The expansion of Improving Access to Psychological Therapies and stepped care models for long-term conditions

In February 2011, the UK government published the document No health without mental health: A cross-government mental health outcomes strategy for people of all ages (Department of Health, 2011). This set out the strategy for improving the mental health and wellbeing of the nation, with one of the priorities being the expansion of the IAPT programme to include people with LTCs and/or medically unexplained symptoms (MUS).

The original aim of the IAPT project was to increase the provision by primary care organisations of evidence-based treatments (including cognitive behavioural therapy (CBT)) for common mental health conditions, such as anxiety and depression. This was based on a 'stepped care' or triage model, whereby 'low-intensity' interventions or self-help would be first provided to most people, followed by 'high-intensity' interventions for more-serious or -complex conditions. The later expansion to treat people with LTCs was crucial, as up to 70% of people suffering with LTCs will also suffer from depression and/or anxiety disorders. This expansion was significant because such mental health disorders are detectable and treatable, irrespective of the explanation for the physical symptoms.

Watch this brief video on how IAPT supports individuals with LTCs:

Within phase 1, 15 therapy teams across England were selected to become IAPT LTC/MUS (de Lusignan et al., 2013) Pathfinder sites, with the roll-out of the project starting in April 2012. An evaluation of the Pathfinder phase 1 sites was conducted in September 2013 by the University of Surrey. The evaluation demonstrated that the IAPT project for LTCs was feasible but highlighted issues with care pathways, interventions, training, supervision and skill mix. The quantitative evaluation was based on a very limited data set. However, it did indicate improvement in some of the patients. It was seen as essential that phase 2 data quality be improved to make a stronger case for the IAPT LTC/MUS programme.

Phase 2 began in April 2014 with the government producing the report Achieving better access to mental health services by 2020 (Department of Health, 2014). It detailed what action the government was taking to provide better access to care in mental health services. From 2016, it was guaranteed that individuals would receive treatment within six weeks for 75% of people referred to the IAPT programme, with 95% of people being treated within 18 weeks (Mental Health Taskforce, 2016).

This led to the development of the new IAPT LTC guidelines in 2018, which guided the implementation of integrated services (National Collaborating Centre for Mental Health, 2018).

Further reading

You can read the full implementation guidance from the National Collaborating Centre for Mental Health for IAPT in people with LTCs on the Royal College of Psychiatrists website. The implementation guidance can be found under the heading 'The IAPT pathway for people with long-term physical health conditions and medically unexplained symptoms' and is titled 'IAPT LTC full implementation guidance'. You will need to read this guidance in preparation for Activity 9.1.

More recently, Seaton et al. (2022) conducted a study to establish the association of LTC status with clinical outcomes, using routinely collected IAPT data. They found that having an LTC was associated with only 32% recovery from mental health illness, compared with 39% recovery in patients without an LTC. These findings led the authors to suggest that mental healthcare treatment in patients with an LTC remains an unresolved priority. After Activity 9.1, we'll move on to examining the types of treatments that would be offered, aimed at improving outcomes in LTCs, and will begin by discussing CBT.

Activity

Aim: To consider the benefits of integrating mental and physical healthcare.

Duration: 15 minutes

Resources: Unit 9 materials and implementation guide for IAPT in people with LTCs produced by the National Collaborating Centre for Mental Health.

Task: Read about one benefit of integrating mental and physical healthcare in the implementation guide. Add this to your personal notes.

Feedback: You will have the opportunity to discuss your point with other students and your tutor during the first ten minutes of the webinar.