BACP welcomes this report which we hope will improve understanding of the challenge and opportunity the NHS faces in effectively treating common mental health problems such as depression and anxiety. BACP also welcomes the connections made between mental and physical health and the clear argument for investing to save.
BACP Chief Executive Laurie Clarke said:
"Lord Layard's timely report is a stark and compelling reminder to the Government and the NHS about the scale of mental health care needed in the UK and the importance of investing in it now. As the report demonstrates, providing access to mental health care for all those who need it will be a considerable challenge but it is one which we must tackle head on. Our counsellors and psychotherapists are among the best in the world but we need the Government to establish a comprehensive framework through which they are able to deliver their services across the UK to all those in need."
In addition to the recommendations made in the report, BACP would like to add that psychological therapists also work with individuals, couples and families who seek therapy to help with addressing and resolving specific problems, making decisions, coping with crises, adjusting to challenging life events, living with addiction, stress, surviving sexual abuse working through conflict or improving relationships with others.
Thus while IAPT is an important model developed to help people with depression, it needs to be delivered alongside targeted models of service delivery such as primary care counselling services and counselling in the voluntary sector that has evolved to meet community needs over four decades. For example, commissioners in Bristol have implemented the IAPT model and after extensive local public consultation are now innovating with the Any Qualified Provider model to provide more counselling for a wider range of issues.
To safeguard both the implementation of IAPT and continued provision of other valued psychological therapy services, BACP suggests that each of the recommendations in the report be broadened to take account of the enhanced services required to meet those needs.
Government's announced mental health policies should be implemented on the ground - BACP agrees that budgets allocated for the implementation of IAPT should be used to roll-out the programme at the local level. BACP has recently presented a case to the DH on how to improve cost efficiency and outcomes in IAPT by recruiting a higher proportion of qualified and experienced therapists and providing them with brief top-up training in one of the NICE - approved trainings, instead of recruiting non-therapists and training them over the course of a year.
IAPT targets should be reflected in the NHS Outcomes Framework - BACP believes that the Outcomes Framework should be more balanced to include more on mental health and wellbeing. IAPT targets should feature as one strand.
After 2014 the IAPT programme needs a further phase when it is expanded to cover people suffering from long-term conditions and medically unexplained symptoms. Children and Young Person's IAPT will also need to continue till 2017 - BACP agrees there is a strong case for investing in psychological therapies for people with long-term conditions and medically unexplained symptoms, as well as investment in services for young people. BACP would argue that it is more efficient for the NHS to build on existing provision than to continuously reinvent services and suggests that in broadening its remit IAPT needs to work collaboratively with other established and effective services.
In the context of young people, BACP is campaigning for access to counselling in every secondary school as a preventative and accessible model for addressing many of the problems young people face that can lead to mental ill-health in childhood, or later as an adult.
Commissioning Board will need to nurture IAPT - BACP suggests that the Commissioning Board needs to nurture the commissioning of mental health and wellbeing services, including but not exclusively IAPT. BACP also suggests that mental health and wellbeing is a public health concern, therefore Health and Wellbeing Boards and Local Authorities should also be more engaged.
Training of GPs will also need to change and include a rotation in an IAPT or CAMHS service - BACP considers that GP training in mental health and wellbeing could be improved and suggests that rotation on an IAPT or CAMHS service might be part of the solution. BACP recommends a review of GP training in mental health and wellbeing.
Recruitment to psychiatry should be increased, if we are to handle properly the more complex cases of mental illness - BACP understands that complexity is not the same as severity of mental illness, although the two often co-exist. Psychological practitioners at every level can work with clients who have complex presenting problems. BACP suggests that an audit of supply and demand across psychiatry, psychology and psychological therapies would be beneficial.
In summary, BACP is broadly supportive of the report and the recommendations, while indicating that the focus for the NHS needs to be broader than depression and anxiety to take account of the problems that people need help with in enhanced psychological therapy services. This report presents an important part of the picture, but not the whole picture.
The full report published by the London School of Economics can be viewed online here: http://tinyurl.com/d6azuzf