How to integrate online text-based CBT within IAPT

How to integrate online text-based CBT within IAPT was the topic of a presentation by Sarah Bateup, Clinical Lead for PsychologyOnline and lecturer at Exeter University, at the recent Recovery-Focused Conference organised by Bournemouth University and Dorset HealthCare University NHS Foundation Trust.

Sarah, who is a BABCP accredited therapist with over 27,000 hours of CBT, discussed her experiences gained with PsychologyOnline of integrating live synchronous, Internet-based text CBT into Step 3 IAPT services.

Prior to joining PsychologyOnline Sarah had worked for many years with the South London and Maudsley Trust where she trained junior doctors how to deliver CBT within IAPT. Before this, Sarah was a manager of a primary care CBT service in the South West of England. So she has a good understanding of IAPT and the support required for therapy services.

Sarah comments, "I am very interested in seeing how technology can enhance therapy and learning. Increasingly we are seeing more learning being offered online and accessed remotely. CBT is very much based on people learning and therefore it fits well within this model.

"Interestingly the benefits of text-based therapy are maintained for a long time. I think this is partly the action of writing and reading that takes place during the session. This is very much how we are used to learning and creates a real change in the thought processes.

"Originally IAPT was designed to offer patient choice and PsychologyOnline's service supports this by making it easier to access therapy. For example, we have seen particularly good results for patients with anxiety disorders for whom arranging and attending a face-to-face session in itself creates stress."

The bi-annual Recovery-Focused Mental Health Conference was held on September 6th 2013 and was attended by mental health professionals, health commissioners, researchers and service users. The purpose of the conference is to disseminate information about new research, innovation, best practice, and inspirational developments in mental health.

PsychologyOnline is exhibiting at the Mental Health Forum

PsychologyOnline is exhibiting at the Mental Health Forum for the first time. The event, on the 12th September 2013, is aimed at clinicians and commissioners involved with the care of people with mental health conditions.

Dr Michael Reilly, Business Development Director for PsychologyOnline, says that the event will provide a good opportunity to showcase how people with mental health problems can achieve measurable benefits by using the live online instant messaging-based therapy method developed and pioneered by PsychologyOnline.

Although numerous people are affected by mental illness, many are reluctant to access face-to-face therapy services.  Sometimes because they can’t due to mobility issues.  Sometimes because they won’t because the stigma of mental health prevents them from talking to their GP about their problems or attending a specialist clinic.

Many healthcare system players are becoming increasingly aware of the mental health problems of people with long-term conditions.  Many PsychologyOnline users do not wish to spend any more time than they have to in medical centres and clinics and are therefore reluctant to access face-to-face therapy services.

“Delegates will be able to see a demonstration of PsychologyOnline. This will enable them to see for themselves how effective Cognitive Behavioural Therapy with a live therapist can be when delivered securely over the Internet in a way that is easy to access.  The patient and the GP now have more choice – working online enables the patient to access therapy sessions at convenient times whilst still receiving very high quality treatment from a qualified therapist."

“We use our own network of highly trained psychologists and psychotherapists – multi-specialism and multi-lingual – who adhere to British Psychology Society and NHS standards for clinical and information governance.  Our therapists can provide sessions at any time to suit our patients, 24 hours a day, 7 days a week.

“The service is already available to NHS patients across the county of Surrey, where initial data show very positive engagement between therapist and patient following referral, and positive feedback from GPs and patients on improved outcomes”.

Dr Reilly continues; “We are improving the service all the time.  Feedback from GPs and commissioners is really helpful.  We are looking forward to meeting as many as possible at the event.”

The Mental Health Forum is to be held at the Novotel London West One, Hammersmith, W6 8DR.  It is sponsored by Lundbeck UK with partners including ADASS, South London and Maudsley NHS Foundation Trust, Rethink Mental Illness and Pulse.  PsychologyOnline will be at the conference all day.  If you would like to arrange a private meeting then please contact Stephanie Ruskin on 07986 616451.

Mental health care overlooked by NHS review of emergency services

A series of unsettling findings suggests the need for an agreed care pathway across the police, providers and local government, according to The Guardian.

NHS England's large scale review of all emergency services, partly driven by the premature mortality rates across hospitals, seems to have made a significant omission by overlooking mental health emergency care.

While the evidence accompanying the consultation suggests that 4,400 lives a year could be saved if weekend services were as good as those during the weekdays, there is a chance that those experiencing mental ill health could fall through the upgraded safety net.

