Improving Access to Psychological Therapies (IAPT) in London Implementing NICE Guidance

Professor Stephen Pilling PhD Director, National Collaborating Centre for Mental Health Research Department of Clinical, Educational and Health Psychology University College London

IAPT in London

• IAPT is NICE’s largest and most successful implementation programme • Initial focus on depression and anxiety disorders (IAPT-DA) • In London – 100,000 people accessed IAPT since 2008 – Recovery rate of 42% (50% in RCTs) – 600 new clinicians recruited and trained by HEIs – Range of NICE recommended treatments (GSH, CBT, IPT, BA, CT, Counselling, DIT) – 31 services established based on stepped care model (LI and HI) – Outcomes available http://www.ic.nhs.uk/pubs/psychologicaltherapies1112 • New developments – IAPT-DA – focus on LTCs and MUS – IAPT-Chd – depression, anxiety and parent training for children (in CAMHS) – IAPT-SMI – for schizophrenia and bipolar disorder (in secondary care services) – IAPT-PD – for personality disorders (in specialist services)

The key ingredients of IAPT

• A strong commitment to the delivery of evidence based interventions to defined populations • Effective systems for the efficient delivery of care – The stepped care system • Case identification and assessment • Least intrusive most effective interventions first (LI and HI interventions) • A self-correcting mechanism – Strong links with primary care – Accessibility (self-referral and multiple routes of entry) • A competent and skilled workforce – High quality training in psychological interventions – High quality training in supervision – Delivery of high quality supervision • Routine outcome monitoring – Sessional outcome measurement – Robust electronic systems for data collection – Transparency about outcomes

Maintaining quality

• Maintain focus on effective service delivery – The stepped care system (balance of LI and HI) – Effective progression through the system – Ensuring the

right

– Continued training balance of effective treatments are provided – Strengthen links with primary care – Develop new models of working (LTCs, MUS, Comorbidities – D&A Misuse) – Strengthen links with public mental health • A competent and skilled workforce • Replenishing the workforce • Developing existing staff skills – Continued supervision • Use outcome monitoring

to improve

– Service targeting and quality – Individual staff performance – Meeting national benchmarks (resource dependent)