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Time to Increase Access to Psychological Therapies in Wales?
There's a new delivery plan (2016-19), for realising the objectives of the 2012 'Together for Mental Health ' strategy for mental health and well-being in Wales. This builds upon the 2010 Mental Health Measure and its various statutory requirements for service standards, and work undertaken since the launch of the strategy in 2012.
The foreword in the strategy by the First Minister proposed that mental health is very much everybody's business, and cannot be compartmentalised as a specific function of a single government department. The responsibility is shared across work, culture, leisure, housing and the economy, "our actions are all intertwined", as well as resting with individuals. There was also recognition that the most vulnerable within society, are more likely to present with mental health problems, which inevitably draws in many individuals receiving social care and support.
Elsewhere the document refers to building upon mental health care within primary care settings, service ‘redesign’ and increasing early access to high quality preventative and treatment services. With this in mind, I wonder why Wales hasn't replicated the English experience of the Increased Access to Psychological Therapies (IAPT) programme.
IAPT in England
In England, IAPT has seen a huge increase in the availability of psychotherapy. It is a national initiative to help people with common mental health problems such as anxiety and depression gain timely access to evidence based treatment. Treatment is based upon protocols developed from Cognitive Behaviour Therapy which are highly specialised to each specific condition. As IAPT has expanded so has its coverage of more complex mental health presentations as well as its reach across the age range, with services for children and adolescents becoming available.
Typically, individuals receive 6 - 8 sessions of CBT. There is a strong focus upon building rapport, assessment, formulating the dynamics of the problem and working out why it persists, and directly addressing underlying thought and behaviour patterns. Clients have input in terms of identifying goals which are meaningful and motivational for themselves, whilst therapists are required to ‘check-in’ with clients throughout therapy.
The evidence for CBT is drawn from research studies which show that psychological conditions based around medical diagnostic criteria, such as 'depression', or 'phobia', display mood, thought and behavioural patterns which are characteristic of the condition. From such research, treatment protocols have been developed which allow therapist and client to work with these problematic experiences in a focussed way.
In 2014 – 15, around 1.3 million referrals were made to IAPT services. Whilst not all referrals enter into face to face treatment (self-help, bibliotherapy and online resources are also available), of those who did and completed treatment just under half report 'reliable recovery'.
Whilst IAPT is not without criticism, some decry what they see as the over-reliance upon a single treatment modality (CBT). The large caseloads and unspectacular recovery rates, it is clear that IAPT has significantly increased the availability of effective talking therapies to those who need them.
Time for a Welsh IAPT
Wales has seen no replication of IAPT. Whilst there has been some development of local CBT based services, it has not been on the scale or level of systematic organisation that there has been in England. This means that provision is patchy and waiting times longer, especially at a primary care level.
Whilst the new strategy is laudable, it is no substitute for concerted action on a national basis. Whilst austerity and availability of funding is clearly an issue, a serious evaluation of effectiveness might highlight shortcomings in existing mental health services. In an age where money is tight, and the level of under/untreated psychological distress considerable, in my view it would be better to move services towards the evidence and initiate a Welsh IAPT.
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