Agenda item

Presentation: Improving Access to Psychological Therapies (IAPT)

Meeting of Health Policy and Performance Board, Tuesday, 4th November, 2014 6.30 p.m. (Item 29.)

Minutes:

The Board considered a report of the Strategic Director, Communities which highlighted that 5BP had recently been awarded the contract to provide the Improving Access to Psychological Therapies (IAPT) service which went live on 1 August 2014. It was reported that 5BP were the principal provider but were also working in partnership with Self Help Services (SHS) to deliver the service.

The Board was advised that IAPT was the Department of Health’s (DoH) mandated model for providing talking therapies for anxiety and depression in primary care. The main principles of the service were:-

· Improving access;

· Improving quality; and

· Demonstrating effectiveness.

The Board was further advised that the IAPT model stated that provision should be the least intrusive intervention first i.e. start with brief therapy, if this was not successful, offer more intensive therapy. The three steps are as follows:-

· Step 1 - GP interventions;

· Step 2 (provided by the IAPT service) - Guided self help, between 6 and 8 half hour sessions with lots of things to read and do between sessions; and

· Step 3 (provided by the IAPT service) - “Traditional” therapies, between 12 and 20 hour long sessions and Cognitive Behaviour Therapy (CBT).

It was reported that referrals for the service came in writing from GPs. Clients were written to and asked to call the service for an appointment and were usually assessed within a week and placed on an appropriate waiting list.

The Halton model had been based on the Award winning Wigan service provided by 5BP. This service was recently identified as being in the top ten services in the country with regard to quality. The model used a self-referral system that improved access to talking therapies for clients and had the highest recovery rates in the North West. It had also met the 50% recovery rate target “since records had begun.

Staff were also supported using a complex continuing professional development system to ensure that the clinical quality of the service was good.

The Board also received a presentation from Mr Paul Campbell, Clinical Psychologist on the IAPT service which included:-

· The principles of the IAPT service;

· The conditions that they treated within the service;

· Details of what the service would look like including the three steps in the process;

· Explained that CBT was a type of therapy that helped the client to understand how mood, behaviour, thinking and styles and physical factors were all linked and the associated risks;

· Undertook a short quiz; and

· Highlighted how clients were referred to mental health services.

It was reported that 45 days was the average time on the waiting list and work was taking place to reduce this to 28 days. It was also reported that 45% of people recovered after receiving therapy. Evening appointments were also popular and consideration was being given to offering the service on Saturdays.

The following comments arose from the presentation:-

· It was noted that therapies ranged from three weeks to 20/25 weeks;

· It was noted that there were only two clinical psychologists in the service as the model worked in a process of steps and it meant that therapy was not always required immediately i.e. if an individual was depressed, they would commence treatment immediately with a mental health coach;

· Concern was raised that referrals were via a GP and it was very difficult to see the same GP, there was no continuity and therefore this could result in the model failing. In response, it was reported that encouragement and training would be given to GPs, nurses and health visitors etc to identify the issues and encourage them to refer individuals as soon as possible;

· It was noted that there were currently 350 referrals a month and it was anticipated that this number would increase as the service progressed. It was also noted that many of the referrals had been from people who had been depressed for many years. The model, it was reported was designed for people who had been depressed for a short time, but to date not many had been referred to the service;

· Concern was raised regarding the self referral method which relied on the individual contacting the service to make an appointment. It was highlighted that if the GP did not undertake a follow up on whether an appointment had been arranged, it could result in serious consequences. In response, it was reported that training would be given to health care professionals and GPs would also have their own therapist and mobile number which would help to address this potential issue;

· Clarity was sought on whether there had been any referrals from SAAFA or other military groups. In response, it was reported that there were a lot of hard to reach groups and there would be therapists with lead responsibility for various hard to reach groups such as the military and BME etc and would undertake visits. In Wigan, it was reported that the Veterans Council had referred directly to the service;

· Concern was raised that 28 days was a long time if an individual was seriously depressed. In response, it was reported that 28 days was the target and the best case scenario would be for an individual to receive an assessment and commence treatment a week later. However, it was highlighted that due to a national crisis in recruiting staff for Step 2 individuals offering people a service less than 28 days was very challenging;

· The Board noted the marketing strategy and the LEEF campaign; and

· The Board requested that an update report, including the response from GPs be presented to the Board in six months.