Psychological therapies for mild to moderate common mental health problems

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • People who present with Mild - Moderate common mental health problems
  • IAPT services for people of 17 years + including older adults and people with learning disabilities who are in a position to make use of the specific psychological interventions provided through the Primary Care (IAPT)

This guidance does not cover:

  • The specialist needs of older people or people with learning disabilities continue to be served by Secondary Level Specialist Older Adults and Learning Disabilities Services.

Treatment

Treatment for mild to moderate common mental health problems
  • Recommendations are a combination of both talking therapies and medication is best treatment for depression.
  • 'Depression and anxiety disorders can have a devastating effect on individuals, their families and society. The National Institute for Health and Care Excellence ( NICE) recommend particular first choice interventions for low mood, anxiety and depression.
  • Kirklees and Calderdale IAPT offer a range of NICE recommended interventions for the treatment of low mood and stress through to depression and anxiety
  • Evidence suggests early detection can result in better outcomes for recovery, if you suspect your patient may be suffering from low mood/stress please consider a referral to IAPT as a first line intervention
Psychological therapies are appropriate for:
  • People who are experiencing MILD to MODERATE* Common Mental Health Problems such as:
    • Depression
    • Anxiety disorders e.g. Panic Disorder, Generalised Anxiety Disorder, Phobias etc
    • Post Traumatic Stress Disorder – as a result of a single traumatic event (not childhood abuse where there are excessive levels of guilt and/or shame).
    • Obsessive Compulsive Disorder
    • Adjustment to life events, e.g. physical health problems, disability, bereavement, or financial stressors, loss of employment -
    • We have dedicated staff working with clients who have a long term physical health condition
    • Problems sleeping
    • Relationship problems
    • See referral section for information about individuals who should not be referred to IAPT
*MILD to MODERATE is characterised by:
  • A level of functioning such that the service user would be able to attend a therapy session outside of their home.
  • Moderate indications of risk but there is no intent and there is evidence of clear protective factors and are able to keep themselves safe.
  • Minor levels of self- harm that would not require medical treatment e.g. superficial scratching or picking of skin.
  • No complex co-morbidity i.e. where the treatment of one condition might have a detrimental impact on another condition (*see note below)
  • People have found psychological interventions helpful in the past.
  • People's capacity to function on a day-to-day basis is maintained to some degree. However some people may experience mild to moderate disruption e.g. brief absence from work, tension within relationships etc.
  • Adjunctive Psychological intervention indicated when initial drug treatment eg. SSRI (see NICE guidance) has had limited benefit

Please Note: It may be appropriate for service users with problems of a more severe characterlogical presentation to receive psychological therapies for the treatment of a discrete aspect of their difficulties (e.g. adjustment, stress or anxiety) - please discuss with the IAPT duty clinician prior to making a referral

Please print and display:

Red Flags

Seek immediate or urgent specialist advice/treatment if:

  • individual is a risk of harm to self or others

Referral

Referral Criteria

  • People with Mild - Moderate common mental health problems
  • Services users can self-refer to IAPT (with or without seeing a GP) - Please provide IAPT Patient Leaflet
  • To be able to utilise a Psychological approach it is essential that service users should:
    • be motivated and prepared to consider a psychological approach to treatment, i.e. people who are curious to understand their difficulties and do not just want them removed and
    • have requested help themselves rather than those who are responding to pressure from others and
    • have sufficient stability to be able to engage in a psychological intervention e.g. housing, finances etc.
  • It is not appropriate to refer people for IAPT services:
    • Who are at immediate risk of self-harm or suicide and require a more urgent assessment by secondary care services - Contact SPA
    • Whose level of risk or level of disturbance first requires more immediate intervention to achieve greater stability – Contact SPA
    • Whose main problem is reliance on drugs or alcohol - Refer to drug/ alcohol services e.g. Lifeline/On Trak
    • Who are experiencing a psychotic illness (including unstable bipolar disorder) - Contact SPA
    • Whose principal problem is Forensic in nature e.g. violence towards others, or have a forensic history relating to violence
    • Who are currently involved legal/ court proceedings e.g. criminal or child custody proceedings
    • Whose principal problem is psycho-sexual in nature and the problem is not associated to trauma or mental health issues –Refer to Psycho-sexual Counselling Service - Contact SPA
    • Who are unable to engage in Psychotherapy due to the effects or side-effects of their medication e.g. high levels of analgesics such as morphine.
    • Who are currently under initial medical investigation to explore a possible physical explanation for their difficulties

Referral Instructions

  • Service-users can self-refer to IAPT: (Please provide IAPT Self Referral Leaflet & IAPT Patient Leaflet)
    • By telephone 01484 343700 Monday – Friday 08:30am 4:30pm (Answer machine outside of these hours, these are then picked up the next working day)
  • if a clinician is unsure if IAPT is appropriate, would like initial specialist assessment or feels they wish to provide background information, a referral can be made to The Calderdale and Kirklees single point of access (SPA) by:
    • Submitting a completed SPA referral form to Beckside Court 2nd Floor 286 Bradford Road Batley WF17 5PW or
    • ringing 01924 316830
  • If you are in any doubt regarding the appropriateness of an IAPT referral please contact the duty clinician on:01484 343700 (8.30 - 4.30)

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/additional information

Assurance & Governance

  • This guidance was developed on: 02.2018
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 03.2018
  • Publication Date: 03.2018
  • Review Date: 02.2020
  • Ref No: MH8 - 02.2018
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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