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
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baa
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Re: Is IAPT failing people with medical problems?

Post by baa » Sun Apr 03, 2011 10:57 am

That sounds like it will link up nicely with the Theory A vs Theory B approach that we use with people with Health Anxiety (and others).

Theory A = I am seriously ill. I need a medical cure.

Theory B = I am anxious, and that make me feel really ill/exacerbates the physical sensations. The way I react to the sensations (poking, prodding, checking etc) might be maintaining the symptoms.

etcetc

So you don't minimise the sensations, but focus on how the person reacts to them or explains them.
At least I'm not as mad as that one!

captain artichoke
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Re: Is IAPT failing people with medical problems?

Post by captain artichoke » Sun Apr 03, 2011 10:59 am

Thanks for all the replies - its really interesting to hear people's views and that link was really useful (thanks KitKat).

It does seem like historically (and currently) these areas seem to have been neglected by both primary and secondary services. Stories such as eastofnorth's seem really common. I agree with eponymouse that more provision at both ends seems important. It sounds really positive that some gaps in IAPT have been identified and specialist groups set up, and that more specialist posts seem to be cropping up elsewhere.
Dr.Dot wrote:I guess it depends on your definitaion of failing. Picking up cases and referring on? or working with the difficulty in primary care?
I don't really get what you say here - no, I wouldn't consider either of these things 'failing' - my understanding is thats the role! My definition of IAPT failing would be if it didn't improve access to psychological therapies for particular groups of people who might benefit from such interventions (the use of the word 'failing' was probably somewhat emotive though - just wanted to spark discussion! :wink:).

With this in mind I was also wondering about the provision of psychological therapies for people with physical health problems in the absence of mental health difficulties. Where the situation isn't complex but where the individual might benefit from therapy to help with issues of adjustment, or maybe people struggling to make the changes to their life which would improve their physical health (traditionally the area of health psychology I think). I appreciate it would broaden the scope of IAPT considerably - but do people think it would be useful?

captain artichoke
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Re: Is IAPT failing people with medical problems?

Post by captain artichoke » Sun Apr 03, 2011 11:03 am

btw: I realise i've totally ignored the other conversation going on about medically unexplained symptoms - its really interesting but I don't know all that much about it!

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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 11:36 am

captain artichoke wrote: My definition of IAPT failing would be if it didn't improve access to psychological therapies for particular groups of people who might benefit from such interventions (the use of the word 'failing' was probably somewhat emotive though - just wanted to spark discussion! :wink:).

With this in mind I was also wondering about the provision of psychological therapies for people with physical health problems in the absence of mental health difficulties. I appreciate it would broaden the scope of IAPT considerably - but do people think it would be useful?
I think it is a fine idea in principal. However, I do think that IAPT need not be running into this quite yet, there is enough work with the Depression and anxiety etc remit, which hasn't fully been evaluated in terms of long-term outcomes. If there is a siginificant move to work with other difficulties because that is what is showing up in services there will be a training - treatment gap, which may cause a lot of difficulty and burnout. IAPT services are developing in this way and I think it is has potential problems for clinical governance. PWP's are not trained to work with this stuff.

Personally, at the moment, I think it would be more appropriate to demonstrate the gap in services rather than try and work with people in the gap. We need to highlight to the goverment / DoH where gaps in services are, not just try and fill them in a potentially unsucessfully manner. It's a matter for commissioning, which may well be within IAPT, in the future.
Dorothy: Now which way do we go?

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h2eau
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Re: Is IAPT failing people with medical problems?

Post by h2eau » Fri May 27, 2011 11:12 pm

There is definitely a gap in services where I am for people aged over 16 with both chronic and acute physical health issues and concurrent psychological issues, as well as those with medically unexplained symptoms. I work in a paediatric psychology and liaison service at the moment based in a children's hospital that covers this remit for the younger population, but as soon as people enter adult services the whole set up changes because acute care then splits into physical health specialties (e.g. oncology) and HIV/sexual health comes under the 'substance misuse and addictions' directorate! There is some psychology input to specific specialities (oncology, clinical genetics, cystic fibrosis, chronic pain, cardiac, neurorehab) and there is a 'psychological medicine' department (with no psychologists) that does liaison work (mainly psychiatry), but nothing comparable with the paeds service. There is definitely a gap in clinical health psychology service provision and I think there is real potential for those trained in psychological approaches to have a lot to offer in helping improve the physical and psychological wellbeing of people who have these issues. I am convinced it would save the NHS a lot of money in the longer term too...
We deem those happy who from experience of life have learnt to bear its ills without being overcome by them ~ C.G. Jung

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Mikel Arteta
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Re: Is IAPT failing people with medical problems?

