Psychological therapies: From there to reality

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Psychological therapiesFrom there to reality

• Kathryn Tyson
• Head of Mental Health Policy

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Introduction

• Who am I?
• What can I tell you about?
• Policy maker
• Handling
• Use psychological therapies programme as worked
  example

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IAPT its simple really

• Improving Access to Psychological Therapies
• Lets look at how the problem has been set out
• then at proposed solution
• Then how it can be so difficult
• Finally, how on earth I can help

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The problem (Layard)

• There is a mass of untreated suffering in anxiety
  and depression which imposes severe burdens on
  the economy.
• Effective means of treating it are enshrined in
  NICE guidelines but these cannot be implemented
  with the current resources of people and money.
• Evidence-based psychological therapies like CBT
  are not adequately available.

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Analysis (still Layard)

• For many people, work is a vital part of therapy
  and of the recovery process.
• At present there are more mentally ill people on
  Invalidity Benefit than the total number of
  unemployed people.
• Pathways to Work pilots show that many of these
  people can be helped back to work. These
  programmes should become available throughout the
  country.

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The proposed solution (still Layard)

• We could meet reasonable demand within 5-10 years
  by a major programme to train more therapists.
• To maintain the quality of training and
  provision, this should be through psychological
  treatment centres, working on a hub-and-spoke
  basis
• with a clear funding stream to support the work
  based on national targets. This should not be
  left to PCT discretion

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What could be easier?

• Acknowledged widespread costly problem
• Evidence-based, NICE-endorsed treatment
• Popular demand
• Case argued by No.10 advisor
• Manifesto commitment
• Professional support
• In line with NSF
• .. I could go on!

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Acknowledged widespread costly problem

• But costs do not fall where spending is
• Burden hidden
• Unmet need is cheap

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Acknowledged widespread costly problem

• But costs do not fall where spending is
• Burden hidden
• Unmet need is cheap
• Joined up Government
• Social Exclusion Unit
• CSR 2008

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Evidence-based, NICE-endorsed treatment the
peoples choice

• Not media-friendly
• But its not a drug!
• Requires workforce to do different things

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Evidence-based, NICE-endorsed treatment the
peoples choice

• Not media-friendly
• But its not a drug!
• Requires workforce to do different things
• Technology
• Making Slough happy
• Extend implementation period
• White Paper

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No.10 advisor Manifesto commitment

• No money
• SR 2006 delayed
• NHS financial situation
• Reform agenda
• Thrust of Government policy
• New wave imminent

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No.10 advisor Manifesto commitment

• No money
• SR 2006 delayed
• NHS financial situation
• Reform agenda
• Thrust of Government policy
• New wave imminent
• CSR 2008
• Fit with reform agenda
• Re-engineer solution

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Professional support In line with NSF

• Were all very busy
• There are other priorities (MH Bill, public
  safety, BME etc
• Acceptability of link to unemployment

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Professional support In line with NSF

• Were all very busy
• There are other priorities (MH Bill, public
  safety, BME etc
• Acceptability of link to unemployment
• Communicate
• Clarify and manage priorities
• Dont be precious
• Plan new effort

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What do you think of it so far?

• Understand aims and outline of service/policy
• Understand pros and cons
• Understand wider context
• Identify push and pull factors
• And employ them merrily to advance the cause

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Out of Hospital White Paper

• What it says on the tin
• New boost for MH NSF?
• Psychological therapies based in primary care
• New money/ basis for CSR bid

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The Mental Health NSF - the vision

• Services that
• Treat service users with dignity
• Value and respects the skills and role of carers
• Provide effective treatment
• Link provision to need
• Emphasise safety especially of service users
• Is provided by a skilled and motivated workforce

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The Social Exclusion Unit Report

• Six Themes
• stigma and discrimination
• role of health and social care services
• employment
• supporting families and community participation
• getting the basics right
• making it happen

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System Reform

• Key Themes
• Payment by Results
• Foundation Trusts
• New providers
• Social Care Regime
• Commissioning
• Choice
• Commissioning a patient-led NHS

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Where are we now?

• NSF Progress new types of service and roles
• SEU progress direct payments,
• Green Paper ? White Paper
• Progress on System Reform Choice, Foundation
  Trusts
• CSR 2008

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Psychological therapiesFrom there to reality