Newham Improving Access to Psychological Therapies a partnership

Newham Improving Access to Psychological Therapies a partnership between Newham Primary Care Trust East London NHS Foundation Trust

Evidence Based Choices & ‘Complexity at the coalface’ Dr Ben Wright Lead Clinician Newham IAPT

Three dimensions of complexity • Complexity of context – (Choice & Access) • Complexity of systems – (Treatment Choice) • Clinical complexity – (Choice outcome)

London Borough of Newham Very Diverse • 61% BME • 130+ Languages Deprived • 44% live in poverty • 20% intense poverty 40% greater demand for mental health services

Access - Pathways into Service Resident in Newham Self Referral Routine screening of new IB claimants Pathways to work referral Community Groups GP Occupational Health Secondary MH Formal referral by professional Telephone Assessment Flexible Engagement, Full Assessment & Treatment

Source of Referral (n=5, 064)

Overall BME Access 66% of Newham residents come from BME groups 64% of referrals from BME groups in 2008

Impact of source of referral on access

Impact of source of referral on access for Men

Impact of source of referral on access for Women

Key points • GP referral remain central to access process • Must be supplemented by multiple points of access • Different sub-groups respond differently to access points

Three dimensions of complexity • Complexity of context – (Choice & Access) • Complexity of systems – (Treatment Choice) • Clinical complexity – (Choice outcome)

NICE Clinical Guideline 90 - Oct 2009 (partial update for depression guide, Research recommendation) • 4. 8 “In people with mild, moderate or severe depression, what system of care (stepped care versus matched care) is more clinically effective and cost effective in improving outcomes? ” (Page 51)

Matched Care Pathway Used in Phase One of National IAPT Pilot, May 2006 -07 Other Services Referral – Mainly GP Flexible engagement by assistant Assessment by Qualified Therapist Formal High Intensity CBT Low Intensity CBT

Semi-Stratified Stepped Care Pathway All Referrals Other Services Administrator calls & offers appointments Brief Telephone Assessment (Qualified therapist) Formal High Intensity CBT Assessment & Intervention Low Intensity (CBT Based) Assessment & Intervention Employment Support Service

System – care pathway flow – impact on recovery rates

System – care pathway flow – impact on recovery rates

System – care pathway flowimpact on productivity

System – care pathway flowimpact on productivity

Three dimensions of complexity • Complexity of context – (Choice & Access) • Complexity of systems – (Treatment Choice) • Clinical complexity – (Choice outcome)

Outcome of Low Intensity Care

Outcome of High Intensity Care

Equity of outcome • Care pathways did have slightly different treatment of some BME groups (e. g. greater proportion Asian & Asian British people going direct to high intensity) however there were similar recovery rates for different BME groups for both Low and High Intensity care • Having Low intensity care first did not alter drop out rate for High Intensity care.

Conclusion – what is needed? • Clinicians need regular, good quality supervision • Clinicians need easy access to a hierarchy of inhouse experts – Includes medical psychotherapy & general psychiatry • Integrated care pathways – Disaggregation reduces access, flow & quality • Good IT system for managing monitoring and directing patients flow through care pathways