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Introduction
The Improving Access to Psychological Therapies (IAPT) programme started in 2008 and has transformed the treatment of adult anxiety disorders and depression in England (NHS England, 2016a, b). As stated by NHS England, IAPT services are characterised by three things:
Evidenced-based psychological therapies: with the therapy delivered by fully trained and accredited practitioners, matched to the mental health problem and its intensity and duration designed to optimise outcomes.
Routine outcome monitoring: so that the person having therapy and the clinician offering it have up-to-date information on an individual’s progress. This supports the development of a positive and shared approach to the goals of therapy and as this data is anonymised and published this promotes transparency in service performance encouraging improvement.
Regular and outcomes-focussed supervision so practitioners are supported to continuously improve and deliver high-quality care.
The initial guidance on IAPT – Commissioning for the Whole Community (IAPT, 2008) was published alongside a number of short positive practice guides giving “top tips” on commissioning IAPT services for specific communities (Dodd et al., 2011). The “Positive Practice guide for people with learning disabilities” was published in January 2009 (IAPT, 2009) and stated that IAPT services may have to take a flexible approach to providing psychological therapies that are effective for people with intellectual disabilities, including offering: materials in easy-to-understand formats; assessments and NICE-approved psychological interventions which have been adapted to meet the needs of people with intellectual disabilities; appointments at specific times or specific dates, perhaps coinciding with individual needs or carer availability; longer sessions than usually to take account of the person’s varying levels of understanding; and need additional support from therapists or requiring the presence of a carer or independent advocate engagement (where possible with strategic primary health care facilitators) for PLD to support access to assessment and services; engagement with community learning disability team members who may already be involved or able to work collaboratively with IAPT services.
People with intellectual disabilities are more likely to develop mental health issues than people in the general population. Prevalence rates of between one in five and two in five have been found in both screening studies and those using psychiatric evaluation to identify cases (e.g. Cooper et al., 2007) compared to one in four...