Talking therapies could create 'revolving door' in mental health
Lauren Higgs
Monday, April 4, 2011
The government's plan to introduce new talking therapies for children with mental health problems could provide children with interventions that are too brief to meet their needs, the Association of Child Psychotherapists (ACP) has warned.
The Improving Access to Psychological Therapies (IAPT) programme, which until now has been aimed largely at adults, is to be adapted for children and young people over the next four years as part of a commitment in the government's mental health strategy (see box). Work on the programme, aimed primarily at people with depression and anxiety disorders, starts this month.
Beverley Tydeman, ACP chair, said the scheme has the potential to help tackle unmet needs for child and adolescent mental health services (CAMHS). But she warned that the IAPT model could result in children being stuck in a "revolving door" to services, where they feel "briefly better but then after a while need to be re-referred".
IAPT currently focuses on relatively brief interventions for less severe mental health problems, running typically for 12 to 15 weeks, rather than long-term support.
Despite this, Tydeman admitted that the programme would be more childand family-focused than many existing services. She added that IAPT could lead to better mental health training for a range of professionals across the children's workforce, suggesting that community CAMHS workers could be trained to work alongside frontline IAPT workers.
Paula Lavis, policy and knowledge manager at charity YoungMinds, argued that IAPT for children and young people must be fully integrated into CAMHS teams, rather than being an "add-on".
"They are skilling up existing staff, so hopefully that should mean integration is more likely," she said.
But Lavis said it remains to be seen whether IAPT will reduce pressure on CAMHS teams.
"It might give some extra capacity, and enable CAMHS to reach out, but it is early days yet," she explained. "Likewise, it is difficult to say whether the most vulnerable children will benefit. The project is quite limited in what it will provide in the first instance, so it is likely that not all vulnerable children will benefit in the short-term.
Jo Webber, deputy policy director at the NHS Confederation, said IAPT would help children who are not currently treated by CAMHS.
"This is going to be another string in the bow of mental health services that are available to children and young people so I'm not sure it will lessen the pressure on CAMHS, it will fill a gap that is already there," she said.
IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES (IAPT) PROGRAMME
- The government is investing £400m between April 2011 and 2015 to make sure that people with depression and anxiety across England have access to a choice of psychological therapies. This includes an expansion of psychological therapies for children and young people's services.
- The Department of Health is initiating a stand-alone programme to extend psychological therapies to children and young people, building on learning from the largely adult-focused Improving Access to Psychological Therapies (IAPT) programme.
- The IAPT programme was created to offer patients with depression and anxiety disorders access to treatments such as cognitive behavioural therapy, where medication had traditionally been the only option available.
- The programme was first targeted at people of working age. Evidence shows that by September 2010 the programme had helped more than 72,000 people to recover from depression and anxiety disorders in the previous two years and almost 14,000 people moved off sick pay and benefits and started or returned to work following treatment.
- The scope of the children and young people's IAPT programme is yet to be fully determined but it will focus on changing practice within existing services.
- Clinical leaders, including GPs and children's mental health charities such as YoungMinds will develop an education and training programme to build the capacity of the child and adolescent mental health services (CAMHS) workforce.
- CAMHS staff will be trained between now and 2015. A limited number of staff will also be recruited annually for the next four years.
- One key change in treatment will be the introduction of routine outcome monitoring for all therapy sessions with children and young people.
- Children, young people and their families will be involved in developing child-centred and patient-reported outcome measures.
- This is intended to help determine the level of need for talking therapies among children and young people. It will also provide confirmation of the extent to which talking therapies aid recovery for children and young people with mental health problems.
- Evidence shows that IAPT can save the NHS up to £272m and the wider public sector will benefit by more than £700m.
Source: Department of Health