The employment and mental health impact of integrated Improving Access to Psychological Therapies: Evidence on secondary health care utilization from a pragmatic trial in three English counties

Psychologists as Pivotal Members of the Pediatric Palliative Care Team

CONTEXT

Pediatric psychologists possess unique expertise to positively impact the care provided to children with serious illness and their families. Despite increasing recognition regarding the value of psychology in palliative care, psychologists are not yet routinely integrated into pediatric palliative care (PPC) teams.

OBJECTIVES

This special paper seeks to demonstrate distinctive contributions psychologists can offer to PPC teams, patients, and families, as well as highlight how psychologists enhance the work of their interdisciplinary PPC colleagues.

METHODS

Existing literature, consensus and policy statements, and recently developed competencies inform and provide evidence for the value of incorporating psychologists into PPC.

RESULTS

As children with serious illness are at risk for mental and physical health symptoms, psychologists' specialized training in evidence-based assessment and intervention allows them to assess areas of concern, create treatment plans, and implement nonpharmacological therapies targeting symptom management and promotion of quality of life. By improving patient and family outcomes, psychology involvement saves money. In addition to clinical care, psychologists are skilled researchers, which can help to advance PPC interdisciplinary research. Lastly, psychologists can play a valuable role in contributing to PPC team education, dynamics, and well-being.

CONCLUSIONS

With strong skills in research, clinical care, education, and advocacy, pediatric psychologists are exceptionally equipped to provide care to children with serious illness and their families. Given their unique contributions, it is critical future efforts are directed towards advocating for the inclusion of psychologists into PPC, with the ultimate goal of improving care for children with serious illness and their families.

Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation

BACKGROUND

Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.

OBJECTIVES

To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links.

DESIGN

A real-world evaluation using IAPT's electronic health records.

SETTING

Three National Health Service IAPT services in England.

PARTICIPANTS

Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline.

INTERVENTION

We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control).

PRIMARY OUTCOME MEASURES

Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models.

RESULTS

Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control.

CONCLUSIONS

Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.

Socio-demographic differences in access to psychological treatment services: evidence from a national cohort study

BACKGROUND

Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level.

METHODS

Using a unique individual patient dataset that linked 2011 Census information of English residents to national IAPT data collected between April 2017 and March 2018, we estimated the rate of access by a wide range of socio-demographic characteristics that are not routinely available. A large household survey was used to estimate the prevalence of probable CMDs by these socio-demographic characteristics. We estimated the probability of access to IAPT amongst people with CMDs by comparing the rates of access from IAPT data and the estimates of prevalence of CMDs from the household survey. Both unadjusted and adjusted (for important patient characteristics) access rates were estimated in logistic regression models.

RESULTS

As a proportion of those with a probable CMD, access to IAPT varied markedly by socio-demographic characteristics. Older adults, males, people born outside of the UK, people with religious beliefs, people from Asian ethnic backgrounds, people reporting a disability and those without any academic or professional qualifications were underrepresented in IAPT services nationally, in adjusted models.

CONCLUSIONS

The identification of patients who may be underrepresented in IAPT provides an opportunity for services to target outreach and engagement with these groups. Further understanding of barriers to access should help increase equity in access.

Riuscire a ottenere un beneficio di massa tramite l'offerta di terapie psicologiche: l'esperienza del programma inglese

Viene pubblicata la trascrizione della relazione tenuta al Convegno "Le terapie psicologiche per l'ansia e la depressione: nuove forme di integrazione clinica e organizzativa" (Isola di San Servolo, Venezia, 26 ottobre 2022). Dopo la descrizione delle principali caratteristiche del programma inglese Improving Access to Psychological Therapies (IAPT), viene sottolineata l'importanza di alcuni aspetti tra cui i seguenti: l'affidabilità delle linee-guida; un programma nazionale di training in cui si valuta accuratamente anche la competenza raggiunta dai terapeuti; la raccolta di tutti i risultati e la loro pubblicazione, che ha permesso di capire molti problemi (come ridurre le differenze nei risultati di gruppi etnici diversi, come migliorare i Servizi in aree povere, etc.); il benessere e la motivazione degli operatori (circa 10.000 terapeuti), che devono avere figure di leadership innovative che non danno solo importanza al risultato ma che sanno anche creare un ambiente di lavoro stimolante in cui si lavora volentieri e col piacere di apprendere sempre nuove cose.

Cleaning in Times of Pandemic: Perceptions of COVID-19 Risks among Workers in Facility Services

Cleaning services are a transversal activity that guarantees the proper functioning and conditions of safety, hygiene, and health across all economic sectors. The COVID-19 pandemic increased the need for clean, sanitary spaces, particularly in health services and other areas with a large number of people. The workers in these services were often placed on the frontline without any specific training or information. Their low average schooling aggravated this situation. Therefore, exploring these workers’ perceptions about the COVID-19 pandemic and its potential influence on their mental health was the primary goal of our research. Structured interviews were conducted based on questionnaires in a sample of 436 women. Their characterisation focused on three aspects related to the pandemic. First, to prevent infecting others (85.5%) and that people close to them could die (86.0%) were the dominant concerns; second, the feeling of permanent vigilance was mentioned (56.2%); and third, the fear of not getting medical care (60.7%). Thus, the workers felt there was a need for more dissemination of individual protection measures, as well as more training, better general working conditions, and access to psychological counselling.

The impact of mental health support for the chronically ill on hospital utilisation: Evidence from the UK

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.