Improving access to psychological therapies: implications for mental health care in general practice

Byng, Richard; Gask, Linda

doi:10.3399/bjgp09x454043

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…5 In addition, the Improving Access to Psychological Therapies (IAPT) programme (2008), is delivering an unprecedented investment of £170 million in additional primary care mental health workers from 2008-2011. 6 The introduction of standardised depression-screening and diagnostic questionnaires into routine practice is controversial. A recent Cochrane systematic review found that the use of screening instruments has little impact on the recognition, management, or outcome of depression in primary care and in the general hospital.…”

Section: Introductionmentioning

confidence: 99%

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Mitchell¹,

Dwyer²,

Hagan³

et al. 2011

Br J Gen Pract

102

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BackgroundThe National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and 'stepped care' for depression. AimTo explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice. Design and settingQualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire. MethodFour focus groups were conducted, using a topic guide and audiotaping. There were 38 participants: GPs, nurses, doctors in training, mental health workers, and a manager. Data analysis was iterative and thematic. ResultsThe NICE guideline, with its embedded principles of holism and evidence-based practice, was viewed positively but its impact was compromised by resource and practitioner barriers to implementation. The perceived imposition of the screening questions and severity assessments (PHQ-9) with no responsive training had required practitioners to work hard to minimise negative impacts on their work, for example: constantly adapting consultations to tick boxes; avoiding triggering open displays of distress without the time to offer appropriate care; positively managing how their patients were labelled. Further confusion was experienced around the evolving content of psychological interventions for depression. ConclusionOrganisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of 'managed' care for depression.

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Section: Introductionmentioning

confidence: 99%

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Mitchell¹,

Dwyer²,

Hagan³

et al. 2011

Br J Gen Pract

102

View full text Add to dashboard Cite

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“…1 Indeed young people are more likely to seek help for psychological problems from an informal source, such as an educational professional, than from a formal healthcare source. 11 In addition, cultural competency skills are particularly important when working through the complex psychological problems that may be experienced by members of an ethnic minority community.…”

Section: Are the Gates To Be Thrown Open?mentioning

confidence: 99%

“…1 One of its intentions is to improve access to talking therapies to a wider population including vulnerable groups such as young people, older adults, and members of ethnic minority communities. 2 An article in this month's Journal 3 reports observational data derived from the evaluations of two IAPT demonstration sites and an evaluation of psychoeducational sessions elsewhere.…”

mentioning

confidence: 99%

Are the gates to be thrown open?

Mathers¹,

Mitchell²

2010

Br J Gen Pract

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“…Of these, half have symptoms severe enough to warrant active intervention. The Improving Access to Psychological Therapies (IAPT) initiative aimed to increase access to evidence-based psychological treatments for common mental health problems in line with National Institute for Health and Care Excellence (NICE) guidelines (Department of Health, 2008).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a non-diagnostic ‘Psychology of Emotions’ group intervention within a UK youth IAPT service: a mixed-methods approach

Howells

Rose

Gee

et al. 2019

Behav. Cogn. Psychother.

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Background:A novel CBT-based intervention, tailored for young people, was developed in response to concerns about traditional diagnostically based approaches. Psychology of Emotions workshops use a normative approach to emotional difficulty instead of a diagnostic framework.Aims:To evaluate the acceptability and efficacy of Psychology of Emotions workshops within an IAPT service for young people aged 16–25 years.Method:This was a mixed-methods study, evaluating routinely collected self-report measures of depression and anxiety, and qualitative feedback forms. The main outcomes were rates of attendance, change in symptom severity, and participant views of the intervention.Results:From January to September 2016, 595 young people were invited to attend the Psychology of Emotions workshops, of whom 350 (58.8%) attended at least one session. Young people who attended all six sessions (8.1%) experienced significant reductions in self-reported anxiety (d = .72) and depression (d = .58) and 35.5% were classified as recovered at completion. Those who attended at least two sessions (41.3%) reported smaller but significant improvements in anxiety (d = .42) and depression (d = .45); 22.0% were classified as recovered at the last session attended. Participants provided largely positive feedback about the intervention.Conclusion:Psychology of Emotions is a promising treatment option, delivered outside of a diagnostic framework, for young people with mild to moderate mental health difficulties seen within IAPT services. Better understanding reasons for non-attendance might enable the intervention to be made accessible to more young people.

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Improving access to psychological therapies: implications for mental health care in general practice

Cited by 11 publications

References 10 publications

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Are the gates to be thrown open?

Evaluation of a non-diagnostic ‘Psychology of Emotions’ group intervention within a UK youth IAPT service: a mixed-methods approach

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