Perspectives on an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) service addressing the wider determinants of mental health: a qualitative study

Abstract

Background A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders’ experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. Methods Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. Results Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. Limitations Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants’ experiences of the service did suggest variation in our sample. Conclusions The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users’ expectations, and improve accessibility for certain groups.

Estimating the effectiveness of an enhanced ‘Improving Access to Psychological Therapies’ (IAPT) service addressing the wider determinants of mental health: a real-world evaluation

“…This aligns with the findings from the qualitative evaluation, which suggests the H&W pathway was perceived by service deliverers and users to have a positive impact on mental health. 11 However, when comparing the intervention to the geographical control over the same time period, we observed little evidence of improvement.…”

“…Previous studies have shown IAPT service adaptation can address harmful health behaviours (eg, smoking) 21 and help treat other mental health-related issues (eg, insomnia). 22 Our evaluation 11 provides evidence that IAPT services can be adapted to provide person centred, tailored links to services, to address the underlying reasons for poor mental health, which meets key policy 7 and WHO recommendations. 3 However, in this study the evidence for an additional benefit over psychological therapy is limited, as we observed small improvements in the historical control only.…”

“…23 Our qualitative evaluation shed some light by highlighting certain implementation issues, such as service users and wider services expressing they lacked clarity and reasoning from PWPs about why a certain referral pathway was chosen. 11 These findings may help to explain the small ATTs and lack of statistical difference compared with the geographical control.…”