Is Improving Access to Psychological Therapies (IAPT) Working?

Introduction

Mental health now represents approximately 25% of the ill health burden and is also the single largest cause of disability in the United Kingdom (Hersen & Sturmey, 2012). Additionally, statistics indicate that 25% of people in the country will experience mental disorder at some point in their lives with 0.01% experiencing severe mental illness. More recent studies indicate that mental illnesses are responsible for approximately 40% of all morbidity in the United Kingdom (Beinart et al 2009). The National Health Service introduced improving access to psychological therapies programme with an aim of increasing the availability of therapies in the country. It is designed majorly for individuals with mild to moderate health difficulties like anxieties, depression, post traumatic disorders and phobias (Bullock et al 2012). Improving access to psychological therapies programme treats these conditions using different therapeutic techniques like cognitive behavioural therapy, couples therapy and interpersonal therapy (Barkham et al 2010). It essentially seeks to employ the least intrusive methods in treating patients. This approach is often referred to as the stepped care mode meaning that the patients first get low intensity therapy in form of computerised cognitive behavioural therapy and guided self-help. In cases where the low intensity treatments are inappropriate or unsuccessful the patients are often transferred to high intensity therapy in the form of one on one cognitive behavioural therapy. Improving access to psychological therapies programme has expended the provision of talking therapies in the United Kingdom and is the only instance in the world where the government has provided free talking therapy on large scale (James, 2010). IAPT is relevant to counselling psychology because it affects the therapies that counselling psychologies use in attending to the patients. The counselling psychologies are required by the National Institute for Health and Care Excellence to rely on the recommendations contained in IAPT while attending to the patients.

Analysis of talking therapies

The World Health Organisation defines health as a physical, mental and social wellbeing of an individual. However in most cases people do not regard mental and psychiatric problems as disease leading to the stigmatisation and marginalisation of the patients away from the normal way of life (Beidas & Kendall, 2014). Although mental illnesses are not as obvious as physical illnesses, they cause serious changes in behaviour that lead to dysfunctional disabilities that interfere with actions, speech and thought. However, talking therapies offer the patients with mental illnesses an opportunity to return to normal way of life. Talking therapies are the most commonly used treatments as they allow the patients to express their thoughts, problems, emotions and feelings with the therapists. The patients are open with the therapists and trust them to generate solutions to their varied challenges (Robertson, 2010). The therapists can deliver therapy through direct interactions with the patients, computerised interactions or group discussions. All these therapies are designed for helping patients experiencing difficult times in their lives by initiating self-belief and optimism to facilitate the recovery process. Talking therapies are also known as psychotherapies or psychiatric counselling offers one of the best means of ensuring that the patients share their feelings with the therapists in order to help them prescribe the best means of helping the patients recover from mental illnesses (Corrie & Lane, 2010). The therapies also present the patients with an avenue for speaking about how they feel more than their families, friends or anybody else would do, thus encouraging them to share as much information as possible for easy intervention by the therapists.

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World Health Organisation reports indicate that depression is among the major mental illnesses affecting people not only in the United Kingdom but across the globe. This has led to the great debate on whether talking therapies are efficient in curing such a widespread disease (Garrett 2010). Some critics of the talking therapies argue that the therapies alone cannot cure depression as curing the disease require other simultaneous treatments and even medication at times. For the psychiatrists to be more effective they need to be amiable and supportive in order to gain the trust of the patients so that they can open up and share more of their experience and challenges. They also need to be very sensitive to the feelings of the patients because for instance aggressive and uncompassionate patients tend to get more demoralised when they feel that they are worthless and insignificant (Cowen et al 2012). At times the therapists opt to make use of group therapy in cases where the patients share similar problems. In this case, all the patients sit down to share their anxieties and problems with each other. Group therapy helps the patients to open up and share their problems with other patients and agree that such problems have solutions which are only possible if they choose to support the efforts of the group. However in cases where some patients feel that they have been suppressed by the group or that the group has formed a judgement against them, it becomes difficult for the therapy to work as it further limits the interaction of such patients with the society and in the process worsening the conditions of such patients instead of delivering cure (Sturmey & Hersen, 2012). There are also cases where the patients get extremely attached to the groups and become extremely dependent on them so much so that they are unable to make decisions without the approval of the group (Dartington, 2010).This is not good for them as it also exacerbates their conditions instead of providing cure.

The talking therapies that focus on the provision of direct solutions to the patients are very effective in managing depression as the patients can use the direct advice given to them or even reject them in cases where they feel uncomfortable with such advice. However the inherent problem with this therapy is that the vulnerable patients might form a habit of letting the therapists solving their problems for them thus denying them the power of personal decision making (Lloyd et al 2013). Furthermore, in case such decisions fail to provide the desired solutions to the patients, they may form a revulsion against the therapist leading to more depression as they tend to get frustrated by the fact that they may never find a solution to their problems.

