Agenda item

The Health Partnerships Overview and Scrutiny Committee has been keen to carry out more scrutiny of mental health services in Brent. Clearly this is an important area, but one that has been overlooked by the committee in recent years as it has focussed attention elsewhere. In order to introduce councillors to mental health provision in Brent, a presentation will be given at the committee on Brent’s Improving Access to Psychological Therapies Service (IAPT).

A copy of the presentation for Members is enclosed separately.

Dr Anupama Rammohan (Improving Access to Psychological Therapies [IAPT] Service) gave a presentation on the IAPT Service and explained that the main aims of the programme were:-

·         Delivering evidence-based and time-limited psychological therapies for people with depression and anxiety disorders

·         Increased access to services and treatments

·         Increases health and wellbeing

·         Patient choice and high levels of satisfaction

·         Timely access

·         Improved employment benefit and social inclusion

Dr Anupama Rammohan confirmed that more than 75% of primary care trusts were participating in the programme with only one trust in London not involved since the programme had been rolled out.  She drew Members’ attention to the IAPT programme’s targets and key performance indicators as set out in the presentation.  The clients who were treated by the service included those with mild to moderate anxiety and/or depressive orders and they were managed within a primary care setting.  The clients benefitted from short term psychological interventions and the service did not focus on those with complex needs, risk issues or social problems.  Dr Anupama Rammohan informed the committee of the treatments on offer, including ‘Step 2’, a telephone based service including guided self-help, brief intervention and group workshops with psychological wellbeing practitioners.  ‘Step 3’ involved individual and group cognitive behaviour therapy (CBT) and counselling.  Members heard that there had been 6,350 referrals to the service between December 2010 to May 2012, the second highest in North West London and the fifth highest in London overall.  Service challenges included a high volume of referrals, waiting times and severity and the complexity of client cases affecting recovery rates whilst only having limited resources. 

With regard to patient satisfaction, Dr Anupama Rammohan advised that the service user satisfaction survey evaluated in December 2011 revealed that 95% of service users felt involved in making choices about their treatment all or most of the time and 92% felt that they received the help they needed and happy with the care they had received.  A key area of dissatisfaction was waiting times for initial contact, however service users were satisfied with waiting times for subsequent appointments.  A GP satisfaction survey evaluated in March 20120 showed that 93% of GPs surveyed used the service often or very often and 82% were clear about the service criteria.  Overall, GPs were satisfied with the service, however a key area of dissatisfaction was waiting times.  Dr Anupama Rammohan confirmed that service directions for 2012 included improving quality in outcomes, communication, service processes and data recording.

Katherine Fraser-Jackson, a patient of the programme, was invited to address the committee to share her experiences.  Katherine Fraser-Jackson explained that she had been diagnosed with an anxiety disorder in 2010 which had affected her Masters studies.  Her GP had referred her to the service in 2010 following her being made redundant and having problems being able to sit through job interviews.  Katherine Fraser-Jackson felt that short term psychological interventions had limited effect and that some patients had felt they had lacked service once they had been discharged from Brent Mental Health Service.  She commented that she had been surprised when she had learnt at a Carers Forum that a psychological therapies service existed and felt that it needed greater publicity and that the service should be expanded in future.

Robyn Doran (Director of Operations) advised that initially it had been decided to take psychological services from a higher to a lower stream and that NHS London provided IAPT with trainees.  However, increasing the number of IAPT workers would be at the expense of higher stream workers in the borough where there were already limited resources, although it was acknowledged that demand for lower stream services was also increasing.

Tes Tesfa-Michael (Service Lead) stated that there had been five members of staff when IAPT commenced in 2010, however there would be twelve members by September 2012.  She advised that those patients whose conditions had deteriorated could ask their GP to re-refer them back to the service and in future self-referrals would be available.

During discussion by Members, Councillor Gladbaum enquired how long the service was funded for and what was the annual budget provision.  She also asked if the service linked up to other services such as adolescent services, particularly as early intervention had proven to be effective and anxiety and depression can be recurring events.

At this point, Councillor Leaman declared an interest as an employee of Young Minds, however he did not consider the interest prejudicial and remained present to consider this item.  Councillor Leaman enquired if there were any transition processes between Brent Children and Adolescent Mental Health Service (CAMHS) and adult IAPT, or did such cases need to be re-referred.  In noting that IAPT was under resourced despite the demand, he asked how this situation was being managed and what reassurances could be given with regard to reducing waiting times.

Councillor Hunter expressed surprise that action had not been taken earlier to reduce waiting times as this was a key factor and she expressed concern that the recovery rates were both lower than the London and national average.

The Chair suggested that the scope of the service’s future could be discussed with the council as there were a number of inter-related issues that the council was also concerned with, such as housing. 

In reply to the issues raised, Tes Tesfa-Michael informed Members that the initial IAPT budget had been £500k, although this would subsequently be increased to around £800k once the new budget was transferred and the contract was on a rolling basis.  A new initiative was to be introduced which would involve closer work between IAPT and Brent CAMHS and a clearer process was to be drawn up to ensure that those who were to become adults would have access to help at an earlier stage.  The IAPT Board was also making changes to ensure complex cases were thoroughly monitored and referred back to the Board where appropriate, including cases where there had not appeared to be a sufficient recovery.  Improvements to the supervision of cases from the outset would also be undertaken.  Tes Tesfa-Michael advised that recovery rates had improved recently and were around 41% at the last quarter. She added that boroughs that were performing better recovery rates, such as Westminster, had much larger resources than Brent. 

Robyn Doran advised that the current rolling contract was a duration of three years and there was no indication that this would be terminated.  IAPT also worked closely with the Primary Care Trust who invested in the service moderately and a good working relationship existed with partners.  It was implicit within the contract about what the expected waiting times should be and these would be achieved through re-designing the service and reducing bureaucracy.  Robyn Doran advised that issues raised by the committee would be fed back to the Board.

Dr Anupama Rammohan explained that it would not be productive to reduce waiting times by cutting the amount of time for each appointment as this would fail to address the problems surrounding cases and would likely mean patients making even more appointments.  Members also heard that a number of the cases also involved long term problems.

The Chair requested that this item be discussed at a future meeting updating Members on progress in improving the service.