Improving Access to Psychological Therapies

Question 1

What challenges face mental health?

Answer 1

-major depression is second leading cause of disability
-medication is commonly only option
-therapy is often not evidence based
-

Question 2

What’s IAPT characterised by?

Answer 2

• self-referral
• accessible locations
• measure and report patient outcomes at every session
• unique psychological workforce

Question 3

What are the motivators behind IAPT?

Answer 3

• economic argument (societal costs of depression exceed treatment costs)
• NICE guidelines (gold standard evidence base for therapies, offers patients a choice)
• stepped care

Question 4

What is stepped care?

Answer 4

• treat people with most effective, least intrusive intervention that meets their treatment need
• least restrictive treatment provided first (still likely to be effective)
• self-correcting
• treatment monitored systematically
• collection of IAPT clinical record fundamental to effective operation (outcome monitoring)

Question 5

What are the roles of a PWP?

Answer 5

• collaborative care

- supervision

Question 6

What is collaborative care?

Answer 6

• PWP acts as a case manager by facilitating communication between the patient and all other clinicians involved in their care
• on its own reported to improve treatment response to both psychological and medical interventions

Question 7

What are the supervisions a PWP receives?

Answer 7

• clinical skills (once per fortnight, groups up to 12)

- case management (individually and weekly an hour for full caseload with an experienced mental health professional)

Question 8

What’s low intensity CBT (LICBT)?

Answer 8

• focuses on patients utilising CBT interventions themselves
• work is between sessions, at own pace
• reduces time the practitioner is in contact with patient
• reduces training time needed for practitioners
• reduced demand on the service for each patient treated

Question 9

What’s high intensity CBT?

Answer 9

• traditional therapist delivered CBT according to evidence-based protocols
• stepping up can be considered when patient fails to improve at step 2, severity/impact of patient’s difficulties is significant, in some cases the patient had a disorder for a long time

Question 10

What are the stages in working with GAD?

Answer 10

• vicious cycle of worry
• recording worries (2)
• categorising worries (3)
• worry time (4)
• problem solving (5)

Question 11

How are practices being adapted?

Answer 11

• self referral route is more acceptable for people from BAME communities
• cultural considerations pre-assessment and during assessment
• collaborative care
• adapting practice

Question 12

What is the overarching approach to adaption?

Answer 12

• identify diverse need
• research and understand the diverse need (keeping patient as expert, exactly how will the treatment be as usual)
• research evidence-based adaptions (keeping patient as expert, maintaining fidelity to treatment and intervention models)
• discuss and agree adaptions to be trialled
• trial and review