Delivering Tailored Support for those with Long Term Conditions

The expansion of the improved access to psychological therapies (IAPT) programme to include people with long-term conditions (LTC) and medically unexplained symptoms (MUS) is an increasing priority for the NHS and for good reason. There is an increasing prevalence of LTCs, in particular people having two or more LTCs. People living with an LTC, are 2 – 3 times more likely to experience mental health problems and management of each is affected by the other.

Co-morbid mental health problems impair active self-management and lead to poorer adherence to treatment plans. People with long-term physical conditions suffer more complications if they also develop mental health difficulties, increasing the cost of care by an average of 45 per cent. In the UK for type 2 diabetes; £1.8 billion of additional costs can be attributed to poor mental health; yet fewer than 15 per cent of people with diabetes have access to psychological support. 

Additionally, distress in the presence of LTCs can be seen as ’inevitable' and as a 'normal' consequence of living with a LTC, making depression less likely to be detected and treated1. Evidence suggests that dedicated mental health provision as part of an integrated service can substantially reduce these poor outcomes 2.

In February 2016, the Mental Health Taskforce published The Five Year Forward View For Mental Health 3. A core recommendation made by the taskforce is the need to treat mental health needs as having equal importance as physical needs. The report sets out a number of priorities for change over the next five years, including more and better integration of mental healthcare and physical healthcare.

The IAPT Pathfinder sites, established in 2012, have made encouraging progress by extending the benefits of IAPT to include those with LTCs and/or MUSs. Dr Niall McCrae, Lead for Qualitative IAPT LTC Evaluation, University of Surrey & IAPT Evaluation Agency recently presented positive findings from the IAPT LTC Pathfinder Evaluation4 with positive clinical outcomes across all measures:

• Overall, results were positive on all primary measures (PHQ-9, GAD-7, W&SAS and EQ-5D)
• Overall recovery rate over 40% (similar to other IAPT services)
• Results do vary considerably in magnitude and significance between sites
• Particularly positive change on GAD-7 for people living with diabetes and cardiac patients.

The evaluation also highlighted a need for specific LTC and MUS training and supervision for therapists and psychological wellbeing practitioners. At SilverCloud we are developing a series of online programmes that are tailored to address the emotional health challenges associated with long-term conditions. The first in the LTC series are programmes for Diabetes, Chronic Pain and COPD; we look forward to developing our library further to help meet the goal of integrated support for people with mental and physical health problems.