The emergency review does not mention mental health services, the conditions leading to emergency presentations, or the role of the police, housing and mental health problems. Yet emergency mental health care plays a vital role, especially in inner city areas where demand is greater due to high levels of poverty and other social determinants of ill health and inequalities such as ethnicity, gender and age.

For example, we know there is a higher incidence of schizophrenia in inner city areas, especially among black African and Caribbean people and other ethnic minority groups, particularly in London.

The recent report by Lord Victor Adebowale on policing and mental health concluded that the presence of offending behaviour by someone experiencing mental illness, which can lead them to have contact with the police, is an emergency pathway which needs to be made safer.

Lord Adebowale's findings emphasised the failures of NHS services and police knowledge, as well as emergency communications, in meeting the needs of people with mental illness. These findings have been reinforced in the latest Care Quality Commission (CQC) reports on the emergency removal of people suspected of having a mental illness to a place of safety (under section 136 of the Mental Health Act). These reports found unacceptable emergency practices leading to deaths in police custody, mentally ill people being transported in caged ambulances and suicides on the railways and transport hubs.

GP practices to host internet training sessions for patients in £750k scheme to reduce health inequalities

NHS England is to spend thousands of pounds to create ‘digital flagships’ in GP practices, health centres and hospitals as part of a drive to train 100,000 people to use the internet this year, according to Pulse.

The training centres are designed to reduce health inequalities - one of the specifications of the Government’s mandate to NHS England - and will be set up in areas of social deprivation, Pulse has learnt.

The major initiative to train 100,000 patients was first announced in NHS England’s business plan for 2013/14 to 2015/16, and the procurement document for the scheme reveals it may cost up to £750,000 in 2013/14, and that it could be extended for a further two years.

The training centres will work closely with CCGs, as well as local organisations and charities to share information and promote NHS digital services, NHS England said.

‘NHS Digital Flagships’ will be set up in GP practices, health centres and hospitals and ‘community hubs’ will be set up in public areas like libraries and community centres, in order to train patients how to access and use the internet.

The governing body for the NHS said that over seven million people in the UK have never used the internet, and although people over the age of 65 account for more than half of all NHS spending, 40% do not have access to the internet at home and five million of these have never been online.

Mental health benefits of good grandparent-grandchild relationships

Grandparents and older grandchildren who have good relationships with each other are less likely to suffer from depression, according to a study presented at the American Sociological Associations 108th annual meeting and featured in Medical News Today.

Researchers from Boston College analysed data from a long-term study called the Longitudinal Study of Generations. The study is a survey of US families consisting of three or four generations, compiled in seven sets of data between 1985 and 2004.

The researchers analysed 376 grandparents and 340 grandchildren. The average grandparent was born in 1917, making them 77 years old at the midpoint of the study in 1994, while the average grandchild was born in 1963, making them 31 years old.

Sara Moorman, assistant professor in the Department of Sociology and the Institute of Aging at Boston College, said of the results:

"We found that an emotionally close grandparent-adult grandchild relationship was associated with fewer symptoms of depression for both generations.

The greater emotional support grandparents and adult grandchildren received from one another, the better their psychological health."

The Today Show highlights the increasing use of anti-depressants across the UK

This morning’s Today Show included a piece on the increasing use of anti-depressants in the United Kingdom.

The piece (starting 50 minutes into the programme and lasting 4 minutes) highlighted that we have now prescribed over 50 million anti-depressants in the United Kingdom.

Particularly interesting facts that the show discussed included:

• 1 in 6 adults in the UK pick up an anti-depressant prescription each month 
• This ratio increases to 1 in 5 in Wales 
• Patients are often given no alternative (e.g. talking therapies) 
• Patients are seen to be 'making do' with the cheapest treatment rather than the best 

A GP highlighted the fact that the waiting list for talking therapies provided by the NHS is often far too long (frequently 6 months) and this sways the patient into using antidepressants.

It seems that local mental health charities, such as Mind, are picking up the slack and allowing individuals access to talking therapies - but in some areas this service is over capacity already.

Adult behaviour triggered in the womb?

Adults could be at greater risk of becoming anxious and vulnerable to poor mental health if they were deprived of certain hormones while developing in the womb, according to joint new research by University of Cardiff and Cambridge scientists.

New research in mice has revealed the role of the placenta in long-term programming of emotional behaviour and the first time scientists have linked changes in adult behaviour to alterations in placental function.

Insulin-like growth factor-2 has been shown to play a major role in foetal and placental development in mammals, and changes in expression of this hormone in the placenta and foetus are implicated in growth restriction in the womb.

