Improving Access to IAPT?
27th June 2018
The Improving Access to Psychological Therapies (IAPT) programme was developed as a systematic way to improve the delivery of, and access to, evidence-based psychological therapies within the NHS. Beginning in 2008, the IAPT programme has transformed the treatment of depression and anxiety disorders in adults in England. Over 950,000 people now access IAPT services each year and The Five Year Forward View for Mental Health has committed to further expanding IAPT services, so that at least 1.5 million adults can access care each year by 2020/21.
Although the Government has made progress with the IAPT programme, work is required to ensure people with mental health problems receive the treatment they need. The We need to talk coalition – a group of mental health charities, professional organisations, Royal College and service providers that believe in the effectiveness of psychological therapy – carried out a report on access to talking therapies, and findings indicated problems with unequal access to psychological therapies: around 40 per cent of people had to request psychological therapies rather than being offered them by a healthcare professional; only 1 in 10 people felt cultural needs were taken into account by the service they were offered; while 10 per cent of people – after being assessed – did not get access to treatment at all.
Accessing psychological therapies among certain groups remains poor – including people from black and minority ethnic (BME) communities, older people, children and young people, people with severe mental illness and homeless people – despite Government commitments to address unequal access. That leaves us with the question: what are some of the barriers to accessing IAPT services for these different groups?
BME groups
People from BME communities face significant barriers to accessing psychological therapies as often many local areas lack culturally sensitive and tailored services which meet the diverse needs of the local population. In addition, people from BME communities often first come into contact with mental health services at the acute stage of their condition due to a range of issues, from stigma and discrimination in the NHS to cultural attitudes within communities which prevent people seeking help. Two focus groups were conducted with BME communities to further explore issues facing this group, and people explained that accessing an IAPT service depended on the type of service that was available locally and whether self-referral options were publicised. They also raised issues with language barriers due to lack of interpreters and differences in how people describe and talk about mental health in different cultures.
Children and young people
Many children and young people are waiting for long periods to receive access to psychological therapy. The Government’s mental health strategy No health without mental health stresses the need for early intervention, however services are struggling to meet demand in the face of financial cutbacks. Since 2010, two-thirds of local authorities have had their budgets cut for Children and Adolescent Mental Health Services (CAMHS) and as a consequence, CAMHS are having to raise the thresholds in response to budget cuts, meaning that a child or young person is only seen if the mental health problem is at a raised level of severity.
Older people
Older people experience more barriers to accessing psychological therapies, despite NICE guidance on the treatment of anxiety and depression making no variation in its recommendations relating to age. A possible barrier is that older people are less likely to be diagnosed with depression by their GP as depressive symptoms can present differently in older people. Also, psychological therapy services are not truly accessible and responsive to older people’s range of needs e.g. someone in their 60s may have completely different needs to someone in their 80s or 90s.
Severe mental illness
For those with severe mental illness (SMI) – such as psychosis and schizophrenia, bipolar disorder and personality disorder – access to talking therapies is extremely poor. IAPT was meant to ‘free up’ resources for specialist psychological therapies in secondary care, however these services have been vulnerable to cuts and so there has been very little provision for these groups.
Homelessness and co-occurring substance dependencies
Mental health problems – in particular personality disorders, depression and schizophrenia – are more common amongst homeless people than amongst the general population. Although many homeless people seek help for their mental health problems at some stage, the comorbidity of substance dependency and mental health issues means that many homeless people are not offered mental health treatment. Homeless people may also be denied access to mental health treatment due to no previous contact with the mental health system or non-attendance due to chaotic lifestyles.
Recommendations
- To make sure sufficient access for all groups is incorporated into the CCG Outcomes Indicator Set and monitor access among these groups.
- To commission more culturally appropriate services and engage with their local community to find out what the needs of their local BME communities are in relation to talking treatments.
- To commission more early intervention and specialist psychological therapies so children and young people, older people and people with severe mental illness, people who are homeless and people with co-occurring substance dependencies are able to access services.
- To ensure counselling is available in all schools
- To raise awareness of psychological therapies via schools, faith groups and other community networks, better publicise self-referral routes and make education staff and GPs aware of the benefits talking therapies can bring to children and young people, older people and people with severe mental illness or from BME communities.
