As NHS England’s Clinical and Informatics Advisor for IAPT, Professor David Clark and his colleagues at the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT) have been assisting NHS England and IAPT services to adapt to COVID-19 and prepare to deal with the mental health consequences.
England has a psychological therapy service for common mental health problems (depression and anxiety related conditions) that is widely admired. Professor David Clark (Department of Experimental Psychology, University of Oxford) and Lord Layard (LSE) lobbied the government to create the service in 2005 and oversaw two successful regional pilots. From small beginnings in 2008, the national roll-out of IAPT (Improving Access to Psychological Therapies) has led to psychological therapy services being established in every area of the country. By the start of 2020 IAPT services were seeing 1.1 million people each year and the NHS had committed to further expanding the services so they could see 1.9 million people per year by 2024. Almost everyone (99%) who had a course of treatment had their outcomes recorded and publicly reported. Remarkably for such a large-scale programme, outcomes were as good as in well-funded research trials and many countries were following the UK example by establishing their own IAPT like services.
It is anticipated that COVID-19 will lead to a marked increase in many of the mental health problems that IAPT was created to treat, including: depression (linked to social isolation, job loss etc), Posttraumatic Stress Disorder (especially following experience in intensive care units), Health Anxiety, and Social Anxiety (as social restrictions are eased). As NHS England’s Clinical and Informatics Advisor for IAPT, Professor David Clark and his colleagues at the Oxford Centre for Anxiety Disorders and Trauma (OxCADAT) have been assisting NHS England and IAPT services to adapt to COVID-19 and prepare to deal with the mental health consequences. As internationally recognised experts in the treatment of PTSD, Social Anxiety Disorder and Panic Disorder, the OxCADAT team, (co-directed by Professors Anke Ehlers and David Clark), are well placed to offer evidenced-based guidance and services.
Moving to remote delivery of therapy
During lock-down, treatment needs to be delivered by therapists working from home to patients who are also in their own homes.
The OxCADAT team, who have researched remote delivery, have created a range of resources to help therapists deliver therapy, including:
- a special COVID-19 Resources page on its free therapist resources website https://oxcadatresources.com/covid-19-resources/. Although many of OxCADAT’s resources were written with NHS clinicians in mind, clinicians in over 120 countries have accessed the website, which had over 54,000 views in April.
- guides to help IAPT therapists deliver the key components of therapy remotely by video or phone.
- webinars for IAPT therapists as part of an NHS England series. OxCADAT’s first webinar on Tuesday 26th April covered treating PTSD remotely and was viewed by over 4,000 clinicians in the first 48 hours. Subsequent webinars are covering the treatment of social anxiety disorder (5th May) and traumatic grief (19th May). They can be accessed at https://oxcadatresources.com/covid-19-resources/.
- a detailed therapist guide on how to treat PTSD following treatment in intensive care units, which is a timely resource as protracted stays in intensive care are an all too common experience for patients affected by COVID-19.
The website also offers evidenced-based recommendations on evidenced-basd well-being and mental health support for front-line NHS staff.
Enhanced Outcome Monitoring and Reporting
Much of the success of IAPT has been based on its unique ability to collect outcome data from everyone who has a course of treatment, and to use the findings from the data to refine the way the services are delivered (see Clark, 2018 for details). In the last few years, feedback from the findings has enabled the NHS to halve the regional variation in outcomes and greatly improve the national improvement and recovery rates.
It is essential that IAPT services continue to collect complete outcome data and report it in a timely fashion as they move to remote delivery of treatment, as this will allow them to quickly learn how to maximise the outcomes achieved with remote delivery and to individually tailor delivery methods. Getting complete data is a challenge when patients are no longer attending clinics and handing in questionnaires. As the IAPT Informatics Advisor, Professor Clark is working with NHS England colleagues and IT system suppliers to quickly develop an online data entry system that will allow patients to input information – using a smartphone, laptop, or tablet – about the severity of their mental health problems before every therapy session.
The OxCADAT team, funded by the Wellcome Trust and the Oxford Health Biomedical Research Centre (BRC), comprises the following clinical academics: Drs Jennifer Wild, Hannah Murray, Emma Warnock-Parkes, Alice Kerr, Nick Grey, Graham Thew, and Kirsten Smith.
Research projects planned:
In addition to helping the NHS and mental health services elsewhere in the world adapt to COVID, the OxCADAT team are planning a number of COVID-19 related research projects:
- Dr Jennifer Wild and Prof Anke Ehlers are collaborating with several NHS Trusts and Universities in the UK and Singapore to deliver and evaluate support and screen and treat programmes for paramedics and medical staff.
- Profs Daniel Freeman, Anke Ehlers and David Clark are designing a large prospective study to identify predictors of poor mental health during the COVID-19 pandemic.