IAPT programme struggling to achieve targets

The Government’s flagship scheme to expand access to psychological therapies is struggling to achieve its targets, with recovery rates dipping and patients in some areas waiting over a year for treatment, according to Pulse.

A Pulse investigation found that CCGs in many areas were struggling to roll out the Improving Access to Psychological Therapies (IAPT) programme to all the intended target groups, and that over two-thirds were reporting waiting times longer than the 28-day maximum target.

Funding for the IAPT programme was also variable, ranging from £1.76 to £14.55 per head of population across CCG areas.

The results come as experts question whether the IAPT programme was cost effective and if it was reaching the right people.

The latest quarterly figures from the Health and Social Care Information Centre on the IAPT programme showed that although the number of patients accessing treatment went up in the first quarter of this year, the proportion of patients moving to recovery slipped back from 47% in the final quarter of 2012/2013 to 43% in the period from April to June this year, against a target of 50% of treated patients.

Overall more than 80,000 people in the system are still waiting for treatment more than a month after they were referred.

Data obtained by Pulse under the Freedom of Information Act from 85 CCGs reveals that 68% report treatment waiting times longer than the 28-day maximum target. Around half of these are down to longer waits for higher intensity therapy, with many areas reporting waiting times of three to five months for higher-intensity therapy while some have waits of over 12 month

Cognitive therapy study hope for hypochondria patients

Cognitive behavioural therapy is more effective than standard care for people with hypochondria or health anxiety, say researchers writing in The Lancet.

In their study, 14% of patients given CBT regained normal anxiety levels against 7% given the usual care of basic reassurance.

It said nurses could easily be trained to offer the psychological therapy.

Between 10% and 20% of hospital patients are thought to worry obsessively about their health.

Previous studies have shown that CBT, which aims to change thought patterns and behaviour, is an effective treatment for other anxiety disorders.

But there is a shortage of specialists trained to deliver CBT, and as a result waiting lists can be long.

In this study, 219 people with health anxiety received an average of six sessions of cognitive behavioural therapy while 225 received reassurance and support, which is standard.

After periods of six months and 12 months, patients in the CBT group showed "significantly greater improvement in self-rated anxiety and depression symptoms" compared with standard care, the study showed.

There was also a particularly noticeable reduction in health anxiety in the CBT group straight after treatment began.

Read more here. 

Rumination: The danger of dwelling

According to Denise Whiteman (BBC News Magazine)  the UK's biggest ever online test into stress, undertaken by the BBC's Lab UK and the University of Liverpool, has revealed that rumination is the biggest predictor of the most common mental health problems in the country.

A bit of self-reflection can be a good thing, say psychologists. But just how serious can it get when introspection goes awry and thoughts get stuck on repeat, playing over and over in the mind?

Rumination and self-blame have long been accepted by health professionals as part of the problems that can lead to depression and anxiety - the two most common mental health problems in the UK, according to the Mental Health Foundation.

But new research has demonstrated just how significant and serious their impact on mental health can be.

The findings of a ground-breaking study, published in the journal PLOS ONE today, suggest that brooding too much on negative events is the biggest predictor of depression and anxiety and determines the level of stress people experience. The research even suggests a person's psychological response is a more important factor than what has actually happened to them.

A total of 32,827 people from 172 countries took part in the online stress test devised by the BBC's Lab UK and psychologists at the University of Liverpool, making it the biggest study of its kind ever undertaken in the UK.

PsychologyOnline responds to BBC investigation into mental health ‘crisis’

An investigation by BBC News and Community Care magazine has revealed more than 1,700 mental health beds have been closed in England since April 2011, an overall reduction of 9%.

However, catching people earlier could reduce the need for acute care in hospital wards.

The Mental Health CCG Collaboration in Surrey is pioneering an approach that offers patients access to a range of psychological therapies, including online cognitive behavioural therapy (CBT) from PsychologyOnline.

The benefit of PsychologyOnline is that it allows fast access to help service users as and when required.  Patients have a confidential text-based “conversation” with their therapist through secure instant messaging, which can be conducted from home or wherever the patient feels most comfortable.

While the Surrey scheme is in its infancy, Dr Fiona Buxton, the mental health lead for Surrey Heath CCG, said her surgery is already referring fewer patients to the hospital-based Community Mental Health Recovery Service.

She explains: “People are under increasing stress from pressures at work, home and financial concerns and we see a growing need for different ways of providing treatment.

“PsychologyOnline is a huge benefit as you can access the treatment from home, there is no travelling involved, no need to take time off work and you can have the same therapist every week so there is continuity.”

Sarah Bateup, PsychologyOnline’s clinical lead, agrees that quick and early intervention can prevent mental health problems from “snowballing”.

“It is a gradual process, people begin to feel overloaded and unable to cope, they cut back on pleasurable activities and over time problems build up. Without help, things just get worse and worse and sufferers try to work harder and harder to stay on top of things.  The earlier someone seeks help, the better”.

PsychologyOnline is now available on prescription in Surrey and via our private service Thinkwell™.  For more information, please visit www.psychologyonline.co.uk. 

Depression risk 'starts in the womb'

Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.

Medical treatment during pregnancy could lower the risk of future mental health problems in the child, say researchers at Bristol University.

