Graham Turpin's column from Clinical Psychology Forum 163
Last week I tried to escape the world of psychology and take in a little R&R in Corsica. Despite being surrounded by the flat TV screens and the World Cup - something I had anticipated - my escape from the UK and the world of work was a dismal failure
I mistakenly purchased several UK newspapers and was overwhelmed by accounts of the LSE report on depression, interviews with Lord Layard and the launch of the Newham demonstration site. So on my return, what should be filling up my e-mail inbox, but copies of press releases and a continuing and lively debate on the Manager’s e-mail list about Layard and Improving Access to Psychological Therapies? Consequently, I thought that it might be timely to update the readers of Clinical Psychology Forum on what has been happening with the IAPT programme since my last report back in the December issue.
Since last year the IAPT has got underway, developing the two demonstration sites at Newham and Doncaster, together with some smaller projects coordinated by the regional development centres (RDCs) of the Care Services Improvement Partnership (CSIP). These were announced formally by the minister in May, and it is hoped that the first clients will be seen by these services in the next few weeks. In preparation for the demonstration sites, much work has gone into determining a minimum data set for their evaluation. This has largely been the responsibility of an expert group, which has included, amongst others, leading psychotherapy researchers and clinical psychologists. Two stakeholder events have been organised to discuss the progress made by IAPT, and one reason for writing this update is that I have just returned from a particularly interesting event hosted by the Doncaster site. More details of the IAPT programme can be found on the Mental Health Choice website.
The object of the IAPT programme is to provide evidence and arguments to persuade the Treasury to make a sizeable investment in mental health services, and especially in widening access to psychological therapies, in its next comprehensive spending review in the spring. I shall not repeat the arguments here since they have been discussed previously in The Psychologist, CPF and elsewhere. Indeed, much of the recent media activity was prompted by The depression report: A new deal for depression and anxiety disorders from Lord Layard and his colleagues at the LSE. It sets out a strong economic and psychological well-being case for enhancing access to psychological therapies.
Nationally, many psychologists are involved in informing this work and through their local contributions to the RDCs. One of the challenges facing the project is to assess the impact of increasing access to psychological therapies on workforce, education and training. For the last six months I have been co-convening a workforce group with Roslyn Hope (director of workforce, NIMHE/CSIP) looking at some of these issues. We have been scoping the availability of training in psychological therapies, future commissioning intentions and the competencies required to deliver IAPT programmes. This work has also been connected with the New Ways of Working for Applied Psychology project.
My reason for writing this update, however, is not to debate these developments - a lively discussion can be followed on the Manager’s e-mail list - but to inform members of the DCP what is happening and also the nature of the Society’s involvement. Individual psychologists are and have been involved in the IAPT programme despite its essential multiprofessional, cross-agency focus. The Society also organised a highly successful seminar in April where presentations were given by Lord Layard and Richard Taylor about the IAPT programme, and some sound and critical discussions took place within a series of workshops. It is the intention of the DCP, through the Society’s Professional Practice Board, to produce a report around the ‘Layard hypothesis’ which could be published in the autumn. We hope that the forthcoming stakeholders’ conference on New Ways of Working for Applied Psychologists on 14 July in Wolverhampton will provide one forum for gathering members’ views. I shall also be following closely the debates on the manager’s e-mail list and would welcome further comment from the DCP membership.
Why should we be commenting on Improving Access to Psychological Therapies and the ‘Layard hypothesis’? Clearly, if the IAPT programme were to receive the kind of funding it is seeking from the Treasury, this would constitute the most radical change in mental health services since the building of the asylums and their subsequent dismantling. It offers a clear challenge to mental health professionals, including psychologists, to rethink treatment provision and to develop meaningful alternatives to medication, offering choices around psychological therapies and reviewing how such services might be made available within community settings away from the stigma of many of our existing mental health service settings. Psychologists must rise to this challenge.
However, these proposals bring with them some fundamental challenges for the profession and its future. Discussions continue about creating a career framework for psychological therapists: it is anticipated that psychological therapy services might be provided by amongst others, the voluntary and independent sectors. A greater diversity of providers reinforces the arguments for more effective public protection and regulation of the provision of psychotherapy; expansion of training for psychologists and other therapists is expected. The future profile of the psychological therapy workforce may well have a greater skill mix and will reflect the competencies required to deliver a full range of stepped care interventions.
It is essential that psychologists think through the impact of some of these ideas, and accordingly, it is essential that we debate, critique and shape these developments.
If there is sufficient interest within the DCP and the Society, we could consider a follow-up event to the Layard seminar in the autumn, to provide a further forum for debate and finalise a Society response. Please let me or Nigel Atter, the PPB Administrator, know if you would interested in participating in such an event.
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