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, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment to enhance ‘identifying suitability’, tailoring the support and delivery mode to provide a more ‘holistic service’, and increasing transparency around continued care to drive sustained benefits, reflected in the theme ‘moving forward’. 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.

Combining causal inference and within-trial economic evaluation methods to assess comparative cost-effectiveness using real-world data: a tutorial with recommendations based on the quasi-experimental ADAPT study of a redesigned mental health service

“…In 2021, a new Health and Wellbeing pathway was introduced into the TTad-service in one geographical area of the UK to address the wider determinants of mental health problems (30). This 'enhanced' TTad-service was developed and delivered in three local authorities in South-West England.…”

“…The intention was to estimate the effectiveness (reported elsewhere) and cost-effectiveness (reported here) of the enhanced service. A published qualitative study provides additional detail about the enhanced service (30). Appendix S3 provides an overview of the TTad-service data requested for the ADAPT study, including data cleaning and structuring.…”