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Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in community mental health teams (CMHTs) can act as gatekeepers for access to psychological therapies for those in secondary care, but little is known about how they make referral decisions. This paper aims to understand how CMHT practitioners make decisions about who to refer or not, to secondary care psychological therapy services (PTS).

A total of 11 CMHT practitioners were interviewed to understand the decision making processes underpinning their referrals or otherwise, to a PTS within NHS England. The data were analysed qualitatively using thematic analysis.

Thematic analysis resulted in 11 sub-themes under three main themes of the self, the organisation and wider structure and the service user. Results indicated that some participants were referred automatically for psychological therapy if a service user asked or if there was external pressure to refer, while others’ decisions were informed by contextual information such as the service user’s ability to engage or change, risk status and limited organisational resources.

This study explores the decision making of multi-disciplinary professionals referring to PTS. The findings have important implications for understanding some of the factors that can influence patient access to psychological treatment in secondary care.

Despite the emergence of NICE guidelines regarding the effectiveness and appropriateness of psychological therapies for the majority of common mental health problems, access to these services is still dramatically underdeveloped and uneven. Estimates of untreated problems such as depression and anxiety in primary care signal the extent of these problems and the scale of investment in new services, if these needs are to be adequately met in the future.The Department of Health's and the Care Services Improvement Partnership's (CSIP) Improving Access to Psychological Therapies (IAPT) programme sets out a framework and a series of co‐ordinated actions, including two national demonstration sites, to begin to address these issues in England.This paper examines the origins and policy drivers that have given rise to the IAPT programme, outlines the progress to date and specifically assesses the implications for the mental health workforce of this programme. Issues addressed include the workforce profiles of existing services, career frameworks for psychological therapists, the capacity of training providers to train new and existing staff in psychological therapies and the challenges implicit in devising a workforce delivery plan to support the IAPT programme.

Measures introduced to mitigate the spread of coronavirus-19 (COVID-19) may have contributed to an increase in waiting times for face-to-face psychological treatments. As adults with intellectual disabilities (ID) are more likely to encounter barriers when accessing remote therapies, it is important they receive appropriate support while waiting. To understand what care is needed, this service evaluation [aimed to] explored the experiences of service users with ID who have waited for treatment during the pandemic.

Seven individuals who had been waiting for psychological therapy during the COVID-19 pandemic, which included those waiting longer than the national health service target of 18 weeks, were interviewed. Data were analysed using framework analysis.

The following four key themes were identified: waiting has been “painful”, related to how service users continued to experience difficulties whilst they waited; tolerating the wait, highlighted that individuals understood the reasons for waiting; use of coping strategies where service users identified both internal and external strategies they had used to cope; and support and contact from the learning disability team, related to how individuals experienced the support they received from the service.

To the best of the authors’ knowledge, this service evaluation is the first to explore the experiences of service users with ID waiting for psychological therapy during the Covid-19 pandemic. Results guide suggestions on improving support whilst they are waiting to help prevent further decline.

The purpose of this paper is to provide an overview of the clinical governance issues involved in the provision of psychological therapies within a context of massive demand and expansion underpinned by recent policy developments at the Department of Health. Raises awareness of the potential risks to Trusts involved in inadequate governance of therapy provision.

The paper shows an informed review of the recent policies and influences affecting the development of psychological therapies and the clinical governance issues arising from them.

The paper compares the realities of service provision with the ideal model of service delivery recommended by the Department of Health. Raises concerns for all those Trusts providing psychological therapies about their governance and risk management arrangements.

The paper shows the key summary and opinion for all Trusts responsible for provision of psychological therapies.

The purpose of this study was to explore the views of psychologists working in community teams for people who have intellectual disabilities (ID) on the provision of psychological therapies to those with ID and autism spectrum disorder (ASD).

Semi-structured interviews were carried out with seven clinical psychologists working across a large geographical area. Interviews concerned the accessibility and effectiveness of psychological therapies. These were transcribed and analysed thematically.

Participants expressed concern about lack of access to mainstream services, the lack of visibility of their service and the suitability of the physical space to deliver therapy. They were positive about the effectiveness of therapy but emphasised the importance of adaptations and managing expectations.

There is a lack of research in this area, and further research is needed with service users to develop a fuller understanding of their needs.

