1. Demand and Capacity for Psychological Therapies
TRAINING IMPLICATIONS

2. Aims of this Presentation:
An introduction to demand and capacity theory as it applies to psychological therapy services
Consider training implications
Plant a few seeds of interest and hope

3. Definition of a Psychological Therapy Service
Any local service – providing psychological therapy
Primary Care Mental Health Team
CMHT
Clinical Psychology service
Psychological Therapies Service

4. Context: “The Matrix”
A Guide to delivering evidence-based Psychological Therapies in Scotland
‘Local matched/stepped-care models designed to maximize capacity of the system, and make best use of available expertise and resources’
up-skilling of staff alone will not be enough to produce the necessary increase in capacity
organisational change and service re-design will be essential
One of the functions of the Mental Health Collaborative will be to facilitate such change

5. New Jargon - Demand Capacity Activity and Queue
Demand is not how many people are referred or our waiting list
Capacity is not the number of staff we have
Activity is what we do within our capacity
Our waiting list is actually a Queue

6. Why are Demand and Capacity Important?
Knowing more about our demand and capacity means we can make informed changes:
“If you always do what you have always done,
you will always get what you always got.”

7. Demand Demand is not a number of referrals:
it is how much staff time each referral takes to discharge x number of referrals
e.g. 10 referrals that take 10 hours each are a demand of 100 hours
different types of referrals require inputs of differing duration
brief therapy referral may take 4 hours of Low Intensity therapist input
complex psychotherapy referral may need 100 hours of expert psychotherapy

8. Capacity Capacity is not simply a number of staff:
it’s what is delivered with the time
But Capacity is not simply clinical hours:
there are different types and levels of input
different staff have different capacity
self-help 3 sessions
low intensity CBT 6 sessions
integrated complex therapy 18 sessions
self-help capacity is twice low intensity
low intensity is a third of complex

9. The Pyramids of Demand and Capacity

10. A Typical Service

11. 100 Cases by Tier 20 30 50

12. 20 Staff by Tier 3 7 10

13. Cases
Staff 20 30 50 3 7 10

14. 100 Cases by Time - Demand 20 x 20 hrs 400 30 x 10 hours 300
200

15. 20 Staff by Capacity (cases per week)
3 x 10 30
7 x 10 70
10 x 20
200

16. Demand and Capacity
May Not Match! 
Demand Capacity

17. Measuring Demand and Capacity
The more data we have
the more informed changes we can make
Demand
analyse referrals by demand
Capacity
analyse capacity by time and type

18. Patient Group / Severity Training required / competencies
Help From “The MATRIX”
Level of Therapy
Patient Group / Severity
Treatment delivered
Training required / competencies
Low Intensity
Patient Group: Common Mental Health Problems – Stress/Anxiety/Depression
Severity: Mild/moderate, with limited effect on functioning
Supported self-help, solution-focused problem solving, structured anxiety management groups, self-help coaching.
1 to 4 appointments
(1 to 3 hours)
5-10 day training plus intensive, ongoing clinical supervision
Level of competence: must meet the ‘Skills for Health’ ‘Low Intensity’ competences
High Intensity
Patient Group: Common Mental Health Problems
Severity: Moderate/severe with significant effect on functioning.
Standardised psychological therapies – delivered to protocol and normally lasting between 6 and 16 sessions
(6 to 16 hours)
Diploma level
Normally at least 24 days formal teaching, 24 days of CBT in the workplace, plus intensive supervision over at least 1 year of training.
Level of competence: must meet the ‘Skills for Health’ ‘High Intensity’ competences
High Intensity - Specialist
Patient Group: Moderate/Severe mental health problems with significant effect on functioning-Specialist areas
E.g.: Schizophrenia, Personality Disorder, Bi-polar Disorder, Eating Disorders, Substance Misuse etc
Severity: Moderate/Severe with significant effect on functioning
Standardised psychological therapy, developed and modified for specific patient groups. 16 to 20 sessions.
(16 to 20 hours)
Diploma level CBT training, plus further training in application of CBT techniques to specialist area. Further knowledge and skills may be acquired through formal training or through specialist supervision.
Level of competence: must meet the ‘Skills for Health’ ‘High Intensity’ competences
Highly Specialist
Patient Group: Complex, enduring mental health problems with a high likelihood of co-morbidity, and beyond the scope of standardized treatments.
Severity: Highly Complex
High specialist, individually tailored, interventions, drawing creatively on the theoretical knowledge base of the discipline of psychology. Normally lasting 16 sessions and above.
(20 + hours)
Competences:
Specialist knowledge of a range of theoretical and therapeutic models
Ability to formulate complex problems using a range of psychological l models, taking into account historical, developmental, systemic and neuropsychological processes.

