By 2020/21 over 1.5 million people with common mental health problems each year will access psychological therapies. People with common mental health problems often also have physical long term conditions such as diabetes or cardiovascular disease. When mental and physical health problems are treated in an integrated way people can achieve better outcomes. We are supporting 22 Early Implementer projects across the country to lead the way in integrating psychological therapies with physical health care:
Aylesbury Vale and Chiltern
Chiltern and Aylesbury Vale already has an integrated mental and physical health care pathway for Respiratory Disease called “Breathe Well” and has some integrated services for management of Long Term Conditions in primary care called “Live Well”. The Live Well service will be rolled out to all GP practices and primary healthcare teams in both CCGs. Each physical health care team will have a psychological therapist linked to them – providing a single point of contact and access to all long term conditions and Lifestyle management services.
Blackburn with Darwen and East Lancashire
East Lancashire and Blackburn’s vision is for an integrated mental and physical health care service working across NHS and Third Sector IAPT providers. A clear pathway will be created, understood and owned by patients and providers. In year 1 they will develop an integrated service for people with chronic obstructive pulmonary disease. In year 2 this will be expanded to include diabetes, other respiratory problems and cancer. These areas have the greatest numbers of unplanned admissions with no clear clinical outcomes locally, this strongly indicates that the population would benefit from an integrated IAPT intervention.
In Calderdale psychological therapies will be embedded into cardiovascular , respiratory and diabetes pathways. This will enable service users to get a full package of physical and psychological support. Long term conditions champions will be developed across each service. Champions work closely with physical healthcare services and professionals including physiotherapists, respiratory nurses and cardio nurses. They will provide and attend training, and engage with GPs to embed psychological therapy into surgeries.
Cambridgeshire and Peterborough
Cambridgeshire and Peterborough are developing an integrated care pathway with community and acute healthcare specialities. They will be collaborating with physical health teams and building on their existing links to expand their Psychological Wellbeing Service. The new service will focus on diabetes, cardiovascular disease and respiratory disease. It will be built into their new primary care service which incorporates physical and mental health care – ensuring integrated care is at the heart of the new service
Coastal West Sussex, Crawley and Horsham and Mid Sussex
The IAPT services in this area already have a good record of working with patients presenting with long term conditions and good interfaces with community nursing teams. Building on these strengths therapists will be co-located in physical health teams allowing better communication between teams and integrated care. Initially the service will be working with chronic obstructive pulmonary disease, coronary heart disease, diabetes, chorionic fatigue syndrome and ME.
Greater Huddersfield and North Kirklees
Greater Huddersfield and North Kirklees plan to develop integrated care pathways with chronic obstructive pulmonary disease, dementia care, cardio vascular disease, diabetes and pain management. Existing links with the providers of support for people with long term conditions will be used to further develop pathways so that the extended service is an integral part of them. The service will be co-located within GP practices and the acute trusts. To support physical health professionals in identifying and referring people who would benefit from the integrated service the team are developing a screening tool.
Harrogate and Rural District
The Harrogate project will develop an integrated IAPT service in local coronary and diabetes services. The project includes joint training, assessment and co-working to increase access to psychological therapies alongside physical health care. The new service will be integrated into the local primary and acute care systems vanguard. The vanguard encompasses community nursing, adult social care, social work, occupational therapy, physiotherapy, pharmacists, mental health support and voluntary sector input – and integrated psychological therapy will strengthen it further.
Herts Valleys and West Essex
The aim of the project in Herts Valleys and West Essex is to provide a patient centred model of care to support people with long term conditions to improve their mental health and wellbeing. The focus is on delivering a structured programme of interventions to newly diagnosed patients and those who have complex health needs including diabetes, respiratory disorders and musculoskeletal conditions including chronic pain. Services will be collocated and be part of a shared pathway to enable multidisciplinary input and effective supervision of staff.
Hillingdon aims to establish an integrated IAPT service working collaboratively with acute and community care to improve the quality of life of those who live with long term conditions. The service will focus on respiratory problems (asthma and chronic obstructive pulmonary disease) and diabetes. Hillingdon has an established clinical health psychology service is already embedded in acute hospitals – IAPT therapists will work within the existing service (expanding capacity), as well as integrating into community services.
Devon aims to integrate psychological therapy in stepped care delivery across a number of long term condition pathways including diabetes, chronic obstructive pulmonary disease and obesity to improve mental and physical health care. The integrated IAPT service will be co-located in physical healthcare settings, focusing on working collaboratively with practice nurses and GPs and reducing stigma attached to accessing services.
North East Hampshire and Farnham
The project in North East Hampshire and Farnham involves the use of long standing links within primary care and IAPT. The care pathways include a well-established chronic obstructive pulmonary disease pathway that offers a range of protocols including house-bound working, psycho-education courses and integrated working with pulmonary rehabilitation team. Therapists will also be working within a medically unexplained symptoms pathway which includes a formulation team working with GPs and patients who are frequent attenders. Perinatal pathways and pathways for cardiovascular disease will also be developed further.
