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A guide to Improving Access to Psychological Therapies services
The Improving Access to Psychological Therapies (IAPT) Manual is the definitive source of information on how to set-up and deliver excellent IAPT services, says Professor David M Clark.
Depression and anxiety disorders can have a devastating effect on individuals, their families and society. Thankfully, considerable progress has been made in developing effective psychological therapies. This progress has been recognised by the National Institute for Health and Care Excellence (NICE) which now recommends particular psychological therapies as first choice interventions for depression and anxiety disorders. In most countries few members of the public benefit from these advances as there are insufficient appropriately trained therapists. England is an exception. Starting in 2008, the NHS has trained and employed an increasing number of clinicians to work in IAPT services. People treated in these services can expect to receive a course of NICE-recommended psychological therapy from an appropriately trained individual and to have their clinical outcomes monitored and reported.
From small beginnings a decade ago, the IAPT programme has grown so it now sees over 900,000 people a year. Around 550,000 have a course of psychological therapy. The others receive an assessment, advice and signposting (if appropriate). A unique monitoring system ensures over 98% of treated individuals have their depression and anxiety assessed at the beginning and end of treatment. Some attenuation of clinical outcomes might be expected when treatments are delivered outside the artificial environment of clinical trials. However, IAPT set itself the ambitious target of achieving similar results. Specifically, at least 50% of people who have a course of treatment (two or more sessions) should recover.
Initially, this was an elusive target but it was finally achieved in January 2017. Currently, one in two people who have a course of treatment in IAPT recover and two out of three people show worthwhile improvements in their mental health.
Achieving such excellent results has not been easy. Psychological treatments are more difficult to deliver than medication. However, much has been learned from the experience of IAPT services, therapists, patients, and trainers, as well as from analyses of the national data. The IAPT manual brings this learning together in a single document that covers workforce, measures, outcomes, supervision, investment, and service improvement.
The Five Year Forward View for Mental Health commits the NHS to further expand IAPT so up to 1.5 million people a year are seen by 2021. The IAPT Manual has been written to help commissioners, managers and clinicians expand their local IAPT services while maintaining quality and ensuring that patients receive effective and compassionately delivered care. Readers will find invaluable guidance on setting up and running an efficient IAPT service that achieves good outcomes while creating an innovative and supportive environment. Among other things the manual is clear on the importance of ensuring:
- All staff have been properly trained and benefit from regular supervision.
- Patients are treated promptly, receiving the appropriate NICE recommended treatment(s) for their particular clinical condition and up to the NICE recommended number of therapy sessions.
- Patients have the option to self-refer, and are given a choice about their therapy and how it is delivered.
- Services encourage and respond to patient feedback; have a focus on ensuring the well-being of their staff; and ensure that therapists can join their patients in the out-of-the office therapy assignments that are a critical part of most NICE recommended treatments for anxiety disorders.
The Manual also dispels some myths. For example, national data show that IAPT is not just for mild to moderate problems. Around half of the people with depression have moderate to severe symptoms.
IAPT is a work in progress. Much more can be learned about how to effectively deliver psychological therapies at scale. For this reason, the IAPT manual also provides guidance on how to use local and national data to better understand the strengths and limitations of a service, along with advice on developing and evaluating service innovation projects.
Read more information about the history of IAPT and how it has developed.
Thank you for your previous response. Can you inform me who that team of individuals with a wide range of mental health policy and programme management experience as well as clinical expertise is.
The team is the National IAPT Policy Team
Thank you for your previous responses. I have been trying to understand how strategy is decided and implemented for the IAPT programme. Is there a steering body, a committee, board of directors/governors for IAPT within NHS England, or is it solely the remit of the National Clinical and Informatics Advisor?
The national IAPT Programme comprises of a team of individuals with a wide range of mental health policy and programme management experience as well as clinical expertise. The IAPT Programme reports to the Mental Health and Dementia Board which aligns to the NHS England Board. View information on the NHS England Board and its members.
It seems to me that advising on both clinical issues and informatics could present conflicts of interest, on the face of it suggesting that they should be separate roles, held by separate post holders. What are your thoughts on that?
We have no plans to separate those roles at this time.
I wonder whether you could confirm that this blog is still active?
I wonder if you could confirm whether the National Clinical and Informatics Advisor for the IAPT programme is one or two roles? It seems to me that advising on both clinical issues and informatics could present conflicts of interest, on the face of it suggesting that they should be separate roles, held by separate post holders.
The National Clinical and Informatics Advisor for the IAPT programme is one role.
