Background to IAPT
In 2006, ‘The Depression Report’ by the London School of Economics’ Professor Lord Richard Layard argued that mental health related long-term sickness absence costs the economy more than a properly funded psychological therapy service that got people back into work and paying tax. This report was picked up by politicians and the then Labour government began a huge investment into addressing anxiety and depression in the working age population. Prior to ‘The Depression Report’, NICE guidance in 2004 identified evidence for the use of talking therapies in the treatment of anxiety and depression and so Professor David Clark from the University of Oxford, a leading figure in this area was recruited to develop the new IAPT programme (this operates in England only). It is one of the largest mental health programmes in the world, with the aim of increasing the provision of evidence based treatments for people experiencing anxiety and depression and getting people off sick benefits and back into work.
The figures for the 2013 IAPT report are quite staggering. Since 2008, there is now an IAPT service in every Clinical Commissioning Group; 5000 therapists have been trained; 2 million people had entered treatment with 1.2 completing treatment, and 78,000 people came off sickness benefits. The IAPT programme has also been rolled out to all ages, rather than just focus on people of working age.
So where do people with learning disabilities fit into this? As we all know, people with learning disabilities are far more likely to develop mental health problems, with estimates around 40%, and yet we also know that getting the right support and treatment can be really hard. The ‘No Health without Mental Health’ strategy (2011) aimed for inclusivity of mainstream services for people with learning disabilities and autism. IAPT services strive to be accessible to this group of people, but many continue to be excluded. In the past three years two projects by the Foundation for People with Learning Disabilities and King’s College, London have sought to address this.
Deborah Chin and Liz Abraham from King’s College, London looked at the barriers experienced by people with learning disabilities in accessing IAPT services. They sent out a survey to IAPT and Community Teams for people with a Learning Disability (CTLD) and found that IAPT services work best for people for learning disabilities when both teams have developed good working relationships and can co-ordinate their input. Some IAPT staff, who have prior experience of the needs of people with learning disabilities, are adapting their materials and their work practices for this client group. This can include longer sessions, offering more sessions and involving family and carers in their work. An interesting finding was that more GP and self-referrals were made to IAPT than referrals from the CTLD. One possible reason was that in some areas, IAPT services excluded people with learning disabilities. It was also noted that support for work with people with learning disabilities within IAPT can be somewhat piecemeal, and initiatives are vulnerable to service cuts.
The Foundation for People with Learning Disabilities, funded by the Dept. of Health ran a project developing innovative approaches to address barriers to accessing IAPT services. Our work brought together CTLD and IAPT services and used action learning set methodology to help them develop ways of working together to improve access for people with learning disabilities. Professor Dave Dagnan has been a great support on the project and spent time describing the Cumbria ‘First step’ model which inspired the teams to develop their own reasonable adjustments. We are still in the process of gathering the findings but some of the reasonable adjustments to their clinical practice that has increased their efficacy included:
Setting up a flagging system at the referral stage to alert practitioners that the person referred has literacy difficulties or a learning disability so that they may be required to make reasonable adjustments
The development of pathways to direct someone presenting with depression or anxiety person to the most appropriate service. Some people may be seen by both – IAPT can offer practical tools such as mindfulness, sleep hygiene and relaxation techniques whilst a clinical psychologists from the CTLD can help with more systemic issues.
Being given time to develop visual and other easy read resources
Teams worked together to make easy read information flyers and appointment letters and others have developed training modules for the IAPT staff.
Involving family members in therapy and in homework tasks.
It was noted that some of the reasonable adjustments to their clinical practice that has increased their efficacy with all their clients.
The project findings will be launched in September along with a new IAPT Professional Practice Guide for learning disabilities which we hope will support better practice and increase IAPT staff confidence in supporting people with learning disabilities.
For many people with learning disabilities who experience mild anxiety or depression, accessing their IAPT services should be the first port of call and yet people are not aware of them and do not always think they are suitable candidates for such a service. We hope our work in this area addresses this and in the future we will see more people with learning disabilities accessing their local IAPT service.
The Depression Report (2006)