The COVID-19 pandemic increased population levels of depression and anxiety, and infection control measures obliged services to provide psychological therapies remotely. Evidence for the routine provision of psychological therapy via telephone and video-conferencing is limited. This study compared therapy outcomes for 5360 clients in two London Improving Access to Psychological Therapy (IAPT) services before and after homeworking produced a compete shift to remotely delivered therapy. Despite the psychological impacts of pandemic restrictions, and the use of a novel therapy modality in video-conferencing, recovery rates and net score change improved in both services, significantly in one. There was no significant worsening of outcomes for any demographic group or presenting disorder. The findings suggest that for those able to access it, therapy provided by telephone and video is a clinically effective option for IAPT services. Key learning aims (1) To assess the clinical effectiveness of delivering IAPT therapies remotely. (2) To gain insight into the impacts of remote therapy on different client groups, including ethnicity, gender, age and presenting problem. (3) To assess the impact of remote therapy on access to IAPT services.
Abstract. The Improving Access to Psychological Therapies (IAPT) initiative was created to provide mental health services for those experiencing mild to moderate depression and anxiety. IAPT is commissioned on the basis that it achieves adequate performance on a number of 'key performance indicators', one of which is the proportion of clients who 'move towards recovery' following treatment. The impetus for the current evaluation was a significant reduction in the proportion of clients recovering within an IAPT service. Data for this clinical audit was obtained from IAPT electronic records (IAPTus). Three factors (waiting times, clinical contact and starting scores on the PHQ-9 and GAD-7) were examined and explored separately for each level of care (i.e. steps 2 and 3). These factors were analysed in relation to recovery and compared between periods of low and high recovery within the service. Results reveal that there was little change in the severity of clients' starting scores between the periods of low and high recovery. Increased waiting time in the period of low recovery was not associated with recovery status. The amount of clinical contact was related to recovery at both time periods. Limitations and implications of the findings are discussed.
Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility. Key learning aims (1) To gain insight into client and clinician experiences of VT during the COVID-19 pandemic. (2) To assess the acceptability and feasibility of VT within two NHS short-term psychological support services. (3) To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.
People of minority ethnic backgrounds are less likely to access mental health services in the UK, and often report poorer outcomes. This paper describes a Focus Group run in an inner London IAPT service, exploring the lived experiences of women of Black Caribbean heritage who had accessed psychological therapy and not recovered. Important principles and recommendations for clinical practice were identified, which will hopefully stimulate discussion and contribute towards enhancing cultural sensitivity at local and wider service levels.
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