September 2017

Dr Liz Camacho, Research Fellow at the University of Manchester, talks about the latest research into group psychoeducation intervention for people with bipolar.

University of Manchester logo

Psychoeducation involves teaching people specific skills with the aim of improving mental health outcomes, such as problem solving and other forms of coping, healthy sleeping, and working collaboratively. For people with bipolar, psychoeducation can also include teaching people to recognise the early warning signs of an episode.

Group psychoeducation is where up to 18 people at a time are brought together to work through a programme of psychoeducation topics. This approach is recommended by the National Institute for Health and Care Excellence (NICE) in the UK as a low-cost treatment for bipolar.

Our research team conducted a trial to compare how effective a structured programme of group psychoeducation was compared to unstructured peer support groups at delaying/preventing relapse in people with bipolar. As part of this trial we also explored whether group psychoeducation offers good value for money. This is known as cost-effectiveness.

It didn't cost more to provide psychoeducation than peer support but people who attended group psychoeducation used more healthcare services than people who attended support groups. There is a cost associated with this additional healthcare usage, approximately £1100 per person. People who decide how money is spent in the NHS want to know whether this additional cost can be justified by any additional benefits.

Overall it was found that the time to next relapse was similar for people who undertook group psychoeducation and those who attended support groups. However, people did find psychoeducation more acceptable than support groups. But are there other health benefits of psychoeducation?

We used a measure of general health status, the EQ-5D, to see whether psychoeducation had a benefit on overall health. The EQ-5D is used to calculate quality-adjusted life years (QALYs). QALYs measure how much longer people receiving psychoeducation are likely to live for and also take into account how well/unwell they are for this time. People who attended psychoeducation gained more QALYs (0.02) than those who attended support groups.

We also compared psychoeducation to the treatment that people with bipolar usually receive in the NHS using an economic model to estimate costs and benefits based on what we found in the trial (which compared psychoeducation with group support). The model suggested that psychoeducation may be cost-effective compared to usual care if it reduces the probability of relapse (by 15%) or both reduces the probability of relapse and increases the time to relapse (by 10%).

It is hard to say from our findings whether or not psychoeducation is likely to be cost-effective in a real-world NHS setting. One reason for this is that in the trial we compared it with support groups rather than the usual care that people with bipolar receive in the NHS. We have explored this with a health economic model, but models are partly based on guesswork. Because of this we have to be careful about how confident we are in these answers.

The full study from Dr Camarcho's research team is available via the University of Manchester website.

Find out more about Bipolar UK's Support Groups here.