Delivering talking therapies over the telephone can be just as effective as face-to-face but more GPs need to embrace this, says Kevin Rozario-Johnson.
The Improving Access to Psychological Therapies (IAPT) programme marks one of the most innovative and effective improvements made to the health service in the past 60 years. It is a model, grounded in National Institute for Health and Care Excellence good practice, which promotes early access and works around the individual’s needs while also training up a new workforce of wellbeing practitioners.
I manage an IAPT service, Health in Mind, which is a partnership between Turning Point and Sussex Partnership NHS Foundation Trust. It is one of a number of IAPT services that Turning Point runs across the country, which are all centred on providing talking therapies to those with low-level mental health issues including depression and anxiety.
The flexibility in the delivery of talking therapies means the model lends itself well to advances being made in technology and using telephone-based interventions to maximise the number of people accessing support.
Recovery rates across Turning Point’s services are above the national average range of 50%. About 70% of Turning Point’s interventions are telephone-based as this is the preferred way the people we support choose to access their support. In July this year, there was a 52.4% recovery rate recorded in East Sussex for our low-intensity interventions, which exceeds the national IAPT target and is predominantly delivered via telephone treatment.
But we have found that GPs sometimes struggle to embrace this method of delivery and this is problematic because it limits the number of people we can support in this way. It would be good to know whether other IAPT providers are finding this the case too.
Feedback that telephone interventions are considered less effective is not uncommon. But this is a field in which much research has been done and as a result a strong evidence base exists to support this type of intervention. For example, research published in September 2012 by Hammond et allooking at psychological therapies in the East of England concluded that telephone support is no less clinically effective for mild-moderate severity than face-to-face.
Local patient feedback we have received suggests that many people feel this method of support is not only more discreet and confidential but also more convenient for them as appointments can be arranged around work hours and childcare commitments. Psychological wellbeing practitioners are skilled in building a therapeutic relationship over the telephone and in quickly gaining an understanding of the support needs, just as they would during face-to-face appointments. Telephone interventions also provide greater flexibility to patients as they can be delivered anytime between 8am and 8pm, therefore minimising the impact on work or family commitments.
With mental health issues effecting 1 in 4 of us and the cost of this in terms of lost productivity and staff replacement being £30billion, according to the Centre for Mental Health, providers and commissioners need to embrace the use of alternatives to face-to-face treatment to deliver support where it is preferred and outcomes are not negatively affected. We can’t afford not to.
Reference: Hammond GC, CroudaceTJ, Radhakrishnan M, Lafortune L, Watson A, McMillan-Shields F & Jones PB (2012) Comparative Effectiveness of Cognitive Therapies Delivered Face-to-Face or over the Telephone: An Observational Study Using Propensity Methods. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0042916
Kevin Rozario-Johnson is operations manager at Turning Point Health In Mind