Michelle Gallagher (Integrated Diploma in Resilience and Wellness Coaching Skills)
A Long Term Condition (LTC), also known as a chronic condition is a condition that cannot presently be cured; however, it can be controlled by medication and other therapies including coaching. Chronic disease is the biggest problem facing health care worldwide. There are many LTCs including diabetes, heart disease, obesity, cancer, depression, epilepsy and Alzheimer’s. Health care can be made even more complicated when dealing with patients who have multiple chronic diseases (MCC), otherwise known as co-morbidity. Having a long term condition can have a significant effect on a person’s life; physically, emotionally, psychologically and socially; this can also impact on the lives of people living with them and caring for them.
The Department of Health, Social Services and Public Safety published a Policy Framework in 2012 – Living with Long Term Conditions. This policy framework aims to ensure that as far as possible people with long term conditions are able to maintain or enhance their quality of life through high-quality services and supported self management1. Since the early 1990s, more effective management of people with long-term conditions has been a key priority for the NHS. The King’s Fund is an independent charity working to improve health and health care in England. Through research and analysis, they recognised that if people with long-term conditions were managed effectively within their community that they would have more chance of remaining stable and enjoy a better quality of life.2
Long term conditions (or multiple chronic conditions) have the potential to impact on individuals in many ways including how they physically function, their mood and mental well-being, employment potential, their thoughts about the future and this can include feelings of isolation or sometimes stigma.
People with long term conditions account for half of all GP appointments, over half of the outpatient appointments, nearly three-quarters of all inpatient bed days. Financially, around 70% of the total health care spending in England is spent caring for people with LTCs (this spend is by 30% of the population)3. The number of people with one long term condition is projected to remain relatively stable over the next decade, however, the number of people with multiple LTCs is set to rise to 2.9 million in 2018 (it was 1.9 million in 2008)3.
“The most crucial issue in the management of long term conditions is how we better support people to self-care” Dr Michael Dixon, Chair NHS Alliance3.
This is where Health and Wellness coaching can play a vital role. It is known that there is a more positive patient response when patients are empowered by maximising their self-management and choice of how they are treated and helped through the shared decision making and motivational interviewing. The World Health Organisation4 has estimated that by 2020, depression will be the world’s second most burdensome illness. Most cases of depression are not clinical which means that there are other ways of approaching and dealing with depression. By moving away from single point medical interventions e.g. anti-depressants for depression, coaching offers a holistic approach to recovery. To successfully coach someone suffering from depression, it helps to identify the root cause. A lot of the time, depression can be caused by “faulty-thinking” or otherwise known as “catastrophising”. Coaching, mainly using Cognitive Behavioral Therapy (CBT) can encourage people to change their ways of thinking. Coaching provides the client with tools to identify when and why they are faulty-thinking. Coaching also encourages using exercises to alter the individual’s faulty thinking. When the individual repeats the new method over and over, this then becomes the “default” way of thinking through the neural network changes in the brain (neuroplasticity).
There is evidence to show that Mindfulness-Based Cognitive Therapy can reduce the risk of relapse by 43% for people experiencing recurrent depressive episodes5. This approach incorporates many different techniques including gentle yoga, meditation and mind-body exercise.
Wellness and Health coaching can also be effective in the treatment of depression through neuro and biofeedback. This is a therapy with the aim of bringing the mind and body back into balance and thereby achieving wellbeing. Neurofeedback allows the coach to view brain patterns in real time and through the coach’s guidance the client can learn to correct these. Neurofeedback therapy has been successful in reducing and in some cases, even avoiding the need for medication6.
Totally Health7 is an example of an independent company who provide personal health coaches who are all trained nurses, to help people with LTCs. This personal health coaching gives individuals full understanding and awareness of their condition and increased confidence to self-care. Health coaching relieves the financial and time constraints faced by the NHS. Patients no longer have to make multiple visits to the hospital as they can discuss problems by telephone with their coaches at a pace that suits each individual.
If a patient is struggling and resisting coaching, then the coaches will identify the reasons why and agree on a wellness plan that will include specific goals and lifestyle changes. Coaching can be successful due to its motivational and educational approach. I have suffered on and off with depression since my early twenties. I, like millions of others, was always offered medication to “get me through”. At my last visit to the GP, I requested CBT. Almost at the same time, I started meditating. Over the last few months, my life has turned upside down and I feel like a new person.
By empowering the patient to self-care and take responsibility for themselves is not only reducing reliance on the NHS but also ensuring life-lasting changes for clients. This could also have a knock-on effect with members of their own family and even friends. It could even have a knock-on effect from the fact an individual could be suffering from multiple chronic conditions e.g. cancer and depression, could, through effective coaching, prevent the return on these LTCs.
1Living With Long Term Conditions, A Policy Framework, Department of Health, Social Services and Public Safety, (April 2012)
2Managing people with long-term conditions, The King’s Fund (2010)
3Long Term Conditions Compendium of Information, Third Edition, Department of Health, (May 2012)
5 Mindfulness-Based Cognitive Therapy for Preventing Relapse in Recurrent Depression: A Randomized Dismantling Trial. J Williams et al, (2013)