Psychological therapies – Penrith, Cumbria

1. Psychological therapies – Penrith, Cumbria Alan Cohen FRCGP Senior Primary Care Advisor

2. Summary • The development of the Improving Access to Psychological Therapies (IAPT) programme • The current state of play • The role of primary care and general practice

3. First, there was the case for change • The impact of untreated depression & anxiety • 1 in 6 adults (16% population) • 10% new mothers (of whom only 20% receive any treatment) • 1.3m older people • 700k children and younger people • 30% of GP consultations • Long Term conditions • Medically unexplained symptoms

4. What happened? • 2005: Manifesto commitment to improved access to psychological therapies • 2006: 2 demonstration sites created • Doncaster and Newham each funded with £1.5m

5. Demonstration Site Progress report • Access • 5,000 more people treated • 70% GP referrals • 30% Self-Referrals (anti-stigma & inclusive) • Wait times down to 2 weeks • 3 days to assessment • Service Models (Stepped Care) • Low Intensity (>8 hours) • High Intensity (>20 hours)

6. Demonstration Site Progress report • Right Results • Systematic outcome monitoring system • Health & well-being gains • Exceeded NICE guidelines (>50% recovery rate) • Social Inclusion • 100% job retention • 30% back to work or education • 7% off benefits • Choice and user experience • 90% satisfaction rates • 89% able to make choices

7. Then what happened? • May 2007: 11 “Pathfinder” sites, each funded with £200K

8. The IAPT Pathfinders • 11 PCT-led Pathfinder sites • 1 in each SHA area • Service redesign & capacity planning • 1 additional site in Bury (NW) CAMHS • Progress • 109 (70%) PCTs expressed an interest in Pathfinders • 76 (50%) full applications • Sites announced 31 July & commitment to Regional Networks

9. And then... • October 2007: SoS announces £30m/£100m/£170m new funding for IAPT programme

10. What the investment will provide: • 800,000 more people treated; 400,000 recovered • 20,000 fewer people on sick pay & benefits • 3,000 more psychological therapists • Universal GP access to therapies • Waiting times down from 18 months to 2 weeks

11. The Characteristics of an IAPT Service • Multi-disciplinary team • Teams of therapists • Equality of access • Delivering NICE compliant treatment • Stepped care system • Low intensity interventions <7 • High intensity interventions >20

12. The Characteristics of an IAPT Service • Routine outcome monitoring • Clinical and service indicators • At least 90% of patients/users/people will have outcome data • Right workforce • 60:40 high:low intensity workers • Supervision requires that at least a third of workers are fully trained.

13. What an IAPT service delivers • Psychological therapy services • NICE compliant • Links/partnership with employment services • Links/partnership with social care • Need not be delivered by a statutory sector provider

14. The Role of Primary Care - Commissioning • Development of a commissioning tool kit • Designed for any commissioner • Practice Based Commissioning • Does PBC have a role? • What are the risks associated with PBC?

15. The Role of Primary Care - Clinical • Identification, management and onward referral (where clinically indicated) to the new service • The generalist approach: • Association between mental and physical health • Use of acute services • Appropriate prescribing • Anti-depressant prescribing • Benzo prescribing • Information sharing • about the new service • with the new services

16. Physical health Strong associations exist between depression and • Ischaemic Heart Disease • Diabetes • COPD • Better management improves outcomes, and burden of disease in these areas

17. Acute services • Close association between physical symptoms and mental distress • Probably one of the elements in why recognition of mental health conditions in primary care can be “poor” • Lots of referrals to acute out patient services, for people with medically unexplained symptoms

18. Prevalence of unexplained symptoms in consecutive attendees at a UK teaching hospital Clinic % • Chest 59% • Cardiology 56% • Gastroenterology 60% • Rheumatology 58% • Neurology 55% • Dental 49% • Gynaecology 57%

19. Prescribing • Will IAPT services slow the inexorable growth in prescribing of anti-depressants? • Awaiting detailed evaluation from St George’s HMS • Benzo and Z withdrawal • http://www.benzo.org.uk/manual/bzcha02.htm • http://cks.library.nhs.uk/benzos_z_drug_withdrawal/in_summary/scenario_starting_withdrawal • http://www.pjonline.com/medicinesmanagement/editorial/200503/features/p03benzodiazepine.html

20. Benzo/Z drug withdrawal • Guidelines on withdrawal process are consistent that... • Psychological assessment is necessary • Psychological support during and after withdrawal is necessary • In the past adequate and timely availability of this support, and in the management of common mental health problems, has been poor • IAPT provides the opportunity to deliver that psychological support

21. What happens next? • PCT delivery incentives • PSA target • HSC Outcomes Framework objective • NHS Operating Framework 08/09 • SHA leadership for local implementation • Performance management • Ensuring Regional Workforce & Training solutions • Capacity (& demand) planning • Commissioning Toolkit

22. A forward look: 2008/09 • Each SHA will identify at least 2 sites to act as training centres of excellence for therapists • Each SHA will identify providers of training • Each SHA has a budget for development, including… • GP lead • PC lead • Development fund • It is up to each SHA how the development budget is used!

23. Summary • IAPT programme entering a planned dissemination phase • Engaging with groups other than “adults of working age” • Engaging with commissioners • Developing regional networks as part of the programme of dissemination and spread.

24. Further information www.mhchoice.csip.org.uk/Pathfinder/Resources