Improving Access to Psychological Therapies

Our exciting new service, which expands and improves access to psychological therapies and provides a whole new service at the psychological wellbeing level, is now live! The service is provided by the Lambeth Primary Care Psychological Therapies Service.

Background
On 10 October 2007, the Secretary of State for Health announced plans which would begin to build a new system of Psychological Therapy Services delivering NICE recommended treatments in local PCT areas.

NICE guidance for the treatment of most common mental health problems, such as depression and anxiety, recommends a stepped care approach (e.g. NICE 2007). This involves a framework within which the stepped care can be monitored, and the level or step of care stepped up or down as required.

The steps of care are:

• Step 1: Recognition, monitoring and education by GP.
• Step 2: ‘Low intensity’/ Psychological wellbeing.
  The aim is to help people early on, before their problems have irreversible impacts on their lives. This may be when they are first signed off sick, or first prescribed anti-depressant medication. This is ‘mental health promotion’ to people who may have previously not been referred.
  These interventions are aimed at people who are keen to self-manage their recovery from depression or anxiety. They would have access to a brief number of sessions of guided self-help, including computerised packages such as Beating the Blues, signposting, community links, and case management. The work can be carried out on the telephone.
  This also includes exercise referral programmes.
• Step 3: ‘High intensity’.
  Psychological treatments, primarily Cognitive Behaviour Therapy (CBT). 

In light of the announcement by the Secretary of State for Health, NHS Lambeth and South London & Maudsley submitted a successful bid to become an  IAPT (Improving Access to Psychological Therapies) site (December 2008).

Furthermore, since 2007 we have been implementing talking therapy redesign and IAPT has enabled us to build on this by offering significant additional capacity for evidence based Cognitive Based Therapy (CBT).

Staffing
Our Lambeth Primary Care Psychological Therapies Service (SLAM NHS) and our existing primary care mental health workers will make up the spine of the service, to which 28 new workers are being added. Fifteen will be high intensity workers (Step 3) and 13 will be Psychological Wellbeing Practitioners (PWPs) doing low intensity work (Step 2).

The High Intensity staff will have training and experience in CBT, and come from a range of professional backgrounds e.g. clinical psychology, counselling psychology, psychiatric nursing. The service will, also, include vocational specialists who will help patients with employment related needs.

We will also incorporate our local Centre for Anxiety Disorders and Trauma (CADAT) and the Maudsley CBT Psychotherapy Service.

Who is the service for?
Our key target population is people with depression or an anxiety disorder. Within this, we have key additional targets – those who are at risk of unemployment; those who are unemployed; people from our BME communities, and offenders. Additional money has been secured from NHS Commissioning Support for London to support work with people unemployed or at risk of unemployment (four workers employed by Status Employment) and with people from BME communities (one worker employed by Southside Partnership and 10 volunteers).

Referrals
The IAPT model requires a high volume of referrals to be processed.

In Lambeth, the plan is for this to be through a single point, in order for them to be triaged and allocated to the appropriate step of care in the service, or to be referred elsewhere. Allocation to each step depends on the severity of the depression/anxiety and the particular diagnosis of the person’s main problem. Self referral and referral from other agencies is actively encouraged.

We will operate clinics in GP surgeries, Job Centre Plus, local neighbourhood hubs and team bases. Our team bases are in Streatham (Palace Road Surgery), Brixton (Dalbury House, Ferndale Road) and St Thomas’ Hospital.

Our PWPs (Step 2) join us on 14 September and our High Intensity (Step 3) workers on 8 October.

We can take referrals for this exciting new service now

If you would like referral forms and/or our ‘opt-in’ leaflet please contact Sonia El-Harrak on 020 7188 5406 or email sonia.el-harrak@slam.nhs.uk

You can also email us at slm-tr.LambethPTS@nhs.net or phone us on 020 3228 1654.