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How has IAPT evolved?

Improving Access to Psychological Therapies (IAPT) is fast becoming an overarching term for the emerging UK-wide NHS agenda for improving mental health and wellbeing. While there is a common goal, the approach to tackling this varies significantly across the UK.

England

First phase: Demonstration Sites

National IAPT demonstration sites were set-up in Doncaster and Newham in 2006. The shared mission of these sites was to ‘test the effectiveness of providing significant increases in evidence-based psychological therapy services to people with the common mental health problems of depression and anxiety disorders. Their aim was to improve health and well-being and either to keep people in work and joining in community activity or to or return them to it.'

The sites have recently released their first evaluation reports based on the routine measurement of outcomes and patient experience - these are available to download from the IAPT website: IAPT demonstration sites . The text below is taken from the IAPT website and outlines the approach taken in each demonstration site.

Doncaster PCT

Doncaster provided enhanced access to low intensity Cognitive Behavioural Therapy (CBT) interventions. Case managers are supervised by a psychological therapist. Referrals are received from a range of primary and community settings (e.g. GPs, Job Centre Plus, employers) and services are provided both in primary care and at the team base.

In 2006/07, Doncaster developed a comprehensive stepped care model of psychological therapy provision, including frontline services provided by case managers supporting over 4,500 people.


Newham PCT

The East London and The City Mental Health Trust (ELCMHT) provided a comprehensive CBT psychological therapy service to people presenting with common mental health problems in general practices across the Borough.

The service was delivered by CBT-trained therapists and provided either in the individual's practice or in a local treatment centre. Local employers accessed the service to help people stay in employment.
The programme was complemented by increasing access to employment coaches provided by Mental Health Matters (MHM).
In 2006/07, Newham treated an additional 800 people, developed culturally sensitive CBT interventions and a further 600 people were supported in seeking to return to work.

 

Second phase: Pathfinder Sites

In May 2006/07 funding of £2million was allocated to further test the ideas developed through the first phase demonstration sites; this led to 10 pathfinder sites being established. These pathfinder sites involved existing services and staff adopting the IAPT way of working and exploring the different needs of specific patient groups. Each pathfinder site aimed to learn more about providing an IAPT type service to one of the following patient groups:

  • Black and minority ethnic groups
  • Young people
  • Offenders
  • Old people
  • People with medically unexplained symptoms
  • People with long term conditions
  • Perinatal care

For each of these areas the Department of Health also set up Special Interest Groups tasked with developing guidance based on knowledge of the field, research and experiences of the pathfinder sites. This guidance is now complete and available here: Commissioning for whole community Some pathfinder sites were successful in the bidding process to become IAPT sites in the next (current) phase of IAPT. For the full list of current sites with a special interest in specific clients groups visit: Special Interests

 

Phase three: Implementing 32 IAPT sites

In the government's Comprehensive Spending Review of November 2007, funding was announced for three years from April 2008, with the total allowance rising to £173 million in the third year. In 2008/09 this funding has been used to establish a further 32 IAPT sites. An academic/ training institution linked to each site will provide on-the-job training in high and low intensity Cognitive Behavioural Therapy (CBT) and case management for site staff.

In November 2008 the Department of Health (DH) issued a Statement of Intent that in the next round of IAPT commissioning the DH will recommend that PCT's offer an appropriate choice of NICE compliant therapies for depression and anxiety: this currently includes CBT, counselling, couples therapy and interpersonal therapy (IPT). View the statement of intent here: Statement of Intent  

For more information about IAPT sites, Special Interest Groups, training providers, the high and low intensity curriculum, stepped care, the IAPT Commissioning Toolkit, the use of outcome measures (minimum data set) and IAPT vacancies see the IAPT website

LINKS


Phase Four: Additional funding

In March 2009 additional funding was announced to allow:

  • A faster roll-out of talking therapy services across the country throughout 2009 with services beginning to be available in every area by 2010.
  • Employment support workers are to be linked to every talking therapy service, providing job support for people with common mental health problems and help people back to work.
  • Health advisors on dedicated NHS Direct phone line being trained to spot people who might be experiencing depression because of economic problems and refer them to help.
  • Better online advice and information about the availability of services near to people's homes through NHS Choices.

For more information visit the IAPT website: Click here

 

Northern Ireland

In Northern Ireland there have been some changes to funding criteria for counselling and psychotherapy in GP surgeries as part of a drive to encourage the provision of CBT. There has not been any news yet of central investment in extending the provision of psychological therapies.
To help keep informed about developments in counselling in Northern Ireland BACP members can join the independent Northern Ireland Counselling Forum (NICF).

LINK

Scotland

NHS Education Scotland (NES) is taking forward a project titled Increasing the Availability of Evidence-Based Psychological Therapies in Scotland; the argument for this project is made by the Scottish Executive Health Department (SEHD) in Delivering for Mental Health (2006). It focuses on the potential for psychological therapies to help achieve other health priorities for NHS Scotland. The document sets out three targets for Scottish Health Boards in respect of Mental Health Services, these are to:

  • Reduce the annual rate of increase of defined daily dose per capita of anti-depressants to zero by 2009/10
  • Reduce suicides in Scotland by 20% by 2013
  • Reduce the number of re-admissions (within one year) for those that have had a hospital admission of over seven days by 10% by the end of December 2009

These targets require work with a broad range of patient groups and a wide reaching psychological therapies programme; in the early stages NES is to focus on improving service capacity to deliver psychological therapies for the adult patient population in primary care with mild-moderate mental health problems. This strategy aims to impact on the target to reduce anti-depressant prescribing. NES has published a document to set out its plan for phase one implementation: Phase one implementation

LINKS:


Wales

Improving Access to Psychological Therapies (IAPT) Wales
In Wales, IAPT is a collaborative response to the challenges posed by the Service and Financial Framework (SaFF) target of achieving a maximum three-month wait for psychological therapies - a target that has not been achieved across the board.

IAPT Wales is led by clinicians, and its reference group is co-chaired by two service managers and includes representation from each Local Health Board and a range of disciplines including psychology, psychiatry, counselling and nursing. One aim of the reference group is to raise the profile of issues surrounding psychological therapy provision with the Welsh Assembly Government. So far, the group has succeeded in attracting senior civil service representation and administrative support.

To September 2008, work has centred on assessing the impact of collecting data on waiting times for psychological therapy, with the aim of identifying consistent measures. The next areas of focus will be the mapping of existing services, information gathering on those services, and the development of good practice in achieving rapid access to psychological therapies.

It is early days for IAPT in Wales. For now, it is of most relevance to practitioners involved in the delivery of psychological therapies as part of a care pathway involving secondary care. If this applies to you and you want to find out more about how your service is engaging with IAPT you could ask your service manager for more details and/or the name of the person leading on IAPT in your area.

LINKS