Improving Access to psychological therapies for people with severe mental illness (IAPT-SMI): Lessons from the South London and Maudsley psychosis demonstration site

Implementation of evidence-based cognitive behavioural therapy for psychosis (CBTp) remains low in routine services. The United Kingdom Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aimed to address this issue. The project evaluated whether existing services could improve access to CBTp and demonstrate effectiveness using a systematic approach to therapy provision and outcome monitoring (in a similar way to the Improving Access to Psychological Therapies (IAPT) model for people with anxiety and depression). We report the clinical outcomes and key learning points from the South London and Maudsley NHS Foundation Trust IAPT-SMI demonstration site for psychosis. Additional funding enabled increased therapist capacity within existing secondary care community mental health services. Self-reported wellbeing and psychotic symptom outcomes were assessed, alongside service use and social/occupational functioning. Accepted referrals/year increased by 89% (2011/12: n = 106/year; 2012–2015: n = 200/year); 90% engaged (attended ≥5 sessions) irrespective of ethnicity, age and gender. The assessment protocol proved feasible, and pre-post outcomes (n = 280) showed clinical improvements and reduced service use, with medium effects. We conclude that, with appropriate service structure, investment allocated specifically for competent therapy provision leads to increased and effective delivery of CBTp. Our framework is replicable in other settings and can inform the wider implementation of psychological therapies for psychosis

Experiences of outcome monitoring in service users with psychosis:Findings from an Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) demonstration site

Objectives Psychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals’ views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM are critical to successful implementation. We investigated service users’ experiences of ROM in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site. Design ROM comprised a periodic assessment battery completed at baseline, mid‐therapy, and end‐of‐therapy and a single measure completed session‐by‐session. Qualitative and quantitative feedback were sought at each periodic ROM administration, and, for sessional ROM, at mid‐therapy and end‐of‐therapy. Demographic and clinical correlates of satisfaction were examined cross‐sectionally at baseline. Consistency of satisfaction over time and associations of satisfaction with engagement were examined longitudinally. Methods Service users rated baseline (n = 281/289), mid‐therapy (n = 114/121), end‐of‐therapy (n = 124/154), and session‐by‐session (mid‐therapy n = 63/87 and end‐of‐therapy n = 90/123) ROM from 0 (‘extremely unhelpful’) to 10 (‘extremely helpful’) and gave qualitative feedback. Results Service users predominantly found ROM helpful (score 6–10; 64–72%) or neutral (score 5; 19–29%). Finding ROM less helpful was associated with younger age and poorer general outcomes, but not with psychotic symptoms or therapy dropout. Emerging qualitative themes included feeling understood, valuing opportunities to reflect, expressing feelings, and tracking progress towards goals. Shorter batteries would be preferable, particularly for younger respondents, and those with poorer outcomes. Conclusions ROM is acceptable for people with psychosis. Tailoring assessments to specific subgroups should be considered