Opportunities and challenges in Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI): evaluating the first operational year of the South London and Maudsley (SLaM) demonstration site for psychosis

Suzanne Jolley; Philippa Garety; Emmanuelle Peters; Miriam Fornells-Ambrojo; Juliana Onwumere; Victoria Harris; Alison Brabban; Louise Johns

doi:10.1016/j.brat.2014.11.006

Opportunities and challenges in Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI): evaluating the first operational year of the South London and Maudsley (SLaM) demonstration site for psychosis

Behav Res Ther. 2015 Jan:64:24-30. doi: 10.1016/j.brat.2014.11.006. Epub 2014 Nov 26.

Authors

Suzanne Jolley¹, Philippa Garety², Emmanuelle Peters², Miriam Fornells-Ambrojo³, Juliana Onwumere², Victoria Harris⁴, Alison Brabban⁵, Louise Johns⁶

Affiliations

¹ King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK. Electronic address: Suzanne.jolley@kcl.ac.uk.
² King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
³ King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; University College London, Department of Clinical, Educational and Health Psychology, London, UK.
⁴ King's College London, Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
⁵ University of Durham, Durham, UK; Tees, Esk, and Wear Valley NHS Mental Health Foundation Trust, County Durham, UK.
⁶ King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 25499927
DOI: 10.1016/j.brat.2014.11.006

Abstract

Despite its demonstrated clinical and economic effectiveness, access to Cognitive Behavioural Therapy for psychosis (CBTp) in routine practice remains low. The UK National Health Service (NHS England) Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aims to address this problem. We report 14-month outcomes for our psychosis demonstration site. Primary and secondary care and self-referrals were screened to check the suitability of the service for the person. Psychotic symptoms, distress, service use, functioning and satisfaction were measured before and after therapy, by trained assessors. User-defined wellbeing and goal-attainment were rated sessionally. Access to CBTp increased almost threefold (2011/12 accepted referrals/year n = 106; 2012/13, n = 300). The IAPT-SMI assessment protocol proved feasible and acceptable to service users, with paired primary outcomes for 97% of closed cases. Therapy completion (≥5 sessions) was high (83%) irrespective of ethnicity, age and gender. Preliminary pre-post outcomes showed clinical improvement and reduced service use, with medium/high effect sizes. User-rated satisfaction was high. We conclude that individual psychological interventions for people with psychosis can be successfully delivered in routine services using an IAPT approach. High completion rates for paired outcomes demonstrate good user experience, clinical improvement, and potential future cost savings.

Keywords: CBT; Cognitive therapy; Schizophrenia; Therapy outcome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Cognitive Behavioral Therapy / methods*
Female
Health Services Accessibility*
Humans
London
Male
Middle Aged
Outcome Assessment, Health Care
Psychotic Disorders / psychology
Psychotic Disorders / therapy*
Treatment Outcome
Young Adult

Grants and funding

Department of Health/United Kingdom