Critically analyse the IAPT initiative and the development of the low intensity therapist role.
In 2005 Lord Richard Layard, Professor Emeritus at the London School of Economics, an expert in the economic costs of unemployment, in his book, Happiness; Lessons From a new science. (Penguin. London. ISBN 9780141016900), made proposals which led to a new government initiative to reduce the number of days lost to society, and the number of people on benefits in the United Kingdom due to depression.
He noted the paradox that instead of happiness increasing with greater wealth, the richer populations of the western nations were less happy in general than populations of developing countries.
Lord Layard and the government proposed to reduce the cost of the amount of working days lost by an initiative to make treatment for depression available more quickly and to increase the number of channels of referral to expedite the process. Traditionally, a depressed person would have to see a doctor who would refer them to the local Community Mental Health Team, who would arrange an appointment with a health care professional as appropriate.
Cognitive Behavioural Therapy was chosen as the most effective treatment regime as the results have been well documented since the 1980s and because it does not appear to require as much time spent in in depth psychotherapy and should as a result reduce costs. To add a personal note here, I found that, as a student counsellor with the community Mental Health Team (West), the clients I referred to the CBT computer programme, ???Beating the blues???, found it helpful in most cases.
Two towns, Doncaster in South Yorkshire, which has had a high rate of unemployment since the collieries and the railway works were closed and Newham in London which has a high proportion of people in unemployment as well as a high mix of ethnicities, were chosen as demonstration sites for trials and IAPT (Individual Access to Psychological Therapies) was brought into being.
The new initiative has been the target of some criticism, one of the original ones being the assertion by Luke Johnson in The Telegraph (2005) that Lord Layard, having spent most of his working life in the public sector, did not understand what went on in the real world and therefore had no scientific evidence behind his original hypothesis.
In an article in The Guardian (2008) D H Cohen, a 30 year old who works in mental health services in London, argues that the mailbag at his mental health service is filling with complaints. He says that NICE Guidelines state that for mild disorders a patient can expect no more than six to eight sessions and that for even more severe disorders no more than fourteen to twenty sessions. He says that in reality, for mild disorders you could, as a patient, have to go for over twenty sessions and for more complex issues you can go beyond thirty or forty. He also argues that some clients will be readmitted at a later date.
There are more criticisms available on the Internet for anyone who has an interest in them but I would like to move on and to discuss the role of the IAPT Low Intensity Therapist.
In the new method of working, the IAPT system, the client can be referred by a variety of sources, the General Practitioner, Jobcentre Plus, via employers occupational health departments, Community Mental Health Teams or they can refer themselves directly.
Whereas previously it may have taken a few weeks or even months to get an appointment, now the client is contacted by telephone usually within about twenty four hours of making first contact, by the IAPT Team. They are then given a face to face appointment with a low intensity worker, called a case manager, who makes an assessment of the clients condition and any suicidal intention, using tools like PHQ 9 and GAD 7 and draws up a treatment plan using a ???stepped care??? system. This may involve the use of a workbook, such as Dr Chris Walkers ???Depression Recovery Workbook??? or ???Anxiety Workbook??? or another intervention such as counselling, Books on Prescription, Beating the Blues or further CBT with goal setting being part of the clients path to recovery. The Low Intensity worker is trained in listening skills and how to interview a client to elicit information which may help in the course of treatment. They are also trained in the use of CBT. This saves the client from having to take time off work for treatment and in my estimation reduces the time spent by therapists waiting for ???Did Not Attends???.
The critics appear to a large extent to have been answered by the results of the Doncaster and Newham experimental sites.
In 2006/2007 Doncaster helped 4500 people through their stepped care model of psychological provision, whereas Newham treated an additional 800 people and 600 were supported in returning to work.
In Doncaster, according to Laurence Pollock (Guardian, 18th February 2008) over one seven month period a total of 2, 347 patients were treated for anxiety and / or depression, Depression rates dropped from 78% to 24%. Patient satisfaction rates were close to 100%.
In Newham, according to their report of 21/09/07 91% of patients reported satisfaction with the information provided and treatments available. After one hour of care, 73% of patients reported satisfaction, after twelve hours of care, 97% reported satisfaction. Newham also reports that patients showed significant improvement in their economic activity, which may have proved Lord Layard to be correct in his original hypothesis.
Further reading of interest
16th August 2009