Improving access to psychological therapies: Phase IV prospective cohort study

Richards, David; Suckling, Rupert

doi:10.1348/014466509x405178

Cited by 133 publications

(139 citation statements)

References 47 publications

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“…Outcome data showed that large numbers of patients seeking help from primary care could be treated effectively. 33,34 Although outcomes were similar in both sites, the Doncaster site was able to deliver treatment to 3 to 4 times more people. Further, recent data have shown that these results have been sustained in Doncaster beyond the period of initial intense scrutiny, 35 with a pre-post effect size of more than 1.0, and recovery and improvement rates of more than 50% in the total population of treated patients.…”

Section: Improving Access To Psychological Therapiesmentioning

confidence: 95%

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Stepped Care: A Method to Deliver Increased Access to Psychological Therapies

Richards

2012

Can J Psychiatry

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Objective: To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation.Method: Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing highvolume services for common mental health problems are derived from this experience. Results:Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidencebased treatments, access to telephony, and smart patient management informatics systems. Conclusions:Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems. W W WObjectif : Présenter les soins en étapes comme méthode d'organisation de la prestation des traitements, et envisager les facteurs nécessaires pour la mettre en oeuvre.Méthode : Les soins en étapes sont décrits dans le contexte de stratégies comme les soins en collaboration qui visent à améliorer l'accès aux soins de santé mentale par une meilleure coordination des soins entre les soins de première ligne et les services des spécialistes en santé mentale. Les résultats de la mise en oeuvre des soins en étapes au Royaume-Uni et ailleurs servent à mettre en évidence les facteurs nécessaires à l'introduction des soins en étapes dans les services réguliers. Les questions quant au moment de mettre en oeuvre des services ayant un grand nombre de patients avec des problèmes de santé mentale courants sont tirées de cette expérience.Résultats : Les soins en étapes s'inscrivent dans le continuum des systèmes organisationnels, qu'il s'agisse de situations où la responsabilité incombe presque entièrement aux cliniciens des soins de première ligne ou de systèmes où tous les patients sont pris en charge par des spécialistes pour toute la durée du traitement. Ses principes fondamentaux consistant à dispenser d'abord des traitements faciles à mettre en oeuvre, puis à surveiller soigneusement les progrès des patients pour ...

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Section: Improving Access To Psychological Therapiesmentioning

confidence: 95%

“…In IAPT, particularly in Doncaster, more SSM patients were treated via the telephone than online. 33,35 However, not all case managers are competent or comfortable with this mode of working. Where this support is delivered by telephone, case managers need confidence, equipment, and an environment where telephone contacts can take place.…”

Section: Telephonymentioning

confidence: 99%

Stepped Care: A Method to Deliver Increased Access to Psychological Therapies

Richards

2012

Can J Psychiatry

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“…PHQ9: Patient Health Questionnaire Depression Scale; GAD7: Generalized Anxiety Disorder Questionnaire.aThe PHQ9 and GAD7 can be used to determine the likely severity levels of depression and anxiety (Richards & Suckling, 2009). For the PHQ9, these are as follows: not depressed 0–4; mild 5–9; moderate 10–14; moderate–severe 15–19; severe 20–27.…”

Section: Methodsmentioning

confidence: 99%

Experiences of a transdiagnostic group, the Take Control Course, for clients with common mental health problems: A qualitative study

Morris

Mansell

Amos

et al. 2018

Clin Psychology and Psychoth

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ObjectivesDespite the promising effectiveness findings for transdiagnostic groups, studies have not explored clients' experiences. There is a risk that clients could perceive that the content of transdiagnostic groups is not sufficiently tailored to their specific problems. Our aims were to examine whether a brief transdiagnostic group, the Take Control Course (TCC), was acceptable to participants and to explore participants' perceptions of psychological change.MethodsQualitative data were collected via 12 semistructured, in‐depth interviews. Data collection and thematic analysis were concurrent and iterative.ResultsThree superordinate themes were identified: “Style and format,” “Control and flexibility,” and “Change.” The flexible group format was appreciated, as participants felt able to engage at their own pace and adapt relevant aspects. Greater clarity regarding what was within participants' control reduced distress and enabled effective pursuit of valued goals. Participants described significant (predominantly gradual) changes, including substantial improvements within relationships.ConclusionsThe transdiagnostic format did not prevent participants experiencing the TCC as individually relevant. The flexibility and consistent theoretical framework seemed to contribute to this. The results indicated that greater consideration of control and mindfulness allowed greater cognitive flexibility, an ability to reprioritize and let go of unhelpful habits, which better enabled participants to meet their goals. Implications for group therapy include (a) clearly explaining the format of such groups to clients and (b) providing flexibility in the way the group is delivered where possible. Additional qualitative studies of transdiagnostic groups are required to establish if themes generalize to other transdiagnostic groups.

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“…For instance, 70% of patients at intake will meet criteria for moderate depression, while only 20% will do so after treatment. 7,8 What message should Canadian physicians give to their patients with depression? First, there are effective treatments for depression and second, what is medically required should be insured to provide improved access.…”

Section: Better Treatment For Depressionmentioning

confidence: 99%