Improving Access to Psychological Therapies
for Severe Mental Illness (IAPT - SMI)
What is IAPT - SMI?
Improving Access to Psychological Therapies for Severe Mental Illness (IAPT for SMI) is aiming to transform existing mental health services to be better able to provide National Institute for Health and Clinical Excellence (NICE) approved psychological therapies to people who experience psychosis, bipolar disorder or personality disorders.
In November 2012, the Department of Health invested over £1million in 6 SMI demonstration sites:
- Psychosis sites : Lancashire; South London & Maudsley
- Personality Disorder sites: Somerset; Barnet, Enfield & Haringey; North East London
- Bi-Polar Disorder site: Birmingham & Solihull supported by Lancaster University
Lancashire EIS has been chosen as one of two demonstration sites in the country for Improving Access to Psychological Therapies – Severe Mental Illness (IAPT-SMI) in psychosis. The aim of this is to show how our service attempts to provide National Institute for Health and Care Excellence (NICE) approved psychological therapies for psychosis and to routinely collect and record sessional data on the effectiveness of these in the recovery process .
NICE1,2 recommend the provision of individual Cognitive Behavioural Therapy (CBT) over a minimum of 16 planned sessions and Family Intervention (FI) over 10 planned sessions. These interventions are clinically and cost effective, reducing hospitalisation and improving outcomes at no additional cost.
A number of barriers to the implementation of NICE recommendations have been identified, including:
- Competing demands and priorities in tight financial climate.
- Lack of up-to-date knowledge (at all levels of the NHS)
- Insufficient therapists & supervisors with adequate training/competences; Only 10% of individuals experiencing psychosis are offered CBT3
- Lack of appropriate, available training & supervision.
- Organisational/team philosophy and priorities.
- Increasing caseload numbers
The Lancashire Early Intervention Service (EIS) attempts to overcome such barriers, increasing service user choice by improving access to evidence based psychological therapies in existing services:
- Whole Service Ethos of Psychosocial Care : Matched care or tiered approached to delivering psychological care across whole workforce
- Education & Training :
- Psychosocial Intervention (PSI) Training: All of our staff are trained in CBT-informed interventions (manualised, effective and accredited)
- Behavioural Family Therapy (BFT): We have 20+ staff trained and we have our own BFT trainers
- Cognitive Behavioural Therapy (CBT) & Cognitive Behavioural Family Intervention (CBFI): Cohort of staff trained to Diploma, Masters and Doctorate level
Our involvement in the project
The role of Lancashire Early Intervention Service (EIS) in the IAPT-SMI project is to record people’s progress within psychological therapy in terms of their personal recovery, quality of life, health and long-term service use.
During therapeutic work together, short questionnaires are completed based upon difficulties that may be experienced. This helps to monitor progress and the quality of service that we provide. The information is collected from questionnaires, combined with that of other individuals and used in reports to help us find out how our service compares with other services across the country.
Future benefits for individuals who use the Early Intervention Service nationally:
- This enables us to measure our service and respond to the feedback we receive from service users
- Demonstrates the contribution of psychological therapies in the recovery journey
- Allows us to feedback to other mental health trusts what works best for individuals who receive therapy for psychosis
- Helps inform government and NHS policy about how best to treat individuals who experience psychosis
- NCCMH (2013). Psychosis and Schizophrenia in Children and Young People. Leicester and London: The British Psychological Society and the Royal College of Psychiatrists. [Full guideline]
- NCCMH (2014). Psychosis and Schizophrenia in Adults: NICE Guideline on Treatment and Management. Leicester and London: The British Psychological Society and the Royal College of Psychiatrists. [Full guideline]
- The Schizophrenia Commission (2012). The Abandoned Illness: A Report by the Schizophrenia Commission. London: Rethink Mental Illness