title: Opportunities and challenges in Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI): evaluating the first operational year of the South London and Maudsley (SLaM) demonstration site for psychosis.
abstract: Despite its demonstrated clinical and economic effectiveness, access to Cognitive Behavioural Therapy for psychosis (CBTp) in routine practice remains low. The UK National Health Service (NHS England) Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aims to address this problem. We report 14-month outcomes for our psychosis demonstration site. Primary and secondary care and self-referrals were screened to check the suitability of the service for the person. Psychotic symptoms, distress, service use, functioning and satisfaction were measured before and after therapy, by trained assessors. User-defined wellbeing and goal-attainment were rated sessionally. Access to CBTp increased almost threefold (2011/12 accepted referrals/year n = 106; 2012/13, n = 300). The IAPT-SMI assessment protocol proved feasible and acceptable to service users, with paired primary outcomes for 97% of closed cases. Therapy completion (≥5 sessions) was high (83%) irrespective of ethnicity, age and gender. Preliminary pre-post outcomes showed clinical improvement and reduced service use, with medium/high effect sizes. User-rated satisfaction was high. We conclude that individual psychological interventions for people with psychosis can be successfully delivered in routine services using an IAPT approach. High completion rates for paired outcomes demonstrate good user experience, clinical improvement, and potential future cost savings.
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK. Electronic address: Suzanne.jolley@kcl.ac.uk.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Jolley
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Garety
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Peters
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK; University College London, Department of Clinical, Educational and Health Psychology, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Fornells-Ambrojo
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
authors.forename: Juliana
authors.initials: J
authors.lastname: Onwumere
authors.affiliation: King's College London, Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Harris
authors.affiliation: University of Durham, Durham, UK; Tees, Esk, and Wear Valley NHS Mental Health Foundation Trust, County Durham, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Brabban
authors.affiliation: King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Johns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: CBT; Cognitive therapy; Schizophrenia; Therapy outcome