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Psychological Therapies for Severe Mental Illness: National IAPT Update

Alison Brabban National Advisor for Severe Mental Illness (IAPT) NHS England & Consultant Clinical Psychologist
Tees Esk and Wear Valleys NHS Foundation Trust spoke at today’s Psychological Therapies for Severe Mental Illness conference on:

• psychological therapies for serious medical conditions: the evidence
• IAPT for Severe Mental Illness: National Update
• improving choice
• developing the workforce
• the importance of early intervention

Alison began her presentation by discussing the lack of interest in talking treatments for SMI, stating the following reasons: 
•    Seen as fundamentally different from neurosis.
•    Symptoms not seen as understandable in psychological terms.
•    Seen as a brain disease.
•    Poor results from early trials of psychotherapy.
•    Medication seen as the only viable treatment option.

Alison went on to look at why psychological therapies should be offered:
•    They impact on symptoms and relapse (and personal recovery).
•    The are cost effective.
•    A large proportion of patients do not respond fully or at all to medication.
•    Service users want access to talking treatments.
•    Patients and carers should have access to the full range of NICE recommended treatments: they should have choice.

However the number of service users actually having access to and receiving these types of intervention is very low.  The Early Intervention in Psychosis Services standard aims to improve access to treatment.

Alison made the following comments;

"Moving away from the dichotomy to a truly bio psychosocial model

What is causing your fear? Fear or Adeline?  It is both!

Depression- chemical reaction and acknowledge there is life events that trigger off depression and this is the same for psychosis

Vulnerability- stress Model- lots of factors can affect vulnerability, causing increase in stress and therefore psychosis will become noticeable  

Meta Analysis- people that developed psychosis are three times more likely to have been exposed to adversity- the more trauma the person is exposed to the more psychosis appears

Psychological therapies

Over the last 10 years there is more focus on therapies rather than medication for life and understanding the conditions rather than labelling people that there is something wrong with chemical reactions in their brain

Good evidence that CBT and FI for psychosis work is working along with medication- Trials are being carried out on patients that are not taking medication

People who are at risk at developing psychosis should not be offered antipsychotic medication

Why should you be offering therapies?- They impact on symptoms and relapse and personal recovery. They cost effective. Patients do not respond fully or at all to medication. Service users want access to talking treatments.

Patients should have choice and is that choice available?

Problems with auditing therapies:

  • Defining therapy- is it genuine?
  • Does it make minimum fidelity requirements?
  • Understanding quality of therapies’?
  • Adequately trained therapists?


Something needs to happen as NICE guidelines is not working efficiently

Huge challenge ahead to achieve psychological therapies a reality

Why focus on early intervention? This has been the most positive development in mental health services

The success of EIP- Improve outcomes, save money, high levels of satisfactions from service users and carers.

Features of EIP delivery allow implementation of psychological therapies

2 strands- referral time to treatment in 2 weeks and access to NICE concordant care within the service

In IAPT SMI- selected 6 demonstration sites and these were chosen for systematic approach to delivery of psychological therapies"

Alison’s full presentation is available for download at the end of this page.

Alison qualified as a Clinical Psychologist in 1990 and now works for Tees, Esk and Wear Valleys NHS Foundation Trust in the Early Intervention in Psychosis service.  She has a special interest in CBT for psychosis.  She feels passionately that everyone experiencing psychosis should have access to evidence based psychological therapies and works as the National Advisor for Psychosis and Bipolar Disorder for the Improving Access to Psychological Therapies programme within NHS England.   Alison was part of the Schizophrenia Commission and was involved in the development of the recent update of the NICE guideline for schizophrenia and psychosis.  She works as an Honorary Clinical Senior Lecturer at Durham University and was also given a visiting senior lectureship at Harvard University Medical School in 2006.  

Future conferences of interest:

Implementing the national objective to end Prone/Face Down Restraint: Examining Restraint Positions in Practice
Tuesday 22 September 
ICO Conference Centre, London

Adult Safeguarding Enquiries & Safeguarding Adults Reviews
Monday 12 October 
Hallam Conference Centre, London

Improving Mental Health Crisis Care
Thursday 15 October 
Hallam Conference Centre, London

Smoking Cessation in Mental Health
Tuesday 20 October 
Hallam Conference Centre, London

Safe Staffing for Nursing in Mental Health Inpatient Units
Monday 16 November 
Hallam Conference Centre, London

Improving the Quality of Perinatal Mental Health Services
Tuesday 1 December 
Hallam Conference Centre, London

Psychological Therapies in the NHS
Wednesday 3 February — Thursday 4 February 
Millennium Conference Centre, London

Download: Alison Brabban full presentation

1 July 2015


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