Is IAPT failing people with medical problems?

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
captain artichoke
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Is IAPT failing people with medical problems?

Post by captain artichoke » Sat Apr 02, 2011 12:03 pm

Disclaimer: I know very little about IAPT - this is just something which occurred to me the other day so am seeking clarification and other people's views!

I was at a talk the other day relating to the efficacy of psychological interventions for increasing the well-being of people with physical health problems and it led on to a discussion about the lack of provision of psychological therapies for people with such problems (for example, diabetes, cancer, head injury). It got me wondering whether IAPT has any role with these groups and, if not, whether really it should?

Cheers :)

KitKat
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Re: Is IAPT failing people with medical problems?

Post by KitKat » Sat Apr 02, 2011 12:33 pm

I don't know too much about IAPT so hopefully someone more in the know will come along soon! However, I have heard (through this forum, I think) that IAPT does have a role in providing therapy to people with physical conditions, have a look here for some more info: http://www.iapt.nhs.uk/services/models- ... onditions/

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baa
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Re: Is IAPT failing people with medical problems?

Post by baa » Sat Apr 02, 2011 2:03 pm

that is now on our referral criteria! So we see people with long term physical health problems, and unexplained medical conditions.
At least I'm not as mad as that one!

LIWY
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Re: Is IAPT failing people with medical problems?

Post by LIWY » Sat Apr 02, 2011 3:42 pm

baa wrote:that is now on our referral criteria! So we see people with long term physical health problems, and unexplained medical conditions.
Yes, we have all been told this is now something we provide or will be providing. No training on it yet though or information about when/if/how it will happen.

As for unexplained medical conditions, I do hope that NICE will also set down which medical tests people should have had before being referred because some GPs seem great and rule out things such as anemia, inflammation indicators in blood, vitamin deficiencies, coeliac etc.. when people present with aches, pains, tiredness, ibs type of symptoms and others don't seem to bother at all and send them along for talking therapy. I have sent people back to GP for tests and a few have come out with thyroid, PCOS, anemia, major Vit deficiencies...oh and sleep aponea for someone who thought they were waking up with panic attacks.

Unexplained medical symptoms/illnesses that are hard to diagnose (CFS for instance)/long term diagnosed health conditions are three quite separate areas and I hope will be treated as such.

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baa
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Re: Is IAPT failing people with medical problems?

Post by baa » Sat Apr 02, 2011 3:55 pm

oh, definitely. We've got ourselved a handy psychiatrist on the team, he's doing a lot of the gp liaison work. Handily, a good chunk of our gps are happy to do further tests, especially when the worker and therapist work as a team ;)

As far as training goes, we're planning to do a lot of ours within the trust, we've got to chat up the health psychs and the pain people.

Ooh, and apparently the babcp conference has a speaker on cbt and long term medical conditions.
At least I'm not as mad as that one!

eastofnorth
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Re: Is IAPT failing people with medical problems?

Post by eastofnorth » Sat Apr 02, 2011 5:39 pm

I work in paediatric long term health problems. Referrals to CAMHS are outright rejected in many areas. Most do not have the expertise/training in long term health problems, but the reason they are rejected is because of lack of resources. Put simply, they are triaged as not needing any care unless they become harmful to themselves or others.

That said, some have health/clinical psychologists attached to their teams who run clinics especially for paediatric service users with long term health disorders. We expect more provision/support in 2012 following PbR specifications and recently released DH priorities.
"It's not what you look at that matters, it's what you see." ~ Henry David Thoreau

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eponymous85
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Re: Is IAPT failing people with medical problems?

Post by eponymous85 » Sat Apr 02, 2011 5:52 pm

For adults there are medical psychology/clinical health psychology services available, though I guess like most services you could argue that the resources are scarce. They work with all the populations you mention (though I think brain injury usually comes under neuro rather than health) as well increasingly with services like heart failure, genetic conditions and transplants. From glancing at NHS jobs every now and again and talking to colleagues, it feels like these specialities are on the up.

I'd be enthusiastic about having some IAPT style services adding to the primary care end of the market, though considering they would generally be dealing with complex interactions and co-morbidity I would prefer to see more secondary care provision.
The mind is not a book, to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many layered thing.

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russ
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Re: Is IAPT failing people with medical problems?

Post by russ » Sat Apr 02, 2011 9:22 pm

LIWY wrote:Unexplained medical symptoms/illnesses that are hard to diagnose (CFS for instance)/long term diagnosed health conditions are three quite separate areas and I hope will be treated as such.
Perhaps, although unexplained medical symptoms and CFS-like presentations are sometimes considered presentations with a heavy psychosomatic presentation, especially within psychoanalytic spaces, and there are services that have been commissioned on this basis.

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Re: Is IAPT failing people with medical problems?

Post by astra » Sat Apr 02, 2011 11:39 pm

russ wrote:
LIWY wrote:Unexplained medical symptoms/illnesses that are hard to diagnose (CFS for instance)/long term diagnosed health conditions are three quite separate areas and I hope will be treated as such.
Perhaps, although unexplained medical symptoms and CFS-like presentations are sometimes considered presentations with a heavy psychosomatic presentation, especially within psychoanalytic spaces, and there are services that have been commissioned on this basis.
. . .and crop up where there is a history of abuse a little too often for it to be a co-incidence, IMHO.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn

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Dr.Dot
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Re: Is IAPT failing people with medical problems?