Cognitive behavioural therapy deals with patients that suffer from very mild to moderate depression. It encourages patients to understand and accept their negative emotions and then provides assistance to them so that they can think positively and usefully (McHugh & Barlow, 2012). The therapy involves both behavioural and cognitive therapy. Cognitive therapy is concerned with the patients’ thinking patterns whereasbehavioural therapy deals with associated actions. When the two approaches are combined carefully, they provide a powerful means of helping the patients overcome many emotional and behavioural problems. Cognitive behavioural therapy may involve a mix of the two therapies depending on the nature of the problem because some problems require more behavioural interventions while others require more cognitive intervention therapy. One of the strengths of the Cognitive behavioural therapy is that it not only aims at helping the patients overcome their conditions but also equip them with new skills and strategies that they can use in solving future problems (Osimo & Stein, 2012). The therapy examines all the elements that maintain the problems faced by the patients. It involves creating a partnership between the therapist and the patients and heavily involves the patients in planning and treatment throughout the process.

Arguments for talking therapies used by IAPT

According to McQueen (2008), the majority of the patients who use talking therapies say that it helped them as they benefited in many ways. First off, it gives the patients an opportunity to be listened to regularly and as such they are able to express their feelings to the therapists. This helps the patients to forget the bad things that happened to them in the past and start over afresh. In this way, the therapy ensures that the patients let out their feelings that could have otherwise remained deeply bottled up. The other benefit of talking therapy is that the therapists are non-judgemental and impartial while attending to the patients (Norman & Ryrie, 2009). This helps the patients to share their negative feelings without the fear of being criticised making it easier for the counselling psychologist to attend to them. In addition to this, it boosts the confidence and self-worth of the patients which is crucial to their recovery because many patients struggle with this. Talking therapies equips the patients with learning skills and techniques for managing anger or relaxation which is important in reducing the chances of the patients suffering a relapse of the diseases. Talking therapies helps the patients in combating loneliness because at times the patients do not have people to confide in, but the counselling psychologist gains their trust and present them an opportunity of opening up about how they feel and think and the reasons behind such perspectives (Mueller, 2010). The counselling psychologists ask the patients questions while respecting their boundaries which is important in getting them out their shells and suggesting ways of overcoming loneliness. Lastly, most of the time the patients are capable of solving the problems on their own but all they need is moral support when things get tough for them. This what talking therapies offer to the patients as the counselling psychologist offers them an opportunity for sharing their problems and provides them with empathy that they may not be getting from friends and family.

Arguments against talking therapies used by IAPT

Walker & Fincham (2011) claim that talk therapy is one of the best mechanisms available for the average individuals to deal with mental illnesses. However, one serious limitation to the therapy is that it is reliant on what the patients can remember. Most studies on talking therapies do not use the therapists or their techniques in evaluating the success of the therapy partly because most of them are written by professional counselling psychologists (Smith, 2012). Instead they focus on the willingness of their patients and their level of motivation in their quest for psychological assistance. Regardless of the techniques employed by talking therapy, it still has some inherent limitations. These limitations fall into general categories that include the level of motivation of the patient, nature of the problem and the skills of the therapists (Sturmey & Hersen, 2012). Talking therapies are not able to achieve high levels of efficiency with the low motivated and uncooperative patients. These patients too need help but none of the techniques used by talking therapies can function without the active partnership between the patients and counselling psychologists. This implies that some patients are not able to receive treatment from talking therapies. The patients that come to the counselling psychologists with the expectation of the counselling psychologists doing something to fix them often go back home disappointed and quickly terminate the treatment once they realise that the process has nothing to do with doing something to someone but rather an interactive process of doing something with someone (Walsh, 2009). As such a well-motivated patient is more likely to receive effective assistance from a poorly skilled therapist than a low motivated patient is from a well skilled therapist.

Conclusion

The findings of this study reveal that although talking therapies being emphasised by IAPT have registered some levels of success, they have their own inherent weaknesses that limit the efficiency of care delivery offered by counselling psychologists. Counselling psychologists rely on these recommended therapies in delivering treatment to the patients with mental illnesses but the weaknesses in IAPT reduces the level of their efficiency. The major weakness of IAPT is its over reliance on talking therapies, particularly cognitive behaviour therapy. In addition to this, it fails to cover some sections of the population. In order to improve the efficiency of IAPT it needs to include other therapies and increase its coverage to include other neglected segments of the population like children and young people. Furthermore there is still need for the National Institute for Health and Care Excellence to look into better ways of helping the counselling psychologists improve the quality of care being offered to the patients with mental illnesses in the United Kingdom.

References

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Beidas, R. S., & Kendall, P. C. (2014). Dissemination and implementation of evidence-based practices in child and adolescent mental health. Oxford: Oxford university press

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McQueen, D. (2008). Psychoanalytic psychotherapy after child abuse: Psychoanalytic psychotherapy in the treatment of adults and children who have experienced sexual abuse, violence, and neglect in childhood. London: Karnac.

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Norman, I. J., & Ryrie, I. (2009). The art and science of mental health nursing: A textbook of principles and practice. Maidenhead, Berkshire, England: McGraw Hiil, Open University Press.

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