EQUITy Is Underway

By Peter Bower (co-PI)

Improving support for people with anxiety and depression is a government priority. England is  unique in having a large-scale initiative to help people access help and support quickly – the Improving Access to Psychological Therapies programme (IAPT).

IAPT reaches just shy of one million people a year, providing evidence-based treatments to people with anxiety and depression. Good outcomes are demonstrated for those who complete treatment.  Although controversial at times, there can be few disagreements that IAPT has revolutionised the delivery of care for anxiety and depression.

Ten years after its launch, the programme is being pushed to develop further – to improve quality and access, to better meet the needs of people with long-term conditions, and to improve patient experience. The EQUITY programme funded by the NIHR is our contribution to that aim.

We are interested in how the telephone can be better used to deliver effective treatments in IAPT. The telephone is everywhere in modern society, and IAPT is no exception – one in five of the sessions they offer are delivered by telephone, and this way of delivering care is recommended by the National Institute for Health and Care Excellence for depression and anxiety.

Participating in psychological therapy over the telephone has significant advantages, because appointments are easier to get to, and less stigmatising than going to clinics for mental health issues.

However, psychological therapy delivered through telephone is not without its challenges. Quite a lot of the people who are offered treatment by telephone are not starting or finishing telephone treatment, which means that they may not be getting all the help they need.

We don’t know exactly why this happens. It may be that people expect to get their treatment face-to-face, and that offering telephone treatment does not meet their expectations of what psychological therapy should be like. It could be that the convenience of telephone appointments actually acts as a barrier to uptake, as people feel less invested, and the very convenience of the appointments makes them easier to miss.  

Possibly most important is the therapeutic relationship. The relationship between patients and staff in psychological therapy is known to be crucial for good outcomes, but staff and patients often worry that they will struggle to develop a relationship over the phone. There are concerns that important body language may be missed if people cannot see each other.

What we do know is that the people who deliver psychological therapy over the telephone in IAPT say that they do not receive enough training to do so. This is where the EQUITY programme comes in. We want to help IAPT get the most out of psychological therapy by telephone, by ensuring that people who are offered telephone therapy ‘stay the course’ and get the high quality support they need.

We will work closely with patients and practitioners to better understand the issues they face with therapy by telephone. This will include very detailed analysis of actual conversations about mental health on the telephone. We will take these findings and develop an intervention for IAPT services which will help them deliver the highest quality telephone therapy. Finally, we will introduce this intervention into some IAPT services and test whether it improves outcomes.

IAPT is a world leading system for helping people access psychological therapy, and the telephone is a key ingredient to help people get the help they need. Our EQUITY programme aims to make  telephone therapy delivered within IAPT of the highest quality.