1. CNWL Talking Therapies Service Westminster Improving Access to Psychological Therapies

2. Overview of the National IAPT Programme Improving Access to Psychological Therapies (IAPT) is a Department of Health initiative to implement NICE guidelines for psychological therapies for depression and anxiety 2005: Lord Layard made the economic argument for investment in evidence-based psychological therapies

3. Core IAPT Staffing Two core types of psychological therapy practitioners: High Intensity therapists trained to offer evidence-based psychological therapy for people with moderate and severe depression and anxiety disorders. In Westminster these therapists are CBT Therapists and Clinical / Counselling Psychologists. Offer step 3 treatment. High Intensity therapists Low intensity therapy workers (Psychological Wellbeing Practitioners) trained in cognitive behavioural approaches for people with mild to moderate anxiety and depression. These approaches include guided self help and delivering psycho-educational groups. Offer step 2 treatment. Low intensity therapy workers

4. Stepped Care Offer the least intrusive, most effective treatment to meet the patients needs Steps 1-3: Primary Care - Mild – Moderate presentations, less complexity, lower risk Steps 4-5: Secondary Care - Moderate – Severe presentations, complex, high risk

5. The IAPT Stepped Care Model

6. IAPT in Westminster In Westminster there are a number of different IAPT providers of which the CNWL is the largest. CNWL Talking Therapies Westminster provides CBT treatment to adults (over 18) with common mental health problems who live in Westminster or have a Westminster GP Queen’s Park & Paddington area is an exception where services are provided through K&C IAPT (Take Time to Talk) Counselling in the borough is provided by Westminster MIND and individual GP counsellors.

7. Types of Intervention Cognitive Behavioural Therapy – Structured, short-term, problem-focussed – Working on the “here and now” – Development of a “tool-kit” of behavioural and cognitive coping strategies – Focus on specific symptoms of anxiety / depression Counselling / Psychotherapy – Exploratory space to think about experiences, less structure – May be more focussed on early life experiences and attachments – Emphasis placed on relationship between therapist and patient and how this might reflect other important relationships

8. IAPT Service Delivery in Westminster Based in community locations: GP practices, health clinics, Job centres, children’s centres Outreach groups at other sites by arrangement Partnerships with Jobs In Mind Professional and self-referrals are received by mail, email, fax, phone or walk-in Interpreters and translated materials available Open 8am – 8pm Mon – Thurs, 8am – 5pm Fri Saturday morning assessments and workshops Group and individual treatments

9. How can people access the service Referral from professional Self referral by telephone: 030 3333 0000 Self referral by email: westminster.iapt@nhs.netwestminster.iapt@nhs.net Through our website: www.westminsteriapt.org.ukwww.westminsteriapt.org.uk Visit one of our offices: – 11 Praed Street W2 1NJ – 192-198 Vauxhall Bridge Road SW1V 1DX

10. Referral Form

11. Treatment Provided: Low Intensity Treatments for depression, generalised anxiety, panic and phobias: Guided self-help – Face-to-face or telephone Workshops – Improve your Sleep; Assertiveness; Managing panic; Confidence; Procrastination 6 week CBT courses - Mood Boost; Stress & Worry; Sleep - rolling format

12. Treatment Provided: High Intensity Individual CBT for – depression, generalised anxiety, panic and phobias not fully resolved by Low Intensity treatment – Social anxiety – Health anxiety – Post-traumatic stress disorder – Obsessive-compulsive disorder Group CBT – Self-esteem group for patients with depression – Mindfulness-based Cognitive Therapy group for recurrent depression – Post-natal depression group for mothers with a baby under 12 months – Workshops: Introduction to CBT; Unhelpful Thinking; Introduction to Mindfulness; Taking care of mental health in pregnancy and post-natally Behavioural Couples Therapy for depression or anxiety

13. Outcome Measures

14. Case Example: Roy 45-year-old male with low mood and depression (first episode) Married with 3 children, wife not working Recently made redundant, financial problems, unable to support family, unable to focus on finding work Feelings of guilt and shame.

15. Roy: Assessment and Treatment Assessment with PWP. Identified depression. Offered individual GSH or mood boost course Attended unhelpful thinking and introduction to CBT workshops Chose to attend 6-week Mood Boost course Follow up session with PWP Signposted to Jobs In Mind

16. Roy: Outcome Started to implement changes after workshops Fully recovered after 6-week group – learnt behavioural strategies to manage mood and deal with procrastination Follow up with PWP put together plans for the future and cognitive strategies from courses Possible self-referral to self-esteem group in the future to address underlying vulnerabilities

17. Feedback from Patients “It’s now a year since I received treatment. I’m still applying the lessons derived from guided self-help and much more able to handle life’s stresses and strains.” “Therapy has helped me greatly to regain my confidence.” “I would wholeheartedly recommend this service - it is a way of treating people which focuses on them individually, yet gives a very simple and effective way of helping them find their own way out of their difficult circumstances.”

18. CNWL Talking Therapies Service Westminster Improving Access to Psychological Therapies Any questions?