The study followed the offspring of more than 8,000 mothers who had postnatal or antenatal depression.

The risk is around 1.3 times higher than normal at age 18, it found.

The study is published in JAMA Psychiatry. Lead researcher Dr Rebecca Pearson told the BBC: "Depression in pregnancy should be taken seriously and treated in pregnancy. It looks like there is a long-term risk to the child, although it is small."

She said it was an association, not a causal link, and needed further investigation.

Prof Carmine Pariante of King's College London's Institute of Psychiatry said the development of an individual's mental health did not start at birth but in the uterus.

"The message is clear - helping women who are depressed in pregnancy will not only alleviate their suffering but also the suffering of the next generation."

Read more on the BBC website.

PsychologyOnline urges GPs to seek help to manage burnout with Thinkwell

The wellbeing of GPs is of growing concern following the publication of yet another piece of research claiming that rising stress levels and a lack of job satisfaction are putting the mental health of family doctors at risk.

Last week, the national GP worklife survey found stress levels among family doctors hit their highest recorded level since 1998.

The study found, worryingly, that GPs are less satisfied in their jobs, feel they are working too many hours, and feel they are not appreciated.

It does much to reinforce the findings of a June 2013 poll by medical magazine Pulse, which found nearly half of GPs surveyed are classified as being at high risk of developing burnout of some form.

At PsychologyOnline we welcome any research which raises awareness of so-called GP burnout. We know that our secure instant messaging-based CBT service benefits many people. This could include any family doctors for whom stress and burnout are becoming detrimental to their professional and personal lives.

To complement our NHS services (GPs can refer NHS patients in Surrey), we have recently launched our new Thinkwell™ service offering discreet, confidential access to a qualified therapist for people who would prefer to purchase therapy directly.

Barnaby Perks, CEO at PsychologyOnline, says doctors are “often reluctant to address issues with their own mental health”, and believes the Thinkwell™ service could help.

In addition, one of the biggest barriers in enabling GPs to seek psychological help is the fact many are unwilling to meet a therapist in their geographical location, or cannot find the time to seek help and attend face-to-face consultations on a regular basis.

Barnaby continues: “Our service is discreet and confidential. Users can keep their therapy to themselves, managing their recovery with their therapist without having to visit a consulting room for face-to-face therapy.”

The effectiveness of PsychologyOnline’s therapy was demonstrated in a 300 patient clinical trial published in The Lancet in 2009. An average of just six sessions of online therapy was needed for recovery for patients suffering from moderate to severe depression.

Any GPs feeling overwhelmed can currently benefit from our special offer; a discount of 50% on the initial consultation followed by a 10% discount on any further online treatment sessions.

GPs can access the offer by sending an email to gp@thinkwell.co.uk and inserting the code POL-GP-X913 in the subject line.

GPs suffering highest stress rates for 15 years, finds DH study

GPs are suffering the highest levels of stress recorded since 1998, with over half of those aged over 50 years saying they intend to quit direct patient care within five years, a DH-commissioned survey has found.

The national GP worklife survey - carried out by researchers at the University of Manchester - found the number of GPs over 50 intending to quit direct patient care has increased by 12% in the last two years.

The news comes as Pulse launched its Battling Burnout campaign earlier this year, which urged GPs to write to their MP to raise awareness to the issue. This followed from an investigation which found that almost half of GPs were at a high risk of becoming emotionally exhausted, depersonalised towards patients and feeling like they are not making a positive contribution to people’s lives in their job.

The national GP worklife study also found that stress in GPs was rising. In terms of job satisfaction, it revealed that on a seven-point scale where 1 means ‘extremely dissatisfied’ and 7 means ‘extremely satisfied’, average satisfaction had declined from 4.9 points in 2010 to 4.5 points in 2012 in both the cross-sectional and longitudinal samples.

GPs were least satisfied with hours of work, recognition for good work and hours of work, with the largest decreases in job satisfaction between 2010 and 2012 in the domains relating to hours of work and remuneration.

Read more here.

IAPT 'does not cut antidepressant prescribing'

The Department of Health’s scheme to improve access to psychological therapies (IAPT) for patients with depression and anxiety disorders has had no effect on antidepressant prescribing, according to the findings of a new study published on the Pulse website. 

The study into the DH’s IAPT scheme and rates of antidepressant prescribing between 2008 and 2011 in England showed that prescribing levels rose by 10% despite the introduction of IAPT.

Researchers from Imperial College, London found that IAPT, which in the NHS is largely based on offering patients access to cognitive behavioural therapy, concluded that ‘the implementation of IAPT had no significant impact on these increasing rates [of antidepressant prescribing].’

However, the study in this month’s edition of the British Journal of General Practicecautioned that the interpretation of antidepressant prescribing rates is ‘complex’.

‘Several recent factors may impact on diagnosis and management of depression. For example, QOF incentives following a diagnosis of depression may either increase rates or alternatively discourage GPs from applying a ‘label’ because of the workload involved.

‘In addition, waiting times for IAPT may necessitate intermediate action by GPs, such as prescribing antidepressants. As these results suggest that IAPT has not curbed the rise in antidepressant prescribing, it is important to re-explore factors that influence this prescribing,’ they said.

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.