Maintaining progress in the IAPT journey

by Steve Skinner

15 January 2019

The IAPT programme (improving access to psychological therapies) has been running for 10 years. With good outcomes, the NHS is currently on a journey to ensure more patients can benefit from the evidence-based services. This blog follows a presentation by NHS England at a mental health site visit to Nottinghamshire Healthcare NHS Trust

Many of us will experience mental health problems that we will seek help for at some stage of our life. 

The improving access to psychological therapies (IAPT) programme has been operating nationally for 10 years with significantly more people benefiting from evidence-based talking therapies than ever before in the UK.  IAPT delivery is characterised by the provision of evidence-based psychological therapies, delivered by an appropriately trained and supervised workforce with routine outcome monitoring of patients’ progress. 

Approximately one in two patients recover based on set psychometric measure thresholds and two in three show a reliable reduction in their symptoms.

Drawing on its undoubted success, IAPT has set out on a journey under the Five-year forward view for mental health. There are plans to see more patients year-on-year by 2020/21, improve the quality of service for patients seen with long term health conditions (LTCs), implement an activity- and outcomes-based payment approach and increase the use of digitally enhanced therapies. 

Such ambitious aspirations have presented significant challenges to partnership areas, themselves undergoing radical change processes.  However, the benefits of a fully functioning IAPT service offer great rewards to patients and their families, increased efficiency in mental health delivery and significant financial savings to healthcare systems.

Investment in IAPT is often undermined by drift in practice, which can result in poorer performance and efficiency of the treatment system.  One example of this is not identifying the right problem descriptor at assessment or recording everything as ‘mixed anxiety and depression’. 

Although this seems a trivial issue, it results in patients not receiving the right treatment for their condition and spending longer in treatment than is necessary.  Additionally, in some areas, perverse incentives in contracting have also led to a reduction in the availability of low-intensity interventions and treatment interventions across systems being capped.  Such schemes often lead to poor treatment experiences for patients and a poor return on investment by commissioners. 

2018/19 has been the first year of clinical commissioning groups’ targets for the number of IAPT expansion trainees and of CCGs’ directly providing funding for salary support costs.  In setting the scene for this development, many areas have completed demand and capacity exercises to better understand patient flows in their IAPT services and allow detailed planning for the expected increase in patient numbers leading to 2020/21. This has also allowed trajectories for trainee recruitment to support an appropriately IAPT trained workforce to ensure delivery of national model and NICE treatments.

This year has also seen a focus on the development of integrated IAPT pathways for LTCs in non-pilot CCGs (and embedding of IAPT LTCs for pilot sites), and  the wider roll out of employment adviser pilots supporting IAPT patients to retain and regain employment. 

Further development and embedding of IAPT LTC pathways is important for a number of conditions ensuring patients receive psychological intervention adapted to their particular health condition.   Recovery rates have been maintained above 50% and there have been universal reductions in primary care utilisation in most pilot areas.

This blog was prepared in conjunction with Zoe Boyes – senior quality improvement manager, East Midlands Clinical Network, NHS England.

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