Careers in Psychological Therapies in Primary Care. Presented by: Lisa Horton RMN, CBT Practitioner Joanne Mears RMN, CBT Practitioner

Agenda What are you expecting from us today?

Historical Lord Layard (an economist), recommended that more services be provided for people with common mental health problems ie: Anxiety and Depression. He identified that people were waiting too long for interventions and as a result their presentation could become more chronic and then they cost the taxpayer money.

What do you know about IAPT? Improving Access to Psychological Therapies is an NHS programme rolling out services across England offering interventions approved by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and anxiety disorders. It was developed in 2005, following a white paper commitment in Our Health, Our Care, Our Say.

IAPT It was created to offer patients a realistic and routine first-line treatment, combined where appropriate with medication which traditionally had been the only treatment available. The programme was first targeted at people of working age but in 2010 was opened to adults of all ages.

What do you know about IAPT? In 2006/7 the IAPT demonstration sites at Doncaster and Newham were set up. Their core purpose was to collect evidence of delivery to substantiate the development of a business case for a national roll out of the IAPT service model.

IAPT By 31 March 2011: 142 of the 151 Primary Care Trusts in England had a service from this programme in at least part of their area and just over 50 per cent of the adult population had access, 3,660 new cognitive behavioural therapy workers had been trained, and over 600,000 people started treatment, over 350,000 completed it, over 120,000 moved to recovery and over 23,000 came off sick pay or benefits (between October 2008 and 31 March 2011). Two important published 'stock takes' on progress were Realising the Benefits (2010), and `IAPT: 3 Year report; the First Million Patients` (2012).

IAPT From 2011, the programme's focus has broadened, following publication of Talking Therapies: a four-year plan of action, one of a suite of documents supporting No health without mental health, the cross-Government mental health strategy for people of all ages.

IAPT By April 2015: the nationwide roll-out of psychological therapy services for adults will be completed, a stand-alone programme for children and young people will be initiated, and models of care for people with long-term physical conditions, medically unexplained symptoms and severe mental illness will be developed. Evidence shows this approach can save the NHS up to £272million and the wider public sector will benefit by more than £700 million.

Commissioners The IAPT programme has given commissioners a good opportunity to collaborate with providers from all sectors and find genuinely innovative ways of meeting local people's common mental health needs. The NHS Mandate commits all commissioners to manage improved access levels and to achieve a minimum recovery rate so that more than half of those receiving treatment will move to recovery.

IAPT for Adults Minimum Quality Standards-  As IAPT services have matured and been evaluated, a number of key characteristics have emerged which appear critical in terms of assuring quality of delivery and achieving good clinical and other outcomes. These characteristics are set out in the form of a series of standards with an accompanying rationale and suggested metric to support effective commissioning and delivery of IAPT services, and as a basis for service specifications, care pathway design and /or service audits for improving the quality of IAPT services. These are minimum standards that can be used as the foundation for implementing the choice agenda (Any Qualified Provider, AQP) in conjunction with implementation guidance at https://www.supply2health.co.uk

Our Experiences Core profession: Registered mental Nurses with fifteen + years Mental health experience in a variety of settings; inpatient, community, psychological therapies. Both had worked within primary care as liaison to GP for psychiatric triage (Gateway)

Training Post Graduate Diploma in High Intensity Cognitive Behavioural Therapy (IAPT) at University of Birmingham Sept 2008-Feb 2010 This was the first cohort of trainees employed specifically within the IAPT programme by various trusts across the region. Including Worcester, Stoke , Dudley. Training was full time

Role of HI CBT Practitioner 16 session Recommended NICE guidelines, disorder specific Eg: PTSD, Phobia, OCD, Depression, Anxiety spectrum disorders. Autonomous, lone workers, virtual team, GP Surgery based, Liaising with GP, MH Primary Care nurses, Voluntary sector, counsellors

A day in the life of a CBT Practitioner (IAPT) Appointment led Currently 9-5 service (patient choice may affect this in the future) Appointments can be for a variety of purposes: detailed CBT screening for appropriateness and suitability Therapy Pre group discussions.

A day in the life of a CBT Practitioner (IAPT) Therapeutic Group work Liaison with GP’s, team members, referrals to other services, voluntary/NHS Training and education Supervision (Peer, Group and Individual) Computer inputting (paper light service)

Typical Cases Panic with Agoraphobia: May require exposure work which could include supported visits to supermarkets, town centres, bus work. This may be done in liaison with PWP workers to ensure consistent and repeated supported treatment.

Typical Cases Depression: Treatment individual or group. Use of behavioural activation as well as cognitive restructuring. May include working with supportive family members or voluntary sector support. Liaising with GP for Antidepressant medication Assessing risk issues and creating crisis management plans

Typical Cases Anxiety based Disorders: Obsessive Compulsive Disorder (OCD) Generalised Anxiety disorder PTSD Phobia Social anxiety Health Anxiety

Limitations Currently commissioners have not tasked our service to provide therapy for: Body dysmorphia learning disabilities impulse control disorders psychosis anger issues eating disorders Expectations are that this may change in the future

Limitations Current session limits is 16 within the service No cross treatment with secondary mental health services

Today The IAPT programme is now established in every area of England. There are a number of accredited higher education institutions across the country commissioned to provide training to Psychological Wellbeing Practitioner and High Intensity Therapy trainees. These higher education institutions use the approved IAPT national curricula to train therapists. By the end of 2014/15 it is estimated that the IAPT programme will have trained 6,000 therapists to work across the country.

Today Not pure IAPT now Commissioners requirements differ regionally. GP funding influence requirements. Enhanced primary care service

Recommendations Mental health experience Voluntary?

Considerations Experience, MIND Healthy minds www.babcp.com

Requirements Initially the specifications required the candidates to have mental health experience, however this has been refined over time and now candidates are preferred who have a recognised core profession under the BABCP .

Other professions Low Intensity /Psychological Wellbeing Practitioners Graduate Workers Guided self help, Motivational interviewing, short term CBT skills based Step care model

Conclusion Review of agenda Any other questions