"The growth of a baby is a very complex process and there are lots of control mechanisms which make sure that the nutrients required by the baby to grow can be supplied by the mother," according to, Dr Trevor Humby, a behavioural neuroscientist in the Schools of Psychology and Medicine, who jointly led the research with Professor Lawrence Wilkinson.

"We were interested in how disrupting this balance could influence emotional behaviours a long time after being born, as an adult," he added.

One in eight GPs have sought help for stress in past year

One in eight GPs have sought help from pastoral or wellbeing services within the past year, according to a new Pulse survey which suggests the profession is struggling to cope with a rising workload and an increasing risk of burnout.

Some 12% of 441 GPs surveyed about a wide range of unrelated topics said they had sought help from local pastoral or wellbeing services in the past 12 months, with one GP spending almost £2,000 on private psychotherapy after finding it difficult to handle his workload.

The findings prompted GP leaders to urge those struggling with stress to ‘pull down their oxygen mask’ and ask for help.

Respondents to the survey blamed Government policy and changes to the GP contract as significant factors in exacerbating their difficulties. Many also said the pastoral services they had accessed had been effective at helping them cope.

The results come as the NHS in England reviews whether to continue funding these services for GPs, as part of a wider review of ‘discretionary’ funding formerly supplied by Primary Care Trusts.

Nearly half of IAPT patients 'move to recovery'

Just under half of patients who are treated under the Government’s Improving Access to Psychological Therapies programme move to recovery, but drop-out rates remains high, according to Caroline Price at Pulse.

Official outcomes data suggest the programme is moving steadily towards the Government’s goal of having half of patients with depression or anxiety recover after treatment. But take-up remains low, with just under 60% of patients referred entering treatment and then less than two-thirds of these completing a minimum of two sessions.

The figures for January to March 2013, published today by the Health and Social Care Information Centre, show 46.8% of patients who completed at least two treatment contacts moved to recovery, defined as a score of less than 8 on the GAD7 and/or less than 10 on the PHQ-9.

This means the programme is getting closer to delivering the Government’s target 50% recovery rate, as set out in Talking Therapies: A four-year plan of action, and is delivering a better average recovery rate than at its outset. The action plan states that by 2014/2015, the NHS should deliver ‘at least 50% of those completing treatment moving to recovery and most experiencing a meaningful improvement in their condition’.

The data suggest all participating areas are performing better, although there is still considerable variation in recovery rates – ranging from 23% in Hull to 83% in North Lincolnshire.

The HSCIC also highlights that a total of 6,776 people moved off sick pay and benefits under the IAPT programme over the final quarter of 2012/2013.

However, access rates have slipped behind the target trajectory – at 2.5% of the eligible population compared with the goal of 3% at this stage.

Dr Mark Ashworth, clinical senior lecturer at King’s College London and a GP in south-east London, said the recovery rates were ‘very impressive’, but that the programme still had a way to go to fulfill it’s aims.

He said: ‘On the other hand, for just 6,776 patients (out of 154,700 starting treatment) to move off sick pay and benefits isn’t really an endorsement of Lord Layard’s founding principle that talking therapies would pay for itself by increasing the numbers of people returning to work.’

He added: ‘At least it looks for now as though the service is safe and will continue to be funded which, in the present climate, has got to be encouraging.’

'Mental Health Pathway' for paramedics to provide appropriate care for mentally ill patients

According to News Medical.NET Ruth Elliot, Senior Lecturer in the department of Mental Health and Learning Disability at the University of Huddersfield, has published an article discussing the need for a national 'Mental Health Pathway' to enable paramedics to provide the appropriate care for people who present mental health issues. 

The Department of Health (DH) (2005a) acknowledges the huge modernisation of the ambulance service in England and faster access to people with immediate life threatening conditions, however the service is also responding to an increasing number of patients who have an urgent primary care need, which includes mental distress, as opposed to clinical emergency. 

The DH (2006) policy calls for a "New Vision" where the ambulance service could increase efficiency and effectiveness towards patients who are experiencing non life threatening emergencies. The key aims are to form a programme of advancement to address both improving mental health and accessibility of services for people with poor mental health. The vision of the policy is that by 2020 mental and physical health will have equal priority. The development of a mental health pathway within the ambulance service may help to reduce admissions or re-attendance whilst improving care for patients. An evidence-based approach is used to provide a balanced, logical and supported argument within a reflection of practice (Borton, 1970,). This is evaluated against a hypothetical patient's case study which reflects common issues faced by paramedics and ambulance technicians. The analytical process considers patient, professional, organisational and multi-disciplinary team perspectives.