BackgroundThe Improving Access to Psychological Therapies (IAPT) programme has been impactful in increasing access to psychological therapies at primary care level. However, it remains unclear whether IAPT’s widely disseminated achievements include the reduction in service users’ transition to secondary care services and whether IAPT services are providing interventions that match the level of complexity of presenting problems of those who are referred.AimsThis review sets out to clarify the clinical characteristics of IAPT cohorts, whether the interventions provided target these characteristics, and whether outcomes are related to the use of the stepped‐care model advocated in the operationalization of IAPT services.MethodA systematic literature search was undertaken on PsycINFO, MEDLINE, and Embase using the terms: IAPT, anxiety, and depression.ResultsOf 472 paper identified, 24 articles were deemed pertinent. It appears that IAPT cohorts are complex and current service delivery frameworks may not meet their needs. IAPT developments and research for long‐term physical health conditions and serious mental illness have been recently advocated, though whether these are sufficient and viable when set in IAPT’s prescriptive backdrop remains unclear.ConclusionsImproving Access to Psychological Therapies provision and research at present does not adequately consider the complexity of its clientele in the context of treatment outcomes and service delivery. Recommendations are provided for future research and practice to tackle these deficiencies.Practitioner Points
Improving Access to Psychological Therapies (IAPT) has significantly increased access to psychological therapies within primary care over the last decade, though it is unclear whether its interventions are sufficiently tailored to meet the actual levels of complexity of its clientele and prevent them from needing onward referral to secondary care as originally envisaged.
Given the ongoing focus on and investment in IAPT informed developments into long‐term conditions and serious mental illness, this review considers whether additional elucidation of the model’s original objectives is required, as a precursor to its expansion into other clinical areas.
The review indicates that there is a stark lack of data pertaining to the generalisable, real‐world clinical benefits of the IAPT programme as it currently stands.
Recommendations are provided for future areas of research, and practice enhancements to ensure the value of IAPT services to clients in the wider context of NHS mental health services, including the interface with secondary care, are considered.
Using LESs for preventive services highlights gaps in 'core' primary care responsibilities and in the national pay-for-performance framework. Current incentive arrangements are complex, could increase inequalities and provide only a partial, short-term solution to developing a proactive approach to prevention in primary care.
This paper reports an evaluation of a training programme to enhance the skills and confidence of school nurses in addressing mental health and emotional wellbeing issues among school children. The training was offered to school nurses and nursery nurses in one school health service in London. The evaluation drew on face-to-face semi-structured interviews with, and online contributions from, school health staff members. There was evidence of considerable satisfaction with training; of attitude change; of increased confidence, knowledge and skills in addressing mental health issues; and of changes in practice. The evaluation illustrates how, in a favourable context where staff feel respected and supported, well-designed training programmes can deliver changes in practice.
Lucy Marks is the Chief Executive Officer at Compass Wellbeing CIC, London, UK.
AbstractPurpose -The purpose of this paper is to describe some of the barriers and solutions to implementing good practice in perinatal mental health promotion in universal services, and propose some ways forward. Design/methodology/approach -This paper describes the rationale and evidence base for proactive management of perinatal mental health in primary care and community services and good practice recommendations. Thereis considerable evidence that these recommendations have not been implemented nationally in the UK. A range of solutions and proposed ways forward to manage barriers to implementation are set out. Findings -It is proposed that a number of factors need to be in place in order to deliver best practice in perinatal mental health. Originality/value -The value of this paper is to set out what needs to be in place in order for services to promote good perinatal mental health and secure attachment and change the life chances of children and their parents, by intervening early. This will also ultimately save financial resources for public services, because the quality of early relationships is linked to health and mental health.
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