State of the mental health nation

IAPT mental healthcare service status summary

Sharon Harrison and Nii Wallace-Davies share their findings from conversations with IAPT services about how they are handling patient needs during the pandemic.

Mental healthcare is available and online

The IAPT (Improving Access to Psychological Therapies) programme is regarded as critical by the NHS to keep mental healthcare up, running and available, particularly during the COVID-19 crisis. Most health care providers have put contingency plans in place to support the ‘remain open’ directive, including:

Adopting or increasing capacity to digital psychotherapy services as alternative approaches to face to face treatment delivery. For example, some NHS Trusts are deploying services like Ieso’s online CBT or extending existing digital contracts in order to move more people through treatment and reduce waiting times.

Transitioning face to face therapists to digital communication and collaboration tools, such as Microsoft Teams and Zoom. These tools have been embraced by GPs, NHS Trusts and patients as they continue to take appointments, triage patients and deliver treatments.

While many mental health services are still available and running as usual through digital delivery across much of the UK, in April mental health referrals to services across the country experienced a 30-60% drop off which is surprising during a collective crisis such as COVID-19. In the past few weeks, referrals have begun to pick up again, but they are still not at pre-COVID-19 levels experienced during months leading into the pandemic.

‘Business as usual’ stance

Many healthcare providers recognise that digital as a delivery method for therapy is here to stay, and therapists and patients are becoming more comfortable using digital methods.

Digital delivery will be more embedded into working practice generally, and so for the most part, many NHS Trusts are taking a ‘business as usual’ stance with a focus on getting through each quarter. As no one is really sure what is going happen next, we are also seeing the decision-makers be more pragmatic and flexible in their approach, while also preparing for the expected onset of a delayed mental health services. When moving to online therapy methods there is a period of adjustment, particularly for those clinicians who have been used to delivering face to face therapy in a different set up and environment. However, services are reporting that their clinicians are happier and more productive working from home by delivering therapy via online tools, as they are not having to travel or run between sessions in different clinics.

Despite ongoing security concerns around Zoom, it has become commonplace, and clinicians are reporting that whilst similar to face-to-face, they have had to change their style of working. There will always be some challenges to working in a digital environment, and particularly when more households are at home and online, including uptime of network connections, and lack of privacy. Text-only communication, such as Ieso’s online CBT, means that there is more privacy during sessions, and tech issues occur less often. Transcripts from text-based therapy can also be used by the clinician to provide more support to the patient.

The industry is working hard to help clinicians work more effectively online, particularly as referrals increase. Many providers and associations, including Ieso, the NHS and BABCP, are offering training and support to enable clinicians to transition to digital methods. Advice is also being provided on what to be aware of during the COVID-19 pandemic in terms of how patients are presenting, what to think about in terms of consent and patient contact, what trends are being seen 8+ weeks into the lockdown, as well as more specific training on conditions we expect to see more of during this time.