NHS England is working with 37 early implementer sites leading the development of NICE-recommended psychological therapies integrated into physical healthcare. Improving Access to Psychological Therapies (IAPT) Project Manager Rebecca Gill reflects on the achievements so far of the IAPT programme, and highlights some of the benefits of integrated working for both healthcare providers and patients.
Improving Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies to around 900,000 people a year. In August, IAPT services achieved the national recovery target of 50 per cent for the eighth consecutive month which is a huge achievement for all involved.
Success of the IAPT programme has been recognised nationally and the Five Year Forward View sets out a commitment to expand IAPT services so that 1.5 million people can access IAPT every year. This is equivalent to 25 per cent of people who have depression or an anxiety disorder. Two-thirds of this expansion will focus on improving access for people with a long-term condition (LTC) or medically unexplained symptoms (MUS).
Around 40% of people with a common mental health problem also have a LTC. Conversely, approximately 30% of people with a LTC also have a mental health problem – for MUS we know it is around 70 per cent. As a psychological wellbeing practitioner I have seen the impact co-morbid physical and mental health problems can have on people’s lives. Patients are less likely to engage with treatment for their physical health condition, they are likely to have poorer employment outcomes and less likely to self-manage their physical condition.
Our mental and physical health is intrinsically linked and the time has come for this to be recognised. The Five Year Forward View commits to providing the right care at the right time. We know patients want to have one assessment which meets all their needs, where they only have to tell their story once.
IAPT-LTC services provide access to NICE-recommended psychological therapies that are truly integrated into physical healthcare pathways. There is robust evidence to show that services designed in this way reduce stigma of mental health, improve patient experience and outcomes by providing more coordinated and collaborative care.
As part of the commitment to expand psychological therapies, NHS England has been working with 37 early implementer sites which have trail-blazed development of these IAPT-LTC services. The new services are truly integrated into physical health pathways. IAPT practitioners attend multidisciplinary team meetings, case reviews and are co-located with physical health teams which allows for those ad-hoc corridor conversations which are so valuable. The early implementer sites are acting as pioneers to achieve true integration and have linked up with other parts of the system such as mental health liaison services and health psychology to create a seamless pathway and transition.
Patients report improved experience of services. They report their needs are addressed early on and they are pleased their mental health is considered on a par with their physical health. We have received positive feedback from GPs and physical healthcare staff who have been working as part of these pathways. As a result of providing training across teams, staff report they can now deliver more holistic, patient-centred care and feel more confident when asking patients about their mental health needs.
Patient outcomes for the IAPT-LTC service are in line with the 50 per cent recovery rate of core IAPT. Some early implementer sites have submitted initial findings relating to cost savings and healthcare utilisation. These results show an increase in planned, appropriate healthcare use such as specialist nurse appointments and a reduction in unplanned care including GP appointments and A&E attendance. These findings demonstrate that IAPT-LTC services make economic sense for an NHS under pressure to make savings, and present a strong argument for further investment.
The 2017-19 Operational Planning and Contracting Guidance outlines from April 2018 all CCGs should commission an IAPT-LTC service. NHS England recently collaborated with the IAPT clinical networks to host an event in each network to share the learning so far. All parts of the system need to be involved in the design of the service to create a seamless pathway and for this reason colleagues from across the system were invited to attend the events, including physical and mental health commissioners, GPs and physical health providers.
This was a great example of collaboration between local and national teams, setting priorities and sharing best practice. Each of the IAPT clinical networks invited an early implementer site to present at their event which allowed them to demonstrate their innovative pathways and services. We also had presentations from members of the national team and clinical advisors, including a compelling presentation from Professor David Clark of the Department of Experimental Psychology, University of Oxford, who stated this was our ‘moment in history’ and chance to start treating people rather than treating the body and mind.
As the Health Service Journal, which is followed by healthcare leaders from across the country, reported – providing talking therapies to patients with long-term conditions saved nearly £200,000 for physical health services at one site.