The issue
Depression and anxiety are common mental health problems that cause substantial difficulties for people who experience them. The NHS has created a world-leading psychological therapy service, called ‘Improving Access to Psychological Therapy’ (IAPT), to help people manage and overcome these conditions. IAPT intervention is increasingly being delivered by telephone – a method that is clinically effective, convenient for many patients, and recommended by the National Institute for Health and Care Excellence (NICE).
However, the delivery of psychological therapies by telephone is subject to certain challenges. Although many patients like the idea of telephone-delivered treatments, because appointments are easier to access and less stigmatising than attending mental health clinics in person, the professionals who deliver telephone treatments do not receive sufficient specialised training and many patients who are referred for telephone therapy do not complete their treatment in full.
The research
Funded by the National Institute of Health Research (NIHR), the EQUITy programme is seeking to find ways in which the telephone delivery of psychological therapies under IAPT can be made more effective, leading to higher patient retention and improved clinical outcomes. Alongside the University of York team, this mixed-methods programme involves a consortium of researchers from institutions across the UK, led by Professors Penny Bee and Peter Bower (University of Manchester).
The majority of patients entering IAPT services are offered ‘low intensity’ treatment based on Cognitive Behavioural Therapy (CBT) approaches and following a guided self-help model. Personal Wellbeing Practitioners (PWPs) support patients through a tailored programme of CBT-based information provision, activity and review, with regular monitoring of any change and improvement in mental health status.
Our contribution is to analyse a large sample of IAPT telephone sessions recorded in a number of NHS sites across England, looking in close detail at what actually happens in the telephone interactions between patients and PWPs. We are using the methodology of Conversation Analysis to examine and understand precisely how IAPT is delivered over the telephone, focusing on the language and structures used in these interactions, to identify what works well and what is less effective.
Our analysis has revealed that IAPT sessions consist of a number of standard phases and requisite activities, which can be approached by PWPs in more or less patient-centred ways. We have focused on how the interactions within each phase or activity can be designed to be more personalised; to give patients greater opportunity to discuss their experience in their own terms; to provide clearer explanations about the CBT approach and its benefits; and to provide patients with clear and appropriate goals for their ongoing treatment.
The outcome
The results of our research have fed into the next phase of the EQUITy programme, which is to develop a behaviour change intervention aimed at IAPT services and staff, with the aim of improving service delivery and hence patient engagement and outcomes. Our conversation analysis findings have particularly informed a PWP training package that will be nested within the overall intervention. The intervention will be piloted in 2020, followed by a full randomized control trial in 2021.