Post by Mikel Arteta » Sat May 28, 2011 12:58 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 think a lot of people would disagree with this and it slightly irked me. I see other posts from people seem to think that everything is linked to how we feel 'emotionally', too many thinking like in only a psychological way. Just 'cause you're psychologists, does everything have to come down to how we feel emotionally/psychologically, etc.???

Feb. 2010, doing very well in my job and at uni. Running for an athletics club for only a few years, but starting to do pretty well. Loved the training, loved racing, slowly building it up. I made friends there (new to the area) and got such a buzz out of it, huge part of my life. Mid Feb. I run in the Dewsbury 10k, decent field, 78/801 in 37.18. Not bad. I worked and trained hard, but looked after myself e.g. slept/rested well, ate well, didn't drink much, etc.

Not long after I get Epstein Barr Virus (blood tests to prove it!!), which gives people symptoms of fatigue, low energy levels, disturbed sleep and aches and pains. This eventually passed and now I have mild CFS. I can tell you there is nothing psychosomatic about my symptoms, although I am sure some people will tell me there are! I think I have a good awareness and understanding of my body and mind and know this is medical, currently I have these symptoms, which I hope will evetually go, as it's not nice. I plod on, but I carry a permanent 'tired' feeling with me and not your normal tiredness.

I still work and do social activities, but have not done a 'proper' athletics session or race since Feb. 2010. I started walking, then small runs, but 14 months on can still only manage small runs, a million miles from the very tough session I previously did. I just don't have the energy, that's how my body is. No matter how down, anxious or stressed I got prior to this, it never stopped me from doing a session. I of course experience low mood, stress and anxiety, but this is because of what's happened, just the same as if you broke your leg, lost a friend, you would be down, normal reactions to what's happened.

Maybe some people's is psycosomatic, but I get the feeling from a couple of posters that they seem to ignore that fact that for some people it is a genuine medical condition. If someone came up to me at a party or in work and told me it was all in my head, I would be incredibly insulted. Occasioanlly I do encounter ignorance and lack of empathy and understanding e.g. I go down to the athletics club and do small runs, but people tell me I should do the big session and that I have 'talked myself into it', which seriously p***** me off, though most at the club try to understand. Believe me, I am heartbroken I cannot do the sessions and would do them in a flash if my body could cope, but it can't. If I over excert myself I am absolutely done in for days, even more achey/fatigued than normal.

My condition is mild, but it has still changed my life for the worse and my athletics career is in tatters. I would not wish this on anyone, as it is real s*****. There is a massive lack of understanding out there/ignorance though and I suggest people get in-touch with their local CFS clinic if they don't know much about it. I go to the one in Leeds, seeing the OT and probably after her, the physio.

The GP says it's like a 'hangover' from the EBV. The OT said my battery does not charge up properly at the moment. I won't go into the full ins and outs though otherwise I would be here all night! But, I'm happy to listen to them, as it's their specialism.

LIWY - thank-you for showing some understanding, that it is genuine. You mentioned QoL and readjusting, very true, it seems you have a good understanding of what it is like.

As for IAPT, I work there at the mo, though will be off in Sept. to Cov&Warwick. I think some services say they are not commissioned for physical health problems, but we have worked with some and so I hope more services accept referrals, otherwise they get banded around services.

Right, I'm off for some psychoanalysis to cure my medically unexplained psychosomatic illness ;)

xx
Blackbird singing in the dead of night, take these broken wings and learn to fly, all your life
you were only waiting for this moment to arise
:)

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h2eau
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Re: Is IAPT failing people with medical problems?

Post by h2eau » Mon May 30, 2011 3:35 pm

I don't think any good psychologist or other professional would argue that physical symptoms, such as those you experienced, are not real. I think it is short sighted for any professional to rely solely on one model to explain presenting difficulties (eg medical model, psychological model), as our psychological/emotional and physical wellbeing influence one another and are also affected by relationships and our wider social and cultural environment. So called 'medical conditions' that can be 'proved' by a blood test can affect your emotional and social functioning and vice versa.

The whole approach of clinical health/paediatric psychology services I've worked in (and I imagine many others) is to look at the presenting physical symptoms holistically using a biopsychosocial formulation to see if there is anything making them worse/better or prolonging them. This then informs interventions that primarily focus on managing and coping with the physical symptoms, rather than taking them away or dismissing them as 'all in the person's head'. We try and promote acceptance of the symptoms, whether they are due to cancer or chronic fatigue syndrome or some other cause that remains unidentifiable/not fully understood so that the person can concentrate on getting back to their everyday life in a way that is realistic. This promotion of acceptance, adjustment and coping can be difficult in itself, so it is important to also explore what having the symptoms means to the person experiencing them.

I think it is often more difficult to reflect on things that strike a chord with our own experiences, as it is harder to step back and view all of the variables objectively as our thoughts and emotions connected to the experience usually affect how we see similar situations.
We deem those happy who from experience of life have learnt to bear its ills without being overcome by them ~ C.G. Jung

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