North Staffordshire and Stoke on Trent
North Staffordshire and Stoke on Trent aim to expand their IAPT service to work in partnership with the local healthcare trusts, working with diabetes, respiratory conditions and musculoskeletal pain. Practitioners will be integrated into a new Community Long Term Conditions Multidisciplinary Service. The service have started delivering training to physical healthcare staff on assessment/identification of mental health problems and low-level interventions, and this will be continued and strengthened.
The development of the integrated service in North Tyneside provides an opportunity to build on current progress to support community and acute care in the management of long term conditions. The integrated service will support people with diabetes, cardiovascular disease, respiratory disease, and in the future rolling out to cancer and chronic pain. The existing service has strong links with Health Psychology, Community Matrons and District Nurses and they plan to build on this. Integrated IAPT clinics will be offered at the same time as physical health care clinics to create a one system approach to care and staff to work closely together offering live support, guidance and consultation increasing knowledge of services.
Nottingham West aim to build on their experience of integrating IAPT and services for people with long term conditions. The existing IAPT service works closely with people with long term conditions, older people and those most at risk of hospital admissions. They aim to expand to work with diabetes/ pre diabetes, obesity, chronic pain management, eczema and psoriasis. The integrated service will be operated as part of the adult integrated community services local care team.
Oxfordshire plan to work in an integrated way with other specialists and physical health workers to increase access to psychological treatments, improve recovery rates and reduce health care costs for patients and their carers. The service will initially offer support to patients in the following areas; cardiac, pulmonary, diabetes and medically unexplained symptoms.
In Portsmouth therapists will work in long term conditions pathways to improve access for patients with a range of conditions including chronic pain and fatigue, diabetes, stroke, chronic obstructive pulmonary disease and cardiac arrest. Staff in the integrated service will be working with district nurses and psychologists already working in physical health services. The objectives are to bring together key stakeholders, GPs, A&E, ambulance services and local acute and community services together to create a seamless pathway.
Richmond will start by implementing pathways for people with diabetes and medically unexplained symptoms. These are areas of significant demand pressure in the borough; services will expand to include respiratory and cardiovascular conditions within 2017. Staff in primary and secondary care will be trained in the detection and referral of people with comorbid mental and physical health conditions. Interventions will be integrated with existing physical health rehabilitation and health promotion (e.g. local exercise referral and weight loss programmes) as well as integration with social support through employment specialists.
Sunderland will develop a service that will target a range of physical health conditions in collaboration with primary care and acute sector partners, building on existing integrated pathways in obesity and cancer . Integrated IAPT teams will be embedded into Sunderland city community integrated teams to ensure collaborative working and identification of patients who frequently attend A&E and GP Practices. Sunderland hopes this will also allow for joint referrals, client discussion and closer working with specialist practitioners.
Swindon aims to provide an integrated psychological therapy service for patients with chronic obstructive pulmonary disease and those attending cardiac rehabilitation services in the local community and acute trusts. A range of evidence based treatments will be offered in the service including Cognitive Behavioural Therapy (CBT) and Mindfulness. The service has well established relationships with acute care teams, and is facilitating workshops for teams to share knowledge on mental health and build relationships between teams.
Warrington’s collaboratively designed project aims to respond to local need identified by general practice. The expansion of integrated services will build upon existing services in the area and work with conditions prevalent in Warrington including MUS, diabetes and chronic obstructive pulmonary disease. The IAPT provider will work closely with GPs to identify patients who present at surgeries. They plan to robustly integrate existing drop in sessions for diabetes in the local acute hospital, once this is established they will extend this to patients with chronic obstructive pulmonary disease.
Windsor, Ascot and Maidenhead, Slough and Bracknell and Ascot
Talking Therapies in East Berkshire will build upon their existing ‘Talking Health’ low intensity intervention for people with diabetes and mental health problems. This service will be expanded, and high intensity interventions included alongside a wider range of long term conditions, including chronic obstructive pulmonary disease, chronic fatigue syndrome, and irritable bowel syndrome. The new team of Integrated IAPT therapists will be based in primary care and co-located with others in a ‘GP cluster’. Staff will be working in partnership with nurse practitioners to undertake care planning reviews with those patients who are struggling with self-management and promote effective goal setting.
Wokingham CCG, Newbury and District CCG, North and West Reading CCG and South Reading CCG
Talking Therapies in West Berkshire has developed relationships and protocols for working with people who have long term conditions. The service will now expand by building on this framework to develop the Integrated IAPT service working with diabetes, medically unexplained symptoms, chronic obstructive pulmonary disease and cardiac rehabilitation. They will develop new ways of working to offer an enhanced integrated psychological service within clustered hubs in Primary care to work with targeted patient groups and high users in partnership with GP’s.