THE ROLE OF IAPT SERVICES INSUICIDE PREVENTIONJacqui Howard andTracey Murden17 May 2013
Policy frameworkWhat do Increasing Access to PsychologicalTherapies (IAPT) services do?Role of IAPT services in: preventing suicide identifying and responding to riskContents
Policy frameworkHM Government (2011) No health without mental health More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health Fewer people will suffer avoidable harmDH (2011)Talking therapies: A four year plan of action Complete roll out of IAPT services for adults Improve access for older people and black & minority ethnic communities Stand-alone programme for children and young people.DH (2012) Preventing suicide in England Reduce risk of suicide in key high risk groups Tailor approaches to improve mental health in specific groupsNHS Outcomes framework 2013-14 Treating and caring for people in a safe environment and protecting themfrom avoidable harm
Preventing suicide in England 2012Relevant pointers for IAPT services……. Those who work with men in different settings, especiallyprimary care, need to be particularly alert to the signs ofsuicidal behaviour. Accessible, high quality mental health services are fundamentalto reducing the suicide risk in people of all ages with mentalhealth problems. Depression is one of the most important risk factors for suicide.
What do Increasing Access to PsychologicalTherapies (IAPT) services do?IAPT services:Provide primary care based talking therapies services that offer arange of treatments for depression and anxiety disorders approvedby NICEAre organised through a stepped care approach (least intrusiveinterventions first)Are delivered by trained therapists: Step 2- Psychological Wellbeing Practitioners (guided self help) Step 3- High Intensity Therapists, including cognitive behaviouraltherapists; counsellors; interpersonal psychotherapists; briefpsychodynamic psychotherapists.Monitor outcomes at each session
What does Inclusion Matters Liverpool do?….Covers Liverpool City (Population: 465.7 thousand; 95 GP practices)Provides primary care psychological therapies (IAPT) services fordepression and anxiety, combined with alcohol interventionsNow has over 100 trained therapists working at Step 2 and Step 3 levels ofinterventionWorks closely with a range of community and social inclusion agencies,including the wider mental health system.
High risk groups who are priorities for prevention of suicide:young and middle aged men; people in care of mental health services; people with ahistory of self harm; people in contact with the criminal justice system; &specific occupational groups, including doctors and nurses.Profile of people engaging with the service
The early identification and prompt effective treatment for depression has amajor role to play in preventing suicide across the whole populationTreating depression
Treating depressionDuring my darkest days of depression, I began mysessions with IML. With stress and anxiety havingtaken over my life, Mike listened carefully to my fearsand feelings… his understanding, care and compassionwere a lifeline… I still use the techniques (wedeveloped) and the dark days are slowly lifting…
Initial assessment (usually by telephone)Step 2 : Low intensity interventionStep 3: High intensity intervention……….continuallyIdentifying and responding to risk:When do we assess risk?
Standardised measures: Patient Health Questionnaire(PHQ-9)Q 2: “Feeling down, depressed, or hopeless”Q9: “Thoughts that you would be better off dead or ofhurting yourself in some way”How do we assess suicide risk?
• Ask directly:“ Have you got thoughts of killing yourself?”“ Have you got a plan?”• Explore specifics:“ Why, how, when……..?”How do we assess suicide risk?
Reasons for dying• Loss• Hopelessness• Crisis• Mental stateReasons for living• Hope• Future plans• Other people• FearExplore…….
Previous self harm/suicide attemptsHistory of mental illnessAlcohol/substance misuseRisk factors
Family/friendsFormal support network- e.g.ProfessionalsInformal support network-e.g. Church, community groupsPetsSupport factors
Recognising warning signs that a suicide crisis may beapproaching Identifying coping strategies that can be used byperson to soothe emotions and avert crisis Using family and friends that can be contacted todistract from suicidal thoughts and urges withoutdiscussing these Contacting friends and family who may help resolve acrisis and with whom suicidal thoughts can bediscussed Contacting emergency / crisis services Reducing access to lethal means (disabling suicideplan)As the plan is developed, write each step down onpaper so that the person can take this homeSafety plan (‘crisis response plan’): six steps
We document the following: (on an electronic clinical record /information system) suicide risk assessment management plan (including future monitoring of risk) communications with person’s GP and other agencies involved; forexample, psychiatry emergency/crisis care follow up arrangements.We have a direct referral pathway with the local access/ crisisresponse home treatment teamDocumentation and follow up
Increased training of own staff and other care givers(e.g. ASIST)Training and education for the communityHealth Promotion and awareness to improve thepsychological and emotional wellbeing of thecommunityIAPT: further possibilities for prevention