Post by Dr.Dot » Sun Apr 03, 2011 12:10 am

I guess it depends on your definitaion of failing. Picking up cases and referring on? or working with the difficulty in primary care? If the cases are in effect triaged in IAPT and then signposted to an appropriate service or treated within the service. As baa says the latter needs more training for the therapists/PWP's in treatment and in sensitivity in feeding back a formulation that informs someone that their medical symptoms are not medical but psychological. If it's sold as managing the physical it is a little more palatable.

I have seen people with medically unexplained symptoms in IAPT. One with pain, that had a significant relational element, worked though it for a bit and then signposted to relate. The other has been referred up to secondary care, as it was nothing like anxiety or depression, or even PTSD.
Dorothy: Now which way do we go?

LIWY
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Re: Is IAPT failing people with medical problems?

Post by LIWY » Sun Apr 03, 2011 12:40 am

russ wrote:
LIWY wrote:Unexplained medical symptoms/illnesses that are hard to diagnose (CFS for instance)/long term diagnosed health conditions are three quite separate areas and I hope will be treated as such.
Perhaps, although unexplained medical symptoms and CFS-like presentations are sometimes considered presentations with a heavy psychosomatic presentation, especially within psychoanalytic spaces, and there are services that have been commissioned on this basis.
I would very much say NOT perhaps. It is so damaging to people suffering genuine symptoms to suggest that they are doing it to themselves somehow because we cannot see the symptoms or the standard tests available don't diagnose them. One day we might find that history judges the psychoanalysts who think they are leading to a cure in a medically unexplained condition in the same way that we now judge those who thought that it was down to praying and religous belief that people who most probably had relapsing/remitting multiple sclerosis apparently miraculously recovered from attacks of blindness/diziness/loss of balance.

Living with any long term health condition that changes one's life/quality of life demands readjustment, and often processing a sense of loss. Living with a condition that has a name but one that many associate with you having "done it to yourself" or being a bit weak and not able to take pressure brings another set of difficulties. Living with one that can't even get a name is different again.

LIWY
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Re: Is IAPT failing people with medical problems?

Post by LIWY » Sun Apr 03, 2011 12:46 am

I'm not saying by the way that the mind isn't important of course, but I believe we must see everything as a whole. Those of us who get cold sores for instance and find that they pop up when under stress but equally perhaps when skiing/sunburnt have a very obvious example of the interplay between the mind and body.

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Dr.Dot
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Re: Is IAPT failing people with medical problems?

Post by Dr.Dot » Sun Apr 03, 2011 7:28 am

LIWY wrote: One day we might find that history judges the psychoanalysts who think they are leading to a cure in a medically unexplained condition in the same way that we now judge those who thought that it was down to praying and religous belief that people who most probably had relapsing/remitting multiple sclerosis apparently miraculously recovered from attacks of blindness/diziness/loss of balance.
My understanding, is that a psychoanalyst, or someone working psychodynamically do not think that they are leading to a cure...they offer a different way of understanding physical, psychological and emotional experience. If a person responds to that way of of understanding, it may reduce 'symptoms'. In my experience anyone who works holistically would not be dualistic about the mind and body. Are you talking about the medical model here? A model that has led to putting experience into boxes, and is the fundemental basis of an approach that aims to 'fix' people. The model that underpins the IAPT initiative.
LIWY wrote: Living with a condition that has a name but one that many associate with you having "done it to yourself" or being a bit weak and not able to take pressure brings another set of difficulties. Living with one that can't even get a name is different again.
I am very interested here in "done it to yourself". As if there is blame to be attributed, who is that ascribes such blame? Who is the many?
astra wrote:
. . .and crop up where there is a history of abuse a little too often for it to be a co-incidence, IMHO.
Indeed.
Dorothy: Now which way do we go?

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russ
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Re: Is IAPT failing people with medical problems?

Post by russ » Sun Apr 03, 2011 8:36 am

LIWY wrote:It is so damaging to people suffering genuine symptoms to suggest that they are doing it to themselves somehow because we cannot see the symptoms or the standard tests available don't diagnose them.
I agree, but equally damaging to keep relentlessly searching for a physical cause or cure, when proper attention to potential psychological and relational origins could offer some relief.

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Re: Is IAPT failing people with medical problems?

Post by astra » Sun Apr 03, 2011 9:40 am

I'm with Russ & Dot here. It's not about blaming the patient - far from it, it's about understanding the way our emotional pain can be manifested in physical ways and finding other ways to deal with the emotional distress underlying the symptoms. For example I sometimes get IBS, I don't blame myself for having it, but I do know there's a lot I can do to control it and make it manageable, some of which is physical stuff like diet, meds and sticking to routines, but most of which is about dealing with emotions - anxiety, stress, anger. If I meditate regualrly I'm more in touch with, and open about my emotions and I don't get as many symptoms. My issues and health prob are relatively minor, but the same logic can be applied to people with far more complex difficulties, and when dealt with empathically it can be an enormous help to people living with chronic ill health.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn

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