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The successful impact of adapting CBT in IAPT for people with complex long-term physical health conditions

Published online by Cambridge University Press:  07 September 2020

Rupal Panchal Open the ORCID record for Rupal Panchal [Opens in a new window] ,
Brian Rich ,
Carly Rowland ,
Tessa Ryan  and
Sarah Watts
Rupal Panchal*
Affiliation:
Midlands Partnership NHS Foundation Trust, Staffordshire and Stoke-on-Trent Wellbeing Services (IAPT)
Brian Rich
Affiliation:
Midlands Partnership NHS Foundation Trust, Staffordshire and Stoke-on-Trent Wellbeing Services (IAPT)
Carly Rowland
Affiliation:
Midlands Partnership NHS Foundation Trust, Staffordshire and Stoke-on-Trent Wellbeing Services (IAPT)
Tessa Ryan
Affiliation:
Midlands Partnership NHS Foundation Trust, Staffordshire and Stoke-on-Trent Wellbeing Services (IAPT)
Sarah Watts
Affiliation:
Midlands Partnership NHS Foundation Trust, Staffordshire and Stoke-on-Trent Wellbeing Services (IAPT)
*
*Corresponding author. Email: rupal.panchal@nottshc.nhs.uk
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Abstract

It is widely recognised that a diagnosis of a long-term physical health condition (LTC) is likely to have a significant impact on a person’s mental health. This is highlighted in the Five Year Forward View for Mental Health (NHS England, 2016) where significant numbers of patients projected to be seen through the expansion of Improving Access to Psychological Therapies (IAPT) services are to come from within the LTC community. IAPT services offer evidence-based therapeutic interventions for common mental health issues – anxiety disorders and depression. The South East Staffordshire IAPT services have developed an integrated pathway as a Wave 2 site for the delivery of cognitive behavioural therapy (CBT) adaptations for LTC. The main themes outlined in this paper focus on the innovations and service developments of IAPT-LTC including: the importance of engagement between mental health and medical healthcare professionals, identifying the key professionals in medical healthcare to enhance engagement, extended training for clinicians with in-house continued professional development, as an extension to the National IAPT-approved top-up training for LTC, and developments in clinical supervision structures and practice, along with future developments in the field of IAPT-LTC. These themes have direct relevance to CBT practitioners working within the LTC community in IAPT services. The four contrasting case studies demonstrate how the application of CBT can successfully be adapted to condition related beliefs and behaviours, despite the complexity of the medical condition. Findings show how integrated services and engaging with medical healthcare professionals had profound benefits for the patients, IAPT therapists and medical healthcare professionals.

Key learning aims

  1. (1) The good practice points in the development of the IAPT-LTC pathway within South East Staffordshire IAPT services.

  2. (2) The successful design and implementation of the IAPT-LTC pathway within South East Staffordshire IAPT services.

  3. (3) The key considerations of the interaction for patients between their physical and mental health symptoms.

  4. (4) The application of CBT adaptations for people with complex LTCs can be effective in improving psychological wellbeing and physical condition management.

Keywords

anxiety disorderscase seriescognitive behaviour therapydepressionIAPTintegrated pathwaylong-term physical health conditionservice deliveryservice models
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e36
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Department of Health (2005). Supporting people with long term conditions. Department of Health Gateway Reference 4230.Google Scholar
Department of Health (2008a). IAPT: Long-term conditions positive practice guide. Available at: www.iapt.nhs.uk/wp-content/uploads/2008/11/long-term-conditions-positive-practice1.pdfGoogle Scholar
Department of Health (2008b). IAPT: Medically unexplained symptoms positive practice guide. Available at: www.iapt.nhs.uk/wp-content/uploads/2008/11/medically-unexplainedsymptoms-positive-practice-guidetext.pdfGoogle Scholar
IAPT (2011). IAPT Programme Review. Department of Health. https://www.uea.ac.uk/documents/246046/11919343/IAPT+Review+%282011%29.pdf/133a9732-badd-40ef-9aeb-87040b286744Google Scholar
IAPT (2014a). Medically Unexplained Symptoms/functional Symptoms Positive Practice Guidelines. Department of Health. https://www.uea.ac.uk/documents/246046/11919343/medically-unexplained-symptoms-positive-practice-guide-.pdf/55aea215-100e-4925-a968-65d6e89ad9b3Google Scholar
IAPT (2014b). Measuring Recovery and Improvement in Adult Services. Department of Health. https://webarchive.nationalarchives.gov.uk/20160302155408/http:/www.iapt.nhs.uk/silo/files/measuring-recovery-2014.pdfGoogle Scholar
Mental Health Taskforce (2016). The Five Year Forward View for Mental Health. Redditch: NHS England. Available at: https://www.england.nhs.uk/wpcontent/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdfGoogle Scholar
National Collaborating Centre for Mental Health (2018). The Improving Access Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms – Full Implementation Guidance. London: NCCMH; 2018. Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/nccmh-iapt-ltc-full-implementation-guidance.pdf?sfvrsn=de824ea4_4Google Scholar
National Collaborating Centre for Mental Health. The Improving Access to Psychological Therapies Manual. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/02/improving-access-to-psychological-therapies-manual.pdfGoogle Scholar
NHS England (2017). Five Year Forward View for Mental Health: One Year On. Redditch: NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/03/fyfv-mh-one-year-on.pdfGoogle Scholar
NICE (n.d.). NICE Improving Access to Psychological Therapies. Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/iaptGoogle Scholar

References

National Collaborating Centre for Mental Health (2018a). The Improving Access Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms – Full Implementation Guidance. London: NCCMH; 2018. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/nccmh-iapt-ltc-full-implementation-guidance.pdf?sfvrsn=de824ea4_4Google Scholar
National Collaborating Centre for Mental Health (2018b). The Improving Access Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms. London: NCCMH; 2018. Available from: https://www.england.nhs.uk/wp-content/uploads/2018/03/improving-access-to-psychological-therapies-long-term-conditions-pathway.pdfGoogle Scholar
NHS England (2016). Implementing the Five Year Forward View for Mental Health. Redditch: NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdfGoogle Scholar
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