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Collaborative working for IAPT service access
Professor Gillian Leng, deputy chief executive and director for health and social care at NICE, looks at the importance of assessing technologies for psychological therapies and mental health treatment
According to research published last year, one in six people in England say they experience common mental health problems in any given week. Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has been seeking to improve access to services and quality of care for people with mild to moderate mental health problems which includes depression and anxiety. Over 900,000 people now access IAPT services each year.
The Five Year Forward View for Mental Health (FYFVMH) includes a commitment to improving access to high quality mental health treatment by expanding these services further. NICE is working with NHS England on an innovative project to assess digital therapy technologies which would work alongside face-to-face therapy to help people with mental health problems. The initiative, which will run for three years, aims to assess up to 14 digital therapies to identify which ones are clinically effective and cost-effective. Ultimately this will mean therapists would be able to offer people either face-to-face treatment on its own or by supporting this with digital therapy, based on each person’s needs and preferences.
Digital therapies, such as apps, programmes and websites, are increasingly being offered alongside traditional, face-to-face therapies in IAPT services. For those that choose it as an integral part of their care, digital therapy can offer a wide range of benefits. For instance, people can access therapy in more convenient locations outside of their working hours which can help avoid the need to travel to appointments.
As well as this, people can also choose when and where to access digital therapies, therefore tackling any perceived stigma of seeking help and support for common mental health problems. For mental health professionals the use of digital therapies can help by potentially freeing up more of their time, enabling them to see more people who need care and support.
With any programme of this kind, we need to make sure ideas that are put forward offer clear benefits for the patient, therapists and for the health and social care system as a whole. To do this NICE is assessing technologies in three stages:
Assessing technologies: we’ve asked organisations to let us know about their digital technologies and we’re still welcoming suggestions. Once received, each application is assessed for its eligibility by our expert panel. The panel, which is chaired by the national clinical director for mental health, includes experts with clinical mental health, health economic and data analysis backgrounds, and also includes a patient representative. Eligible technologies are then prioritised and undergo assessments looking at their technical standards, effectiveness and their impact. This is then presented back to the expert panel, and published on the NICE website. The assessments of our first three digital technologies have now been published and can be viewed here.
Evaluation in practice phase: technologies selected by the panel as provisionally suitable will be evaluated by being trialled in selected IAPT services for up to two years, and the outcome data will be collected. After the evaluations are complete, the expert panel will make a recommendation on which technologies should be made available through IAPT services.
Development funding: if the NICE panel decide more work needs to done on the technology they will encourage organisations to apply for development funding from NHS England. After this the technology will be reconsidered for evaluation in practice phase.
Mental health can have a profound and lasting effect on people’s lives. Figures show that mental health problems are one of the main causes of the overall disease burden worldwide and that these conditions are the primary drivers of disability causing over 40 million years of disability amongst 20 to 29-year-olds. There are many initiatives underway at a national level to ensure those who need support can receive the best possible care, tailored to their needs. This new, ambitious project is part of the vision policymakers have to improve mental health services and we hope the digital technologies we identify will help more people with depression and anxiety.