'Mind the gap': Adapting for complexity in the space between NHS Talking Therapies and secondary care

NHS Talking Therapies services for anxiety and depression, (NHS-TT; formerly Improving Access to Psychological Therapies; IAPT) are the main provider of primary care psychological therapies within England, with over 1.2 million people entering treatment annually. However, outcomes are not optimised, and around 50% of referrals do not optimally respond to standard care in TTad services, with those with more severe, complex or chronic presentations commonly falling within this group. There is a further group of clients with mood and anxiety disorders who may not typically be offered care within these settings – namely those with a current or historical diagnosis of personality disorder. Excepting where suicidality risk is ‘high’, both those who are denied treatment in TTad services, and those receive but do not fully benefit from TTad treatments frequently do not meet the threshold for assessment or treatment in secondary care and are discharged to their GP.
There are a variety of ways to address this treatment gap and improve provision in primary care for those with more complex difficulties, including: upskilling the existing workforce to tailor usual care for clients with more complex difficulties, and innovating novel treatments and care pathways to respond to the unmet needs within the gap.
Preliminary findings from an NIHR 3 Schools Mental Health Fellowship developing and evaluating clinician training workshops to adapt usual care for depression and anxiety in the context of complexity will be presented. Preliminary data on workshop feasibility, acceptability and effectiveness to improve therapist and service level clinical outcomes will be discussed.
Ongoing work and future directions of a programme of work adapting an emerging wellbeing and recovery-focused treatment (Augmented Depression Therapy) for ‘complex’ depression will also be presented.

Zoom meeting details:

Meeting ID: 918 1908 4047
Password: 791874