HASCAS - The Health and Social Care Advisory Service

Psychological Therapies

HASCAS developed a Good Practice Framework for Improving Access to Psychological Therapies for NIMHE East. The Framework comprises 10 Principles which cover such issues as access, assessment, availability, use of evidence-based interventions, training/supervision/peer support for practitioners, the management of waiting lists, governance arrangements and mental health promotion activity.

The Framework has been used in two large specialist mental health NHS Trusts covering six PCTs, and three Local Authorities. It was also used in smaller services including one where the PCT Primary Care Psychological Therapies Service was reviewed.

We were commissioned to review one Trust’s psychological therapies services with a particular emphasis to make recommendations and comment on the arrangements for the employment of Primary Care Graduate Mental Health Workers and the implementation of an Early Intervention (In Psychosis) Team.

All the work in these areas was fascinating and the results were similar in that they demonstrated:

the highly individual way psychological therapies services have developed in different parts of the same NHS provider Trust;
the very different levels of investment from previous and current commissioners;
the haphazard way in which outcome data is collected and analysed;
the lack of equity of access and general availability across the whole area served;
the lack of services to older people and to those on acute psychiatric admission wards;
the piecemeal development of services without reference to a strategy from the commissioners or the provider trust – usually due to the number of reconfigurations each had undergone in the previous 10 years;
development being sometimes due to the specific interests of an individual psychologist;
variable standards in service level agreements for a specific service to meet recognised needs in the local population, with little mention of the desired outcomes or the modalities to be used.

HASCAS was able to highlight the different levels of need in the main delivery areas for the Psychology Service in all these settings. These bore little relationship to the level of service provision. Recommendations were made in relation to how to develop a strategy, improving local ‘ownership’ of this, looking at the balance between primary, secondary and tertiary services, staff skills, and priorities for investment and reconfiguration.

There is likely to be a need for similar review and strategy development in the light of the recently announced investment by the government in psychological therapies, as this will be essential to ensure future investment provides added benefit and helps services reach a more diverse range of populations.