I work as a psychotherapist and see the gap in GP practice towards using the mental health service. I am very keen to provide mental health care in the GPs. Are GPs in a position to employ counsellors/psychotherapist or is this provided through arranging an IAPT service.
Thank you for your comment.
Many IAPT services and clinicians now offer treatment within GP surgeries and other areas of primary care which is strongly encouraged nationally. All IAPT clinicians are employed by IAPT services and will need to have completed an IAPT-accredited training programme, with nationally agreed curricula aligned to NICE guidance. High-intensity therapists should be accredited by relevant professional bodies. All clinicians should be supervised weekly by appropriately trained supervisors. The IAPT workforce consists of low-intensity practitioners and high-intensity therapists who deliver NICE-recommended interventions for people with mild, moderate and severe depression and anxiety disorders, operating within a stepped-care model.
All this talk about IAPT,yet my daughter is suffering and struggling to get even the most basic help with her bipolar depression!
She has been in bed alone for over 6 weeks in Norfolk,and has seen a community nurse for one hour fortnightly!
Care in the community has failed her,there is absolutely nothing.
They have drugged her up and sent her packing.
She has had no food not bathed or showered or had any interaction with the outside world for over six weeks,she has no carer and little money.
I live in Lincolnshire and have now fetched my daughter home ,as Norfolk have left her suicidal heavily medicated and unable to care for herself!
Lincolnshire have offered her more but she still needs quality therapy at Maudsley in London.
She is in hospital now I,but treatmen is inadequate and she is still in bed all day and no therapy.
I requested a second opinion at
Maudsley ,Norfolk Pooh poohed my request !
She will not survive unless she goes to a specialist unit and is seen by professionals
I want to learn how to heal the stress disorders, to trigger offs hallucinations
What does this mean for therapists working in IAPT who are not using a ‘NICE recommended therapy?’
I am a cognitive analytic therapist and have worked in IAPT for 5 years. I get good recovery, excellent patient feedback,and can see there is a definite need for a relational therapy for some of the people who refer to the service. Those who primarily struggle intrapersonally, and those who may have not engaged with other therapy approaches. This provides increased access to therapy for the complexity of people who refer to services.
The manual appears not to recognise a need for a broader approach to service development, and I worry how rigidly managers and commissioners will adhere to this.
IAPT services provide evidence-based treatments for people with depression and anxiety disorders, and comorbid long-term physical health conditions (LTCs) or medically unexplained symptoms (MUS) (when integrated with physical healthcare pathways). IAPT services are characterised by providing evidence based psychological therapies at the appropriate dose, having an appropriately trained and supervised workforce and carrying out routine outcome monitoring. Low-intensity interventions (guided self-help, computerised CBT and group-based physical activity programmes) have been identified as being effective for sub-threshold depressive symptoms and mild to moderate depression, as well as some anxiety disorders. For people with persistent sub-threshold depressive symptoms or mild to moderate depression who have not benefited from a low-intensity intervention, NICE recommendations include the following high-intensity psychological interventions: CBT, interpersonal psychotherapy (IPT), behavioural activation, couple therapy for depression, brief psychodynamic therapy and counselling for depression. For moderate to severe depression, high-intensity interventions recommended by NICE include CBT and IPT. Various forms of specialised CBTs are the NICE-recommended high-intensity treatments for specific anxiety disorders.
CAT (Cognitive Analytic Therapy) is not a NICE recommended treatment for the conditions treated in IAPT and therefore it should not be offered within the IAPT model. Should NICE guidance be updated to include CAT as a treatment for IAPT appropriate presentations we would seek to include this within the IAPT model, however this is not the case currently.
If you require any further clarification please get in touch with the IAPT team at NHS England via email@example.com.
All very good saying NICE recommendations .
but if your County has absolutely nothing to offer even when a person becomes suicidal apart from a Pharmaceutical drug cosh( which we all know brings up more questions than it answers )then what is the point of you writing about recommendations.
My daughter lives alone and has been left to fend for herself with depression .
I live in another part of the country and could get no help or even a second opinion,yet you write as though we can all access the NICE guidelines!
Can I suggest you look at what is happening in Norfolk urgently and talk to Cromer MPs etc and Check out Hellsdon hospitals record !
If your family member was suffering you would have written your comment differently ..Norfolk is a county with nothing and there are many more .
Depression can’t wait ,we can’t get help.
This is why I want MY daughter to go to Maudsley Psychosis unit with her depression as they are the only quality people who understand therapy ,any suggestions