Increased Access to Psychological Therapies IAPT

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Increased Access to Psychological Therapies (IAPT)

• Jonathon Cash
• Lead Psychologist Learning Disabilities /
• Trust Advisor for Psychology

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Aims

• To outline what IAPT is and the story so far
• To give a sense of what is happening in the South
  West and services that might be available
• To consider ways in which people with Learning
  Disabilities might benefit from IAPT

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IAPT Aims to implement NICE guidance for people
with depression and anxiety

• First Phase Two demonstration sites - Doncaster
• - Newham
• Aim to increase availability of CBT to those who
  need it

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Pilot Sites

• Doncaster
• Mainly depression although many also considered
  to have generalised anxiety. PTSD and OCD
  excluded.
• Mainly white
• High throughput stepped care. Emphasis on low
  intensity work especially guided self-help
• Newham
• Depression and all anxiety disorders
• Ethnically mixed with many who do not speak
  English
• Greater emphasis on high intensity CBT

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• A treatment at least two sessions
• 5500 referred in 13 months, 3500 concluded their
  involvement
• PHQ GAD used every session
• 52 recovery for people who had anxiety /
  depression for more than six months
• Gains maintained 4-12 months later
• 5 more of treated population in employment

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Self Referral

• 1 in 5 in Newham self-referred
• Appeared to increase access of disabled
  individuals not well served by existing referral
  routes
• Self referrers at least as unwell, had problems
  for longer, more closely match ethic mix of
  community

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Recommendations

• Use Session by session outcome measurement and
  add
• - brief measures of employment
• - disability
• Accept self referrals
• Include a brief diagnostic assessment on entry to
  service
• Clear criteria and capacity for people to be
  stepped up (and down) between low and high
  intensity interventions
• For depression especially, do a routine follow up
  after 3-6 months later and offer booster sessions
  if needed

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Step 1 Interventions

• Watchful waiting
• Books on prescription
• Advice to GP

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Step 2 Interventions

• Exercise on prescription
• Books on prescription
• Guided self help over the phone
• Carers Groups
• Psycho-education courses
• (e.g. stress management, depression,
  assertiveness, relaxation and
  mindfulness, overcoming phobias
• Computerised CBT
• 3-5 sessions face to face CBT

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Step 3 Interventions

• NICE compliant CBT, 8-16 sessions, individual or
  group
• EMDR
• Case Management

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Specialist Services (Step 4 Interventions)

• Complex presentations
• Co- morbidities
• High risk
• Personality Disorders, Trauma, Abuse,
• Parenting and LD
• Longer term / intensity of input,
  Multi-disciplinary
• Communication
• Systems issues

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People with LD

• People with Learning Disabilities have more needs
  and more difficulty accessing services
• Healthcare for All, DDA means people with
  Learning Disabilities must be able to
• access services available to all.
• reasonable accommodations must be made.
• equality of outcome important not just the same
  inputs

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Learning Disabilities

• What works for everyone else is probably a good
  starting point
• Many people likely to need nature of help to be
  adjusted to achieve equivalent outcomes
• Power issues and influence of other people in
  persons life. Who or what needs to change?

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Questions

• Which interventions are likely to be most usable?
• What adaptations / accommodations might be needed
  to give chance of equivalent outcome?
• How do Learning Disabilities agendas such as
  Health Action Plans or Health facilitation relate
  to supporting people to access psychological
  therapies?