Academic journal article New Zealand Journal of Psychology

Low Intensity Psychological Interventions in Aotearoa: What Can We Learn from IAPT?

Academic journal article New Zealand Journal of Psychology

Low Intensity Psychological Interventions in Aotearoa: What Can We Learn from IAPT?

Article excerpt

Increasingly, common mental health disorders such as depression and anxiety are recognised as leading causes of disability throughout the world (World Health Organisation, 2016). Poor mental health impacts on an individual's physical health, family life, and workplace functioning. For example, in the UK depression is considered 50% more disabling than angina, asthma, diabetes or arthritis, and accounts for 40% of government benefits paid and 40% of work absenteeism (Clark, 2016). Effective treatments are available but relatively few receive these. It is estimated that less than 10% of the world population are appropriately diagnosed and treated. The reasons for the scarcity of effective treatment are identified as a lack of resources and trained mental health providers, the social stigma attached to mental health problems, inaccurate assessment, and the fact that these conditions appear to be on the rise globally (World Health Organisation, 2016). Mental health services, particularly in the developed world, including New Zealand, are under increasing pressure to substantially improve, or at least manage this situation more effectively. The National Health services in England have, over the past decade, risen to the challenge by initiating the Improving Access to Psychological Therapies programme (IAPT, 2008).

Low intensity psychological interventions are a key element of this ambitious and wide ranging initiative (Clark, 2011). Two important factors stimulated the growth of low intensity options for mental health problems. These were, the development of the National Institute for Clinical Excellence (NICE) guidelines for the treatment of depression (NICE, 2004a) and the anxiety disorders (NICE, 2004b), and Layard et al.'s (2006) report on the huge economic cost and social burden of the global increase in anxiety and depression. Layard et al.'s (2007) subsequent economic analysis and intensive lobbying regarding the cost benefits of improving access to evidence based psychological interventions resulted in the Improving Access to Psychological Therapies (IAPT) initiative in England. On the basis of the "spend to save" rationale, an investment of 175 million pounds per annum was allocated to the National Health mental health service between 2008 and 2011 to train cognitive behavioural therapists, (identified as a scarce resource), and to implement a stepped care mental health services model (Clark, 2011). It was posited that the cost of implementing these initiatives would be recovered through a reduction in medical costs and welfare payments, and through increases in revenue gathered from return to employment and improved productivity (Layard et al., 2007).

This paper aims to introduce some of the ideas behind the development of this relatively new therapeutic paradigm to Aotearoa New Zealand mental health community. Low Intensity CBT (LICBT), as practised in England, is defined and described in terms of its mode of delivery, type of intervention, and the primary reliance on CBT as the guiding model for practice. One of the central pillars of LICBT is the introduction of "low intensity" mental health practitioners called "Psychological Wellbeing Practitioners" (PWPs). The PWP role is discussed and contrasted with that of the High Intensity Practitioner (specialist mental health practitioners, such as clinical psychologist or mental health nurse). In addition, a brief overview of the research supporting the introduction of LICBT is provided. The paper concludes by highlighting some of the challenges in delivering LICBT in England.

What is Low Intensity therapy?

The significant gap between the demand for mental health services and the availability of specialist providers to service this need has prompted the search for alternative approaches in the delivery of psychological interventions (Haaga, 2000; Lovell & Richards, 2000). Low intensity (LI) psychological interventions have been developed to bridge this gap and are associated with "low usage of specialist therapist time" (Bennett-Levy, Richards, & Farrand, 2010, p. …

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