Improving Access to Psychological Therapies (IAPT)

IAPT - Realising the Benefits.

The IAPT, or to use its full name, Improving Access to Psychological Therapies programme has one principal aim, that is to support Primary Care Trusts in implementing National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders, like OCD by improving access to evidence based talking therapies and treatment choice by the expansion of the psychological therapy workforce and services.

In layman’s terms to, it was designed to provide faster access for people with depression and anxiety disorders like OCD to talking therapies such as Cognitive Behavioural Therapy (CBT).

One of the initial objectives that helped influence the Labour government to fund the IAPT project was the target of helping 900,000 more people access treatment, with of them 25,000 able to return to work and no longer needing to claim sick pay and benefits, by 2010/11.

This would be achieved by regional training programme's to deliver 3,600 newly trained therapists with an appropriate skill mix and supervision by 2010/11, with a specific focused on evidence based treatments like Cognitive Behavioural Therapy (CBT).

Following on from Professor Lord Richard Layard, a former government adviser, on the 2006 instrumental report on depression the IAPT programme was established with two demonstration sites in Doncaster and Newham in 2006. On World Mental Health Day in 2007, the then Labour Secretary of State for Health, Alan Johnson, announced substantial new funding of £173 million to fully implement the IAPT programme over the subsequent three years.

  • £33 million for 2008/9
  • A further £70 million to a total of £103 million in 2009/10
  • A further £70 million to a total of £173 million in 2010/11

However, in October 2009 a report in The Guardian’s Observer magazine reported that only 400 out of the 3,600 therapists had been fully trained, with part of the £173 million funding in jeopardy because of this failure to implement the programme.

But six month’s later this figure seems to have been contradicted by official figures that the Department of Health given to OCD-UK in May (7th) 2010. The Department of Health spokesperson told OCD-UK that as things stand, by the end of this financial year (5th Apr 2011) the IAPT scheme will have recruited and trained 3793 therapists, exceeding the original 3600 government target.

This was broken down a little more for OCD-UK. We were told that up until the end of March 2010, 2502 therapists had been recruited and have been fully trained, or are still undergoing training, and of those still being trained, the majority should complete training by July 2010. A further 1291 IAPT therapists were recruited to start training during this financial year, bringing the number of fully trained IAPT therapists to 3793 by April 2011.

The introduction of the IAPT programme means that more and more primary care trusts (PCTs) are introducing the option of self-referral. A self-referral system will provide quicker access to trained mental health professions, which could lead to quicker diagnosis and treatment. The benefit to our community is that self-referral helps people to help themselves and can prevent other problems developing, such as job losses, relationship difficulties or more serious mental health difficulties whilst waiting for a referral through their GP.

When OCD-UK enquired about access to these self-referral sites the Department of Health advised that the vast majority of the 112 Primary Care Trusts offering IAPT, should be offering self-referral.

So will IAPT help make a difference to people with OCD?

For the future generation of OCD sufferers, those people about to reach out for help and support then without question IAPT is a welcome resource. Self-referral will allow them to access services much quicker and for some treatment will come much sooner allowing them to tackle both OCD and other anxiety problems much more efficiently, and that could well have a significant positive impact on other aspects of that person’s life, both at home and work.

But, will IAPT benefit people already diagnosed and accessing treatment services? Well, in the majority of cases we are not sure it will. 1.2% of the UK population are expected to develop OCD, with 2-3% of people presenting to a GP surgery doing so because of OCD. One OCD textbook (OCD: The Facts by Rachman and De Silva) suggests that a disproportionately large number of cases of OCD fall into the severe category, less than a quarter are classed as mild cases. Certainly the vast majority of people that we see through OCD-UK could be classed as moderate to severe in terms of OCD disability, and this is why IAPT is unlikely to be helpful to this section of our community, because we believe in most cases IAPT is primarily best served for moderate intensity treatment for OCD, at levels 2 and 3 of the stepped care approach.

This can be highlighted by one such case in Derby where one of our members was referred for CBT by a well respected expert on anxiety to a treatment centre that is classed as level 4 on the CMHT stepped care approach. A referral for this patient to IAPT is not considered specialist enough, and this patients OCD is what we consider to be a fairly average level of severity.

To try and explain the stepped care approach to treatment this illustration offers a visual guide.

The Stepped Care Model.

So what level of stepped care does IAPT offer?

The initial step will offer help in recognition and diagnosis of a person’s OCD, and provide guided self-help materials. Whilst for most people with OCD, we believe this will not be sufficient in treating a person’s OCD, certainly earlier diagnosis and education and knowledge of the illness will be only beneficial for the next generation of people trying to access services. Additionally, if the IAPT service is not sufficient to help an individual with OCD, the IAPT therapist should be able to refer the patient up the system to a higher level of psychological intervention and treatment.

IAPT will have two types of psychological therapy practitioners . For steps 1 and 2, these will be low intensity therapy workers trained in cognitive behavioural approaches for people with mild to moderate anxiety and depression.

Moving up the stepped approach to level 3, there will be IAPT High Intensity therapists trained in Cognitive Behavioural Therapy (CBT). CBT of course the treatment of choice, and for many people with mild to moderate OCD this will be helpful, if the therapist is sufficiently understanding of the illness. If this level of CBT is not sufficient to help a person then they should look to make a referral to a level 4 within the local Mental Health Trust, or even a referral to one of the specialist OCD clinics elsewhere in the country.

To try and explain the IAPT stepped care approach to treatment this illustration offers a visual guide.

The IAPT Stepped Care Model.

So is IAPT the answer for the OCD community to access better services?

To summarise, OCD-UK (July 2010) welcome IAPT as a step in the right direction and will undoubtedly provide some benefits to the OCD community. OCD-UK will continue to support the initiative to help the future generations of people with OCD, provided the focus remains on improving access to CBT, the recommended treatment for OCD and most other anxiety related problems.

However, we remain concerned that IAPT is not quite specialist enough to treat the majority of people with moderate to severe OCD, so we would also like to see increased access to specialist OCD treatment services in all areas of the UK, not just England.

A stepped care recovery model seeks to treat service users at the lowest appropriate service tier in the first instance, only ‘stepping up’ to intensive/specialist services as clinically required. We are also concerned that patients with OCD will not be correctly ‘stepped up’ the model sufficiently for their required level of treatment and will remain on a lower intensity treatment for longer than is appropriate, resulting in worsening of treatment which inevitably will take longer to treat.

Additional IAPT Support - Employment Adviser Pilots

In March 2008 Dame Carol Black’s Review of the health of Britain’s working age people, announced that it would fund a pilot to place Employment Advisers with 12 of the IAPT sites in England to run from 2009 until 2011. The employment advisers work alongside therapists, providing information, advice, guidance and practical support to help working people using the IAPT service to remain in work, or return to work as quickly as possible. For IAPT service users who are out of work, the employment advisers help with access to Jobcentre Plus and partner support. The Employment Adviser job retention pilots are taking place in:

  • Camden and Ealing PCTs
  • Swindon PCT
  • Buckinghamshire PCT
  • West Kent PCT
  • Cambridgeshire PCT
  • East Riding & North Lincolnshire
  • Lincolnshire Partnership NHS Trust
  • Shropshire PCT
  • Central and Eastern Cheshire
  • North Tyneside PCT

This article was first published in the July 2010 edition of the OCD magazine, Compulsive Reading.

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