing. IMPARTS is really small in some ways - it's 130 services that have used it across two Trusts, in one city in one country in the world. In a way, it's really small, but I had a supervisor at university who told me about a Jewish proverb  - save one life, and you save the entire world. I think if you've made a difference to one patient in your clinic then you've done a good thing. It's hard, yes, it's difficult and it doesn't always work but if you've helped one person, then it makes it worth it. In the end, you’ve changed one person's life.  

You're changing a culture. Even though IMPARTS is now ending it has changed things. It has changed the way that people think about holistic care and that is going to affect the future in a positive way. It was worth it!  

To learn more about the IMPARTS project, the team have shared a digital book to summarise the impact on this project.