The Improving Access to

Psychological Therapies (IAPT)

Program in United Kingdom (UK)

Dr. Cheryl So, Clinical Psychologist, Kwai Chung Hospital

Dr. Martina Cheung, Clinical Psychologist, Castle Peak Hospital

Dr. Amy Kwok, Clinical Psychologist, Prince of Wales Hospital

Ms. Carole Li, Clinical Psychologist, Oasis, HAHO

Dr. Wilson Tsui, Clinical Psychologist, Kowloon Hospital

Acknowledgement

• The training program and schedule was

organized by Mood Disorders Center,

University of Exeter, UK

– Professor David Richards

– Professor Eugene Mullan

• Working Group on Primary & Community Care,

COC(CP)

• Hospital Authority

Attachment in UKA. University of

Exeter

B. Devon (NHS IAPT Service)

C. University of Reading (Child IAPT)

D. Colchester (NGO IAPT Service)

E. London (Rethink)

Background

• The Improving Access to Psychological

Therapies (IAPT) Program

– Large scale initiative from the UK government in

May 2005 & funded in 2007

• ₤309 m (2008-2010); 3660 new therapists

• ₤400 m (2011-2015); 2400 new therapists

– New standalone psychological service in

community settings

– Depression & Anxiety Disorders

Clinical & Policy Development

1. National Institute for Health and Clinical

Excellence (NICE)

– Clinical guidelines (evidence-based psychological

therapies)

– Cognitive Behavior Therapy (CBT)

– Aims to greatly increase the availability of these

therapies in the National Health Service (NHS)

Clinical & Policy Development

2. Economists and clinical researchers

– An increase in access to psychological therapies

would largely pay for itself

– ↓ other depression- and anxiety-related public

costs (welfare benefits and medical costs)

– ↑ increasing revenues (taxes from return to

work, increased productivity etc)

IAPT Program Governance

1. Well-trained Workforce (Accreditation &

Qualification)

– The Department of Health (UK) commissioned and

developed two national curricular for the training of the

new workforce for IAPT service, based on competence

frameworks derived from the NICE guidelines and

evidence from large clinical trials.

– Postgraduate Certificate (1-year; Low Intensity CBT –

behavioral activation, problem-solving)

– Postgraduate Diploma (1-year; High Intensity CBT)

IAPT Program Governance

1. Well-trained Workforce (Accreditation &

Qualification)

– All IAPT training courses are accredited by

• The British Psychological Society (BPS) / The British

Association for Counseling & Psychotherapy (BACP) /

The British Association for Behavioral & Cognitive

Psychotherapies (BABCP)

• NHS’s IAPT program

• Professional qualification (knowledge & skills)

• Individual registration

IAPT Program Governance

1. Well-trained Workforce (Accreditation &

Qualification)

2. Management / Clinical Guidelines• IAPT Guidance for Commissioning IAPT Training

• Guidance for Commissioning Supervisor IAPT Training

• Good practice guidance on the use of self-help materials within IAPT

services

• IAPT Positive Practice Guides (for Black and Minority Ethnic

Communities, Older People, Perinatal Care, Offenders, etc.)

• IAPT Supervision Guidance

• IAPT Key Performance Indicator (KPI) Technical Guidance for 2011/12

IAPT Program Governance

1. Well-trained Workforce (Accreditation &

Qualification)

2. Management / Clinical Guidelines

3. Treatment Protocols

– Evidence-based treatments recommended by

NICE Guidelines

– Specific treatment protocols

Process of Service Delivery

Step 3 High Intensity

Step 2 Low Intensity

Step 4 Specialist Mental Health Service

Step 1 Self-help, active monitoring

The Stepped Care &

Collaborative Service

Model

IAPT – Step 1-3

Referral

“Least Burden” principle “Self-Correction” principle

Successful Implementation of IAPT

1. Written clinical protocols covering assessment &

treatment of each condition

– Based on the National Institute for Health & Clinical

Excellence (NICE) Guidelines

2. Core of experienced staff (e.g., clinical

psychologist) who are competent in relevant

psychological therapies

3. All IAPT therapists are required to attend

– Weekly 1-hour Case Management Supervision

– Bi-weekly 1.5 hour Clinical Skills Supervision

Successful Implementation of IAPT

Supervision structure in IAPT program

Successful Implementation of IAPT

4. Smart IT system for

outcome measures

and supervision

• Instant profile analysis

• Supervisor Alert

Effectiveness

• More than 40 Key Performance Indicators

(KPIs)

– Patient Health Questionnaire Depression Scale

(PHQ-9; Kroenke et al., 2001)

– Patient Health Questionnaire Generalized Anxiety

Disorder Scale (GAD-7; Kroenke at el., 2007)

– Sick pay / illness-related benefit

• Recovery rate: 42.8% (over 120, 000 people)

• Over 23, 000 people came off sick

pay/benefits

Recommendations

1. Quality Standards & Supervision

– Treatment protocols

– Continuous supervision

Recommendations

2. Training Program

– Structured training program (low intensity CBT)

– Close liaison between COC(CP), Institute of

Advanced Allied Health Studies (IAAHS),

academic psychologists, & relevant professional

bodies (The Hong Kong Psychological Society)

Recommendations

3. Service Development

– Long Term Medical Conditions

• Diabetes, hypertension, coronary artery disease or

chronic obstructive pulmonary disease (COPD)

• 3 or 4 times more: depression & anxiety disorders

• Savings in other costs to the NHS and to society

• COC(CP) – COC(FM)

• COC(CP) – COC(MED)

Recommendations

3. Service Development

– Improve Access to Psychological Therapies for

Children & Young People

• Depression, eating disorders, self-harm, conduct

problems, Attention-Deficit/Hyperactivity Disorder

(ADHD)

• Early intervention – treatment; prevent 2nd

psychological problems

Recommendations

4. Quality Improvement

– Care Delivery Model

• Integrated Mental Health Problem (IMHP) in general

out-patient clinics; Common Mental Disorder Clinic

(CMDC) in psychiatric settings

• Close collaboration between the psychiatric specialist &

primary care services to provide “seamless”,

coordinated mental health service

• COC (CP) / COC (Psy) / COC (FM)

The Stepped Care &

Collaborative Service Model

Step 3 Specialist Psychological Intervention

Step 2 Early Intervention

Beh activation; problem-solving

Step 4

Psychiatric Care

Step 1 Early detection; Initial Assessment; Psychoed

Step 1-3:Non-psychiatric settings

Care pathway

•Who should be seen•By which service

•At which point in theircare

Experienced clinicians – therapy; supervision; collaboration

Conclusion

Concerted effort from different COCs

• Program plan

• Clinical governance

• Management / clinical guidelines

• Structured training curriculum

• Written protocols (assessment and treatment)

Questions & Answers

Thank you!