1. Talking Therapies in Bristol (IAPT) Recommissioning a new model of a Primary Mental Health service

2. Moving towards a Primary Mental Health Service model – why? Current IAPT service contract due for renewal Feedback from service users, providers and professionals suggests changes could be made to the current model – More robust assessment – More flexibility around treatments – Shorter waiting times for treatment National IAPT targets are not being met by the current Bristol service We had to find a way to deal with a wide range of complexity of people referring in to the service

3. What the engagement told us Service User Feedback Service users felt that their needs weren’t understood through the initial assessment The Front Door felt like a barrier to accessing talking therapy services There is too much emphasis on CBT Service users didn’t feel that the Stress & Mood Management course should be the first course of treatment The right therapy should be available first time More 1:1 Step 3 therapies should be available Too long to wait for therapies Length of therapies not enough (not enough sessions) Choice is important – location, times, specific therapist e.g. deaf signing therapists for deaf clients, female therapist That the differences in minority populations need to be recognised and planned for Healthcare Professionals and therapy providers Initial assessment should be provided by most rather than least qualified staff Some service users accessing the system are too complex for current providers There is a wide range of treatments available in the current service but a need for longer “doses” of therapy Enhance therapy with psycho-social support running alongside More support to be made available to GPs around appropriateness of referrals Post-therapy support to be available to maintain recovery – peer-led groups Smarter recording of outcome measures – ensure they retain meaning for service users Active case management and case co- ordination to support and enhance recovery Develop strong working relationships between IAPT and the rest of BMH

4. Principles of a new service The service should be available to anyone who needs it Services should communicate well with service users and each other Waiting times for assessments and therapies should be as short as possible A wide choice of appointments should be available in a range of accessible locations Individuals using the service should have a choice of therapist Those using the service should have an active input into their choice of therapy – experts by experience Individuals shouldn’t have to tell their story over and over to different professionals – continuity and communication Communication is important - access to useful information about the service I am receiving Individuals receive a seamless service from the most appropriate provider, and don’t fall through the gaps in the system

5. Life-limiting conditions Complex trauma/ Refugees/Asylum Seekers Personality Disorder Specialist Therapies (individual contracts) Complex Bereavement Person feels better Open Access Primary Mental Health Pathway Interventions Low intensity 1:1 therapy Initial Triage Supported self-help / online therapy Person feels better High Intensity 1:1 therapy Group Therapies Single Point of Access Robust Assessment Referral to most appropriate intervention Signposting to another service Perinatal mental health Primary Mental Health system co-ordination and leadership – this will be part of the role of the Single Point of Access and the IAPT Service provider Risk Assessment Domestic/ sexual abuse Individual Contract - IAPT Risk Assessment

6. Suicide Prevention and Risk Management in Talking Therapies Service Initial Assessment – risk assessment focussed on suicidality and rating of intent Protective factors and previous history investigated with client GP informed Escalation to secondary services if plan/intent is active and if protective factors are weak – protocols with secondary care developed around acceptable levels of risk in primary care caseload Recognition that starting talking therapies can destabilise people – is it OK to begin treatment?

7. Questions for Consultation on the model Are the underpinning core principles right? Do you think we have captured individual specialist groups in the right way? Do you think the service will meet the needs of those who need to use it? Have we missed anything?