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. (January 2015)

• Record Type: Journal Article
• Authors: Jolley, Suzanne; Garety, Philippa; Peters, Emmanuelle; Fornells-Ambrojo, Miriam; Onwumere, Juliana; Harris, Victoria; Brabban, Alison; Johns, Louise
• Is Part Of: Behaviour research and therapy. Volume 64(2015)
• Page Start: 24
• Page End: 30
• Publication Date: 2015-01
• Subjects: Schizophrenia -- Cognitive therapy -- CBT -- Therapy outcome; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2014.11.006
• Languages: English
• ISSNs: 0005-7967

Abstract

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. Highlights: Cognitive therapy for psychosis in routine care shows good clinical outcomes. Service use reduced following therapy, with medium pre–post effects. Systematic delivery and routine outcome measurement is feasible in this setting. Paired completion rates for primary outcomes are high (97%). No demographic inequity in completion or outcome.