Improving access to psychological therapies: implications for mental health care in general practice

Abstract

A total of 3600 new accredited psychological therapists are being trained and employed in primary care over the 2008–2011 period as part of the Improving Access to Psychological Therapy (IAPT) programme.1 This is the largest investment (£170 million) in primary care mental health ever, and comes with a number of pre-conditions: practitioners will be employed in teams; have routine supervision; collect patient-rated outcome measures at each contact (including the Patient Health Questionnaire–92 and the Generalised Anxiety Disorder Assessment–73); and services will operate according to a ‘stepped care model’. ‘Low intensity practitioners’ have some similarities in training to ‘graduate mental health workers’ whose role was proposed in The NHS Plan in 2000, although lessons have been learned from the problems associated with this previous initiative.4,5 These low intensity practitioners, who may have limited mental health experience, are trained to provide a wider range evidence-based brief interventions derived from cognitive behavioural therapy (CBT), such as facilitated self-help (computerised CBT and bibliotherapy), behavioural activation, and problem-solving, in addition to signposting to other community resources. The more numerous ‘high intensity practitioners’ provide CBT to those who have not recovered with lower intensity treatments. Targets for supporting patients to return to work are being revisited in the new economic climate. Contrary to some reports, counselling and other treatment modalities can be integrated into or co-exist in parallel with the new IAPT teams. The ambitions of the IAPT programme to improve access to talking therapies to a wider population, including vulnerable groups, is bold and potentially of great importance to patients and their GPs; however, this poses some challenges too, not least that of horizontally integrating into primary care an essentially vertically organised programme of care focused on depression and anxiety.6 We suggest that the IAPT programme is best …