Psychological Therapies in Primary Care (InPsyTe) HIT reflect on 2019-20

Directors of the Psychological Therapies in Primary Care Health Integration Team (InPsyTe HIT), Dr David Kessler and Rick Cooper reflect on the HIT’s achievements over the past year.

The local Improving Access to Psychological Therapies (IAPT) service is closely related to the aims of the InPsyTe HIT. Over the summer months of 2019, the IAPT service for Bristol, North Somerset and South Gloucestershire underwent a re-organisation. In the newly recommissioned service, one of our HIT Co-Directors, Rick Cooper, was appointed as service lead.

We completed our evaluation of Silvercloud which is an online Cognitive Behavioural Therapy (CBT) app that clients can work through on their own and includes regular contact with a therapist through the app, by email and phone. It is potentially a way of offering clients access to CBT more quickly and efficiently. Silvercloud aims to deliver what we call ‘low intensity’ CBT; this is a version of CBT based on supporting people to change unhelpful behaviours and is aimed at those with less severe anxiety and depression. We wanted to know if clients referred for CBT would take up the option of Silvercould and whether they would find it helpful.

A total of 342 people took up the offer of online therapy and we compared them to 2,607 clients who received face to face therapy.

On average those who took up online therapy had less severe depression and anxiety symptom scores than those who were seen face to face when they started their therapy. We think this is because the psychologists working in the service selected those who were less unwell or had less complicated problems for online therapy. Silvercloud clients attended an average of five sessions, compared to six for those having CBT face to face. This suggests that online therapy was acceptable. People having therapy in both groups improved overall -those who went from being a ‘case’ of depression or anxiety to no longer being a case (as defined by IAPT) was 45%.

From this study, Silvercloud appears to be a reasonably effective and acceptable for clients selected as suitable by their therapists, and this makes it a useful addition to the treatments on offer in IAPT.

We completed the pilot phase of the INTERACT programme, a six-year programme of research funded by the NIHR. We developed a new intervention that will integrate the use of online CBT materials with therapist-led CBT for depression. This is different from low intensity treatments such as Silvercloud. INTERACT is designed for people with more severe and complex depression and anxiety. It provides online CBT materials and worksheets with regular hour-long sessions with a therapist that mainly take place using instant messaging but also use telephone and face to face video. We are about to begin recruitment for a full scale randomised controlled trial.

With Bristol Wellbeing Therapies, we designed and ran a total of 17 information sessions at Junction 3 in Easton. Just under 200 people attended them over this period. We included a service user forum in the presentation and gathered useful feedback around making the language and content accessible. This was an initiative to reach out to members of BAME communities in East Bristol, who are seriously under-represented in psychological services.

These sessions were led by members of staff who had experience of working with the local BAME groups and we advertised them in community settings such as churches and local shops.

The walk-in BAME information sessions provided information and psycho-education to help people make more fully informed decisions about the psychological therapies and resources available through IAPT. We also had people in the room who could assist with the form filling and answer any questions.

We would like to continue this model of working under the new IAPT provider, Vitaminds, and would like to explore offering webinars and getting other agencies such as Employment, CAB and Drug and Alcohol services to encourage joined up working.

We are currently in the process of accessing the data from these sessions to see if they had a significant impact on the access for BAME people to IAPT services.

We also extended these sessions to the elderly in care homes and students at University of Bristol, and would like to develop this, using webinars and face to face groups when possible.