19. Patient Group / Severity Training required / competencies
Help From “The MATRIX”
Level of Therapy
TYPE OF DEMAND
Patient Group / Severity
Treatment delivered
TIME DEMAND
Training required / competencies
TYPE of CAPACITY
Low Intensity
Patient Group: Common Mental Health Problems – Stress/Anxiety/Depression
Severity: Mild/moderate, with limited effect on functioning
(1 to 3 hours)
5-10 day training
intensive, ongoing clinical supervision:
Level of competence: must meet the ‘Skills for Health’ ‘Low Intensity’ competences
High Intensity
Patient Group: Common Mental Health Problems
Severity: Moderate/severe with significant effect on functioning
(6 to 16 hours)
Diploma level
Normally at least 24 days formal teaching, 24 days of CBT in the workplace, plus intensive supervision over at least 1 year of training.
Level of competence: must meet the ‘Skills for Health’ ‘High Intensity’ competences
High Intensity - Specialist
Patient Group: Moderate/Severe mental health problems with significant effect on functioning-Specialist areas
E.g.: Schizophrenia, Personality Disorder, Bi-polar Disorder, Eating Disorders, Substance Misuse etc
Severity: Moderate/Severe with significant effect on functioning
(16 to 20 hours)
Diploma level CBT training, plus further training in application of CBT techniques to specialist area. Further knowledge and skills may be acquired through formal training or through specialist supervision.
Level of competence: must meet the ‘Skills for Health’ ‘High Intensity’ competences
Highly Specialist
Complex, enduring mental health problems with a high likelihood of co-morbidity, and beyond the scope of standardized treatments.
Severity: Highly Complex
(20 + hours)
Specialist knowledge of a range of theoretical and therapeutic models
Ability to formulate complex problems using a range of psychological l models, taking into account historical, developmental, systemic and neuropsychological processes.

20. Understanding Your Team Capacity
One to One Therapeutic Contact
System Administration
Supervision - receipt & provision
Liaison / Support / Training other services
Continuing Professional Development
Management, Employer Admin
Annual Leave, Bank Holidays, Sick Leave

21. Opportunities for Releasing Capacity for Clinical Work
travelling time
meetings
allocation meetings
clinical admin
sickness rates
Keep it right with individual job planning

22. Increasing Capacity - Training
Define competencies needed to match identified demand
Measure existing capacity
Identify shortfall(s)
Define training needs
psychological therapies
types and levels
Supervision (and making use of supervision)
Assessment skills

23. Consider Demand and Capacity
What Training?
Consider Demand and Capacity
Where treatment options are comparable in terms of effectiveness, consider capacity issues:
the cost of treatment in terms of therapist time and other resources
the time required in training staff to deliver the intervention,
transferable skills
method of delivery – group/manual/computer
time per patient
what percentage of time trained staff are able to deliver the intervention within the service

24. Increasing Capacity with Training
Not just psychological therapies:
Change has many training implications....
admin skills
meeting/leadership skills
research & innovation skills
planning skills
time management skills

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