Consideration needs to be given on how to optimally deliver psychological therapies for this group. This will need services to become more flexible and focussed on the needs of this group of service users.

This paper provides insights into the views of psychologists on providing psychological therapy to people who have autism and ID.

The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities.

As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities’ community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs.

Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature.

This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability.

A number of initiatives have been developed to ensure easy access to mental health services for Black and Asian Minority Ethnic (BAME) communities. Improving Access to Psychological Therapies (IAPT) is a service that delivers first line interventions for South Asian women; however, little is known about what makes IAPT accessible for this population. This paper aims to explore South Asian women’s experiences of accessing psychological therapy and whether therapy within IAPT helps individuals to re-frame their experiences within their own cultural context.

A qualitative approach was used. Semi-structured interviews were carried out with South Asian women who accessed an IAPT service. Ten participants took part in the study and interviews were analysed using thematic analysis.

Six themes were identified; access, experience, cultural framework, therapist characteristics, expectations and “sticking with it”. Having a good therapeutic relationship with the therapist was key. While cognitive behavioural therapy (CBT) enabled clients to manage their symptoms, manualised CBT led to a sense of dissatisfaction for some. Clients spoke of having to make a forced choice to either deny their culture or leave their culture at the door to access therapy. Cultural and religious exclusion had a negative impact on therapy particularly for those whose difficulties were related to their cultural or religious context.

Culture and religion continues to be excluded from psychological therapy for South Asian Women. A cultural shift is required from within IAPT services to maintain engagement for this group. Further clinical implications are discussed.

While the experiences of Black and Asian ethnic minority groups accessing secondary mental health services has been explored, this study explores and highlights the experiences of South Asian Women accessing therapy in primary care, and uniquely identifies the processes that enable women to engage in therapy.

Psychological therapies are increasingly being made available to adults with intellectual disabilities. However, little is known about service user satisfaction with this type of intervention. The aim was to ascertain quantitative and qualitative data on user satisfaction with the psychological therapy they had received.

In total, 20 recipients of psychological therapy completed the Satisfaction with Therapy and Therapist Scale – Revised (STTS-R; Oei and Shuttleword, 1999) and the Experience of Service Questionnaire (Commission for Health Improvement, 2002). The scales were adapted for language and administered in an assisted completion format by an independent researcher after a course of psychological therapy had been completed. Descriptive statistics were used to analyse the quantitative data and thematic analysis was used to analyse the qualitative data.

Generally, recipients were highly satisfied with their therapist and the therapy they received.

The results confirm previous findings from two small-scale qualitative studies. Service user satisfaction is a key quality outcome measure and can be collated in routine practice for people with intellectual disabilities. The collation of qualitative responses in addition to quantitative measures is important to enable the expression of dissatisfaction and greater detail in order to inform service improvement.

Two years ago, we published within this journal a scoping article (Turpin et al, 2006) concerning the urgent need to review and enhance the workforce responsible for delivering psychological therapies to people seeking help for common mental health problems in primary care (London School of Economics, 2006). We estimated that the demand for such interventions, the service models that might deliver increased capacity for psychological treatments, the implications for workforce numbers and the impact that this would have on education and training. Much of the thinking that was adopted within the review was based on current development work around the mental health workforce led by the National Workforce Programme sponsored by the National Institute for Mental Health England (NIMHE) on New Ways of Working (NWW).The current paper reflects on the process and the added value that NWW has contributed to what is a radical new venture, which has been described by the lead evaluator of the pilot Improving Access for Psychological Therapies (IAPT) phase, Professor Glenys Parry, as 'the industrialisation of psychological therapies'. More specifically, it reviews the implementation of a national programme designated as IAPT, which was commissioned on the basis of the NWW work, and the evidence accrued from the IAPT national demonstration sites at Doncaster and Newham, together with the efforts of Lord Layard and the New Savoy Partnership.The first year implementation of IAPT is described, together with the lessons learned from the roll out. As the programme has developed, it has become important to ensure that clients also have a choice of evidence‐based interventions. NWW has provided a means to help practitioners come together from a range of therapeutic orientations and professions to contribute to this more diverse workforce. Finally, it is argued that NWW has been instrumental in helping managers and professions alike think more flexibly about service models and provision, and how to develop a new workforce competent to deliver such an innovative service.

The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic.

A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews.

Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy.

This is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase.