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IAPT and Learning Disabilities

Research output: Book/ReportReport

Deborah Sally Chinn, Elisabeth Kate Abraham, Christine Burke, Jill Davies

Original languageEnglish
PublisherKing's College, London
Commissioning bodyBUPA Foundation
Number of pages67
Published2014

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Abstract

This study explores the relationships between the Improving Access to Psychological Therapies (IAPT) programme in England and people with learning disabilities and the people and services that support these service users. It sets out to answer the following questions:

1. What are the barriers and facilitators facing people with learning disabilities in accessing IAPT? How do these relate to the views, practices and service delivery models described by IAPT and specialist learning disability staff in England?
2. What are the strategies and practices that staff employ to support people with learning disabilities to make good use of IAPT services?
3. What advances are needed at the level of individual staff capabilities, service delivery models, management, commissioning and policy development to ensure equitable access to IAPT for people with learning disabilities?

Study findings were drawn from interviews with staff, service users and carers and a wider national online staff survey. We noted that staff in IAPT services do come across people with learning disabilities as clients. However, the IAPT programme as a whole has not adequately addressed access issues for people with learning disabilities. Some IAPT services exclude people with learning disabilities from the outset, by specifying eligibility criteria that rule them out. The IAPT programme prides itself on being founded on a clear evidence-based that recommends standardised inputs for common mental health problems. There is an emphasis on being a high volume service and on clear accountability in terms of adherence to treatment protocols and close monitoring of outcomes for patients. These procedures, when strictly enforced, can present access barriers to people with learning disabilities.

Despite these difficulties, a number of IAPT staff feel that their service, as a mainstream, community-based service for people experiencing common mental health problems, should be available to people with learning disabilities and can offer treatments that they will find helpful. The Psychological Wellbeing Practitioners (PWPs) seem most optimistic about people with learning disabilities making good use of IAPT. These staff provide shorter, more practical interventions focusing on self-management and education about mental health.

Some specialist learning disability staff are actively involved in promoting IAPT for people with learning disabilities. However, others have either limited knowledge of IAPT services , or have had negative experiences in trying to support their service users to get treatment from IAPT. They do not feel confident that IAPT staff understand the needs of people with learning disabilities and feel that specialist input from learning disability staff is more helpful and appropriate, particularly for people with more complex presentations.

IAPT services work best for people for learning disabilities when IAPT staff and learning disability staff have developed good working relationships and can co-ordinate their input. Some IAPT staff, who have prior experience of the needs of people with learning disabilities are adapting their materials and their work practices for this client group. They generally find it useful to involve family and carers in their work. In some cases the IAPT staff find their managers are happy to support them to work more flexibly and at a slower place. Staff also appreciate training and consultation from local learning disability specialists. However, support for work with people with learning disabilities within IAPT can be somewhat piecemeal, and initiatives are vulnerable to service cuts. This work does not appear to be a priority for commissioners, who generally do not set local goals regarding access to IAPT for people with learning disabilities.

The concept of “candidacy” (Dixon-Woods et al., 2012) provides a helpful framework to understand the position of people with learning disabilities within IAPT. In general, people with learning disabilities can struggle to see themselves, and be viewed by service systems, as legitimate candidates for IAPT services. Their claims to candidacy may be promoted in the following ways:

 Clearer statements of inclusion in IAPT services for people with learning disabilities.
 Recording systems that allow for monitoring of people with learning disabilities’ access
to IAPT.
 Training for qualification of PWPs and other IAPT therapists to include material on working with people with learning disabilities, where possible delivered with the involvement of people with learning disabilities.
 Pathways for joint working between IAPT services and local specialist learning disability services.
 Clear goals and targets regarding use of IAPT by people with learning disabilities specified by commissioners and funded appropriately.

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