The Mental Health Policy Group, at the LSE Centre for Economic Performance published a report this week, entitled, How Mental Illness Loses Out in the NHS.
As the title suggests, it paints a grim picture of mental health services, stating that for the under 65 year olds, mental illness accounts for almost half of ill health. Now, “mental health” is a very broad statement and could cover anything from depression to psychosis, but the report acknowledges that in the main, it is talking about general anxiety, depression, and children’s services.
Unfortunately, the report’s main recommendation to counter this situation is to increase funding for the Improved Access to Psychological Therapies programme (IAPT). IAPT services are the first port of call for GPs making referrals for depression and or anxiety, and in the main, offer Cognitive Behavioural Therapy (CBT) on a short term basis. I thought it would be interesting to examine exactly what is being achieved by IAPT using Key Performance Indicator (KPI) figures for Quarter 3(Oct – Dec) of the last financial year.
The first thing that strikes me, (and which was noted by the LSE) is that the IAPT is clearly unable to cope with the volume of referrals being made to it. During the three month period, only 60% of those referred to IAPT services had been seen, and in general, up to 40% of people referred will wait over one month for treatment, with some referrals waiting over three months.
CBT is quite a focused therapy, and is typically offered short term, (normally 6 – 12 sessions, but sometimes less). This means GPs are given guidance on how to refer, based on the client’s problem, for example, do they have Obsessive Compulsive Disorder, Generalised Anxiety or Social Phobia etc? Thus, on the basis of a 10 minute appointment the GP diagnoses the problem and refers to a practitioner who will provide CBT based around that diagnosis. That’s what GPs do, they look at what the patient presents and make the best referral on consideration of the evidence; it works for physical problems and illnesses, less so for mental health issues. I, and every other independent practitioner I know will spend at least an hour, often more with a new client in that first assessment session, to try to get a very real understanding of what that client is experiencing. Even then, I would say that often the problem that is initially brought to therapy, turns out not to be the biggest issue in their lives. Sometimes, it is only by having the freedom and space to talk safely that real issue can be recognised and tackled. Which brings us on to the number or sessions; I absolutely agree that good therapeutic work can be done within 6 – 12 sessions; however, I also know that sometimes it takes longer. Looking at my own figures I can see that for the majority of clients (63%), 12 sessions or less were enough to be able to make significant changes to their lives and how they felt, however the remaining 37% needed more sessions to achieve this.
The IAPT services score a client’s wellbeing at the beginning and end of their treatment and report that using this measure, 14% of clients referred will be deemed to have “recovered”. My own cohort of clients, who leave counselling feeling better then they arrived is 49% of those referred and I suspect other independent practitioners would show a similar discrepancy with the IAPT figures. One reason may be that IAPT services are provided at two levels, low intensity and high intensity and previous counselling experience is not always necessary, other than the IAPT specific training. For the low intensity workers this can mean a lack of any wider experience in the counselling and therapy arena. A situation that can leave both therapist and client vulnerable to the intensity of feelings that can arise during a real therapeutic encounter.
I know that public services are stretched very tightly at the moment, and that many people find real benefit in what is available via IAPT. However, I also know that it does not fit what some people need, and often this means seeing someone privately in order to make the right choice about the right therapy. One of the ways in which a wider range of therapy and therapists could be opened up to NHS patients would be through organisations such as Get Stable which are working towards providing access to independent practitioners through the NHS. If IAPT services haven’t worked for you or the wait is too long, it might be worth mentioning this to your GP, (the address is below).
Meanwhile, the government is committed to spending more on IAP, which may well continue help fewer people than is necessary.