IAPT for SMI: Findings from the evaluation of service user experiences Julie Billsborough & Lisa Couperthwaite, Researchers at the McPin Foundation
About us A small, specialist mental health research charity Our vision is for a transformed mental health system in which research and services are shaped by the lived experience of people affected by mental health problems Conducting research and evaluation Supporting people to get involved in research Providing consultation and advice A relatively new organisation established in April 2013, but with an experienced team of mental health researchers
Evaluation aims To capture the perspectives of those using services in six sites delivering an NHS England funded programme known as IAPT for Severe Mental Illness (IAPT for SMI) To capture the views of those who were referred to the services, but did not go on to receive therapy To describe the experiences and levels of satisfaction with the IAPT for SMI services To capture any recommendations for improvements to the services
The services Providing psychological therapies for Psychosis: Lancashire Care NHS Foundation Trust South London and Maudsley NHS Foundation Trust Providing psychological therapies for Bipolar Disorder: Birmingham and Solihull Mental Health Foundation Trust and Spectrum Centre for Mental Health Research, Lancaster University Providing psychological therapies for Personality Disorders: Barnet, Enfield and Haringey Mental Health Trust North East London NHS Foundation Trust Somerset Partnership NHS Foundation Trust
Our approach Survey of IAPT service users and non-users Lived experience at the heart of the research methodology Collaborative approach Interviews with IAPT service users and nonusers 305 people responded to the survey questionnaire 61 of these people took part in depth interviews Analysis and reporting Report and summary document available to download: www.mcpin.org/iaptsmireport
Participant characteristics 305 people surveyed
Findings: accessing the services Overall feedback about accessing the services was positive 71% of those who went on to receive therapy were satisfied with the assessment process, while only 53% who didn t receive therapy were satisfied Waiting times were most likely to be negatively experienced I was quite pleased that I was being taken notice of and that I was believed in what I was saying to people. There s a bit of nervousness, like all of a sudden it s got very real I ve never had to talk about my mental health with anybody [before]. It took very long for me to get referred to the service and it was a bit annoying because I had to tell my story again.
Findings: expectations of the services Expectations of the services varied greatly from optimistic to sceptical People also had a range of motivations for wanting therapy Talking things through Identifying underlying problems Improving relationships Developing coping strategies
Findings: experiences of the services Of the 241 participants who went on to receive therapy, most were satisfied with their experience: 77% were happy with the number of sessions offered 84% were happy with the way the service communicated with them 80% were satisfied with the accessibility of the service 83% agreed or strongly agreed that their therapist understood them 77% agreed or strongly agreed that their therapist had helped them to develop skills 67% were happy with the planning for the completion of therapy and arrangements for follow-up support The psychologist communicated by email, which was good. She was friendly, patient, she was sensitive to how I was feeling. I thought we were in mid-flow and it cut off. It s in the back of beyond. It s easier to get to Scotland or to get to Paris. The last session, we did a relapse pack, and it was made very clear that if we were unwell, we could speak to them.
Findings: IAPT service nonusers 64 people who responded to our survey had been referred to the services, but had not received any therapy 27 people had started therapy, and stopped part way through People from both groups gave similar reasons: Not feeling it would be helpful Negative experience of referral, assessment and waiting times Challenging or changing personal circumstances Service not being able to meet their needs, or being refused therapy By the time I was seen I had been through one of the most distressing time of my life. I dropped out early because of going to university and wanting the time to do more university work.
Findings: impact for clients Most people who had accessed the service felt that it had a positive impact on their lives 52% of participants felt that the service had helped them a lot 8% felt that it had not helped them at all Before, I was looking around for ways to kill myself, but now I m looking around for ways to improve my flat.. I m getting my relationship back on track with my girlfriend. I ve become a lot more in tune with those early warning signs. I feel more confident now talking about it to other people.
Findings: overall experience
Recommendations 1. Simplification of the referral process 2. Clear information about what to expect from therapy, including: commitment required from service user, types of therapy on offer and choices people have about their therapy; timings and number of sessions; and endings and planning ahead for completion 3. Information around, and promotion of, ongoing peer support available locally 4. Information and clarity around diagnosis; and Personality Disorders in particular 5. Reduction in waiting times and the provision of clear information about waiting times at the outset 6. Good communication, information and support from IAPT service, and other services, agencies and organisations, during the waiting period 7. Flexibility and accommodation of individual needs regarding the delivery of therapy e.g. face to face, group work, male or female therapist 8. Good organisation, communication and customer service throughout 9. Strong improvement of therapeutic relationship through providing a validating atmosphere and non-judgmental approach. Self-disclosure may sometimes help with this 10. Strong boundaries on the part of the therapist during group sessions 11. Ease of access regarding practical considerations such as work / childcare commitments and travel problems 12. Increased follow-up support
Next steps The IAPT for SMI demonstration sites have been supportive of this evaluation and feedback is ongoing Actions to address the points raised in the evaluation will be considered in each locality The research team is currently undertaking a more detailed analysis of the qualitative data that will result in a peer review publication
Thank you www.mcpin.org www.mcpin.org/iaptsmireport