The 2018-19 work of the Psychological Therapies in Primary Care HIT

Dr David Kessler and Rick Cooper, Directors of the Psychological Therapies in Primary Care Health Integration Team (InPsyTe HIT), give an update on the HIT’s work in 2018-19.

Our HIT aims to improve the delivery of psychological care to patients with depression, anxiety and other common mental disorders. These are a major cause of disability, and patients express a preference for psychological therapies. We also want to innovate, and one of our major themes is the development of online technology to improve access to psychological treatments. Working with commissioners, academics, clinicians and service leads, our main focus this year has been to continue our work on improving patient access and engagement with the local Improving Access to Psychological Therapies (IAPT) service.

One of our IAPT projects is an evaluation of an online therapist supported package, SilverCloud, which was piloted in 2018. The initial analysis was encouraging, so the pilot is continuing with therapists offering SilverCloud to suitable clients. We have collected data on 342 people who have taken up the online therapy and their outcomes are being compared to 2,607 clients who received conventional low intensity cognitive behavioural therapy (CBT).

We can report this encouraging preliminary descriptive data, although the final analysis is not complete:

• The online CBT group had less severe baseline depression and anxiety symptom scores and were less likely to reach the definition of a ‘case’ of anxiety or depression
• The online group were slightly younger (unlikely to be significant) and less likely to suffer from a long-term health condition
• The online group were less likely to be taking psychotropic medication
• Those in the online group who had symptoms scores that were above the ‘caseness threshold’ for IAPT services (181/342) saw symptom score reduction after treatment that were comparable to the face-to-face low intensity intervention

Our second project is an initiative to reach out to members of Black and minority ethnic communities, who are seriously under-represented in psychological services. The initial outreach sessions offering information and psycho-education were reasonably successful, with 79 people attending the sessions at Junction 3 Library.

HIT co-Director Rick Cooper is a member of the Bristol Mental Health Equality Diversity and Inclusion group, who the HIT are consulting for ideas for other venues and ways to publicise the sessions. These include using supermarkets to run the groups and taking the sessions to pre-existing groups such as employers and schools.

We have run the sessions at the University of Bristol to make IAPT more accessible to the student population, especially overseas students, in collaboration with Student Wellbeing Service.

The University of Bristol-led INTERACT programme aims to develop a therapist integrated online CBT intervention for depression, which will be evaluated through a randomised control trial. We have built the online therapy platform, which has been tested in a small group of participants. We plan to start recruitment to the trial in September 2019.

We have set up a group of primary care service-user representatives to advise academics and clinical staff working in this area. This group has helped inform the outreach service and we will continue to work with service users.