Enhancing the quality of psychological interventions delivered by telephone

Project background

Depression and anxiety are common mental health problems that can cause substantial difficulties for people who experience them. The NHS has created an innovative psychological therapy service called Improving Access to Psychological Therapy (IAPT), to help people with these conditions.

IAPT services support hundreds of thousands of people across the country who are experiencing anxiety and depression. Many of the psychological therapy sessions offered are delivered by telephone – a method recommended by the National Institute for Health and Care Excellence (NICE), who provide guidance for the delivery of healthcare.

Many people like the idea of treatment delivered by telephone because appointments are easier to access and can be less stigmatising compared to face-to-face appointments. However, in the NHS, many people fail to begin and complete telephone treatment, meaning that they do not receive the help that they need.

Professionals who support patients in IAPT have reported that they do not receive enough training to deliver treatment over the telephone, and both patients and professionals do not always feel they receive enough support for telephone therapy.

Through the EQUITy programme, we want to improve the way psychological therapies are delivered by telephone so that we can ensure that people receive the care that they need. We will work with patients and professionals to ensure our work is acceptable to the people accessing IAPT services and those supporting patients.


The programme

EQUITy is a £2.4 million research programme funded by the National Institute of Health Research’s Programme Grants for Applied Research funding stream.

Work on EQUITy began in April 2018 and will continue for five years.

The programme is divided into five workstreams:

Workstream 1: Understanding
The first stage of EQUITy will be to understand the issues around telephone-delivered treatments in IAPT.

We will work with patients and professionals to understand their experiences of telephone treatments and the types of challenges they face, and we will explore IAPT data to understand which groups of people experience the greatest difficulties with telephone-delivered treatments.

Workstream 2: Intervention development
Once we understand the problem, we will develop an intervention to help services improve the quality of telephone treatments.

Our previous work suggests that this intervention will need to include several different parts, including professional training, educational materials to help patients understand what telephone-delivered treatments are like and best-practice guidelines and workshops for IAPT teams.

Workstream 3: App development
Alongside workstreams 1 and 2, we will work with patients and professionals to develop a smartphone app.

The app will be designed to make it easier for patients to use telephone treatments, and easier for professionals to deliver telephone treatments, by improving the way information is exchanged.

Workstream 4: Evaluating
We will test whether the introduction of our intervention means that more patients finish telephone treatment, and whether this has important benefits for their health and wellbeing.

We will check the number of treatment sessions that people attend and how they feel, comparing services that receive our intervention with ones that do not.

We will combine our data with data already available to see if our intervention has long-term benefits.
We will talk to patients and professionals about their experiences of telephone treatments following our intervention.

Workstream 5: Sharing findings

Over the course of the entire programme we will communicate our findings to patients, professionals and service managers in a variety of ways.

We will share our work by:

  • developing resources;
  • producing journal articles;
  • giving talks;
  • using creative methods.

At the end of the programme we will offer our resources and consultation free-of-charge to NHS services and charities.

Our progress so far

Since commencing the programme a number of studies in Workstream 1 have been completed:

  • We recruited and interviewed participants from a variety of IAPT services to studies including:
    • 28 people who had received telephone-delivered therapy in the last 12 months or who were waiting for treatment;
    • 34 Psychological Wellbeing Practitioners delivering therapy in IAPT;
    • 11 High Intensity Therapists and Cognitive Behavioural Therapists delivering Step 3 treatments in IAPT;
    • 21 ‘key informants’ in leadership roles influencing national policy and practice.
  • We collected recordings from 120 assessment and first treatment sessions with patients to undertake conversation analysis.
  • We have used synthesised data from Workstream 1 studies to inform our intervention development work.

In Workstream 2 we have completed the development of a multi-faceted intervention to enhance the delivery of psychological interventions delivered by telephone.

In Workstream 3 we are continuing to test and refine a smartphone app, which will facilitate the delivery of telephone treatment sessions in IAPT. Our app has been developed collaboratively with patients, psychological wellbeing practitioners, service managers, and admin staff. 

How to get involved

The EQUITy programme is taking place over five years.

There will therefore be lots of opportunities for practitioners and people who have received treatment from IAPT to be involved in our studies.

If you would like to take part or would like further information about the programme you can email us at equitymh@manchester.ac.uk.

Research team

EQUITy Lived Experience Advisory Panel (EQUITy LEAP)

The EQUITy Lived Experience and Advisory Panel (LEAP) provide independent advice and guidance to the EQUITy research team which his drawn from the lived experience of common mental health problems and IAPT services. They meet four times a year and undertake activities such as: 

* Contributing to the development of research materials 

* Advising on the development of participant recruitment methods 

* Commenting on emerging data analysis 

* Advise and participate in disseminating the findings from EQUITy to key stakeholders 

* Contribute to the development of patient mediated materials. 

You can find out more on their role by reading the EQUITy PPI blog, and hear from David about his experience of the EQUITy LEAP by watching the short video below:


Contact us

Email: equityMH@manchester.ac.uk

Programme Manager: judith.gellatly@manchester.ac.uk

Twitter: @EQUITyMH

This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research NIHR programme (RP-PG-1016-20010). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.