IAPT services have been predominately lauded as an international success story in providing free, self-referred, tailored therapy for people experiencing a psychological crisis. Many of us will encounter these services at one point in our lives, but due to this heavy pressure, technological ingenuity is becoming ever more vital to cut waiting times and give people the urgent care that they require.
At the turn of the millennium, voices arguing for mental healthcare reform were gaining currency. At the time, the economist Lord Layard was successfully lobbying the Blair Government with the argument that common mental illnesses were a social problem that strained the public purse.
The answer that he and the clinical psychologist Professor David Clarke proposed could kill two birds with one stone, for it could provide more than just a GP prescription, actually, GPs weren’t necessary at all, and it could pay for itself by reducing long-term unemployment. They proposed that patients should be able to self-refer to local NHS therapy services.
This new approach would evolve by the end of the first decade into the Improving Access to Psychological Therapies initiative (IAPT). IAPT services treat common mental health problems using NICE-approved psychological therapies, commonly this means some form of Cognitive Behavioural Therapy (CBT), but group therapy and various other therapies are also approved alternatives; with the average patient receiving seven sessions (2019 figures).
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IAPT services in 2021
Recent NHS data shows that there is an increasing demand for IAPT services, with 1.69m people being referred in 2019/20, an increase upon 960,000 in 2017. However, those figures do not represent all those who actually access IAPT services; for example, in 2019, 31% of referrals were not eligible and were signposted to other services.
Once a patient has referred to an IAPT service, there is an average waiting period of 22 days for a clinical assessment and a further average of 45 days to begin treatment. The clinical evaluation involves a one-hour phone call to determine whether the patient is eligible and to collect patient information.
Due to the ever-increasing need for these essential services, merging clinical expertise with new technologies that can automate and streamline specific aspects of the clinical assessment is growing ever more vital. Significantly, demand is projected to dramatically increase due to the impact that the pandemic and successive lockdowns have had on everyone’s mental health.
Limbic’s Access platform, which has been trialled across four IAPT services in January of this year through its partnership with Vita Health Group, utilises chatbot AI to gather information pre-screening, to enable clinicians to save time evaluating incoming referrals, and can either assist in signposting or in the development of individually tailored patient treatment plans.
Easing the pressure on clinicians' time, the interface provides an interactive and engaging experience that patients can access at any time and therefore allowing many to start the process of seeking professional help when they are at the height of a psychological crisis.
Data from the month-long trial period showed that the information gathering tool saved 20 minutes per referral, translating into 430 weeks of waiting time and 86 clinical hours saved by the automation of basic assessment processes.
The interface also reportedly provides a naturalist flowing conversation that wouldn’t automatically be thought of for a computerised chat technology, represented by a 91.64% approval rating from patients who used the tool to begin their mental wellness journey.
Beyond 2021 innovative technological advances for IAPT services
Doctor Ross Harper, CEO and co-founder of Limbic, described the trial as being particularly “salient” as “it's really important now more than it's ever been to accommodate and manage the volume of demand for talk therapy. Covid being a particular issue, but also the trend has been increasing over the last few years. There are more and more patients seeking help for common mental illness. And so, I think part of the timing issue is just so present and necessary.”
Currently, Limbic's conversational AI technology can increase the volume of patient referrals by aggregating individuals by their eligibility for particular services, by informing their treatment pathways, and by sorting applicants by their location. Dr Harper commented: “We can accelerate any subsequent human assessment. But we can also, in a subset of cases, work out that actually, this person has, for example, mild to moderate depression, anxiety.”
However, Limbic’s technology goes beyond the sometimes crude, depthless, and lifeless application of various chatbot interfaces and has attractive further potentials. As Dr Harper explained, the merger of clinical experience and patient-focused design may have an exciting future capability to create a continual, remote dialogue between patients and their therapists.
Through moving on from a website-based chatbot and onto an advanced AI app, Dr Harper described Limbic’s technological potential as a future “bidirectional information flow between the patient and the clinician”, which aims to learn what works for the patient and allow the clinician to be more present in their daily lives.
“In between sessions, patients can log data by just having a naturalistic conversation in the app. And the therapist, because they're in the loop, can also provide better personalisation to their mobile app. Because, they can say a good coping strategy would be x, y, z, and now Limbic knows what to say to this specific patient out in the real world at the moment when it matters most.”
“So, it's no longer just ‘why don’t you try this guided breathing exercise or generic CBT content’, "it will be able to name the streets that you might want to take a walk around or mention going out onto the balcony because we know this person has a balcony, where they can look at the trains for grounding exercise because we've got this super personalised information coming from their therapist.”
Amplifying the reach of therapists via an app is still a work in progress; however, the utility of Limbic’s digital technology has already been demonstrated. Moreover, what is apparent is that by blending the human intellect with innovative technologies, new futuristic solutions can emerge to address present-day systemic challenges and can be at the forefront in the enhancement of access to care and in the treatment of mental illness.