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An evaluation of Access to Psychological Services Ireland: year one outcomes

Published online by Cambridge University Press:  06 November 2015

P. McHugh ,
N. Martin ,
M. Hennessy ,
P. Collins  and
M. Byrne
P. McHugh
Affiliation:
Health Service Executive Laois/Offaly, Community Healthcare Organisation Area 8, HSE Area Office, Tullamore, Offaly, Ireland
N. Martin
Affiliation:
Psychology Department, Health Service Executive West, Roscommon Primary Care Centre, Roscommon, Ireland
M. Hennessy
Affiliation:
Psychology Department, Health Service Executive West, Roscommon Primary Care Centre, Roscommon, Ireland
P. Collins
Affiliation:
Psychology Department, Health Service Executive West, Roscommon Primary Care Centre, Roscommon, Ireland
M. Byrne*
Affiliation:
Health Service Executive Laois/Offaly, Community Healthcare Organisation Area 8, HSE Area Office, Tullamore, Offaly, Ireland
*
*Address for correspondence: Dr M. Byrne, Health Service Executive Laois/Offaly, Community Healthcare Organisation Area 8, HSE Area Office, Arden Road, Tullamore, R35 TY28, Offaly, Ireland. (Email: [email protected])
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Abstract

Objectives

To evaluate the clinical effectiveness and cost-effectiveness of Access to Psychological Services Ireland (APSI), a primary care adult psychology service.

Methods

A repeated measures design was used to evaluate the clinical outcomes of service users who completed an intervention. Psychological distress, depressive symptomatology and anxiety symptomatology were measured using the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM), the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7), respectively. Self-reported health and economic outcomes were measured using the EQ-5D-3L and the Eco-Psy, respectively.

Results

A total of 381 adults were assessed as suitable for an APSI intervention, with 198 (52%) of these completing at least one intervention. Significant reductions in psychological distress were observed for completers of guided self-help and brief cognitive behavioural therapy, with service users also showing significant reductions in anxiety and depressive symptomatology. Reliable and clinically significant change on the CORE-OM was observed for 67.9% of treatment completers. Service users reported significant improvements in their health status but did not show changes in their health service usage in the 3-month follow-up period.

Conclusions

APSI provided an accessible service model that was clinically effective in managing a range of mild to moderate mental health difficulties. The cost-effectiveness of the service model may be enhanced by offering a wider range of high-throughput interventions and by increasing the treatment completion rate.

Keywords

Brief therapycognitive behavioural therapyguided self-helpprimary carestepped care
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 4 , December 2016 , pp. 225 - 233
Copyright
© College of Psychiatrists of Ireland 2015 

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barkham, M, Margison, F, Leach, C, Lucock, M, Mellor-Clark, J, Evans, C, Benson, L, Connell, J, Audin, K, McGrath, G (2001). Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology 69, 184–196.Google Scholar
Baumeister, H (2012). Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: time for the evidence to become practice. Journal of Affective Disorders 139, 240–243.CrossRefGoogle ScholarPubMed
Beck, JS (2011). Cognitive Behavior Therapy: Basics and Beyond. Guilford Press: New York, NY.Google Scholar
Bourke, M, Byrne, M (2012). Evaluation of a pilot primary care adult mental health practitioner – delivered service. The Irish Psychologist 38, 262–268.Google Scholar
Cahill, J, Barkham, M, Hardy, G, Rees, A, Shapiro, DA, Stiles, WB, Macaskill, N (2003). Outcomes of patients completing and not completing cognitive therapy for depression. British Journal of Clinical Psychology 42, 133–143.Google Scholar
Clark, DM (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry 23, 318–327.Google Scholar
Connell, J, Barkham, M, Stiles, WB, Twigg, E, Singleton, N, Evans, O, Miles, JN (2007). Distribution of CORE–OM scores in a general population, clinical cut-off points and comparison with the CIS–R. The British Journal of Psychiatry 190, 69–74.Google Scholar
Cuijpers, P, Donker, T, van Straten, A, Li, J, Andersson, G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 1943–1957.Google Scholar
Delgadillo, J, McMillan, D, Leach, C, Lucock, M, Gilbody, S, Wood, N (2014). Benchmarking routine psychological services: a discussion of challenges and methods. Behavioural and Cognitive Psychotherapy 42, 16–30.CrossRefGoogle ScholarPubMed
Evans, CJ, Connell, J, Barkham, M, Margison, F, McGrath, G, Mellor-Clark, J, Audin, K (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. The British Journal of Psychiatry 180, 51–60.Google Scholar
Fairburn, CG, Wilson, GT (2013). The dissemination and implementation of psychological treatments: problems and solutions. International Journal of Eating Disorders 46, 516–521.Google Scholar
Furukawa, TA (2010). Assessment of mood: guides for clinicians. Journal of Psychosomatic Research 68, 581–589.Google Scholar
Gilbody, S, Richards, D, Barkham, M (2007). Diagnosing depression in primary care using self-completed instruments: UK validation of PHQ–9 and CORE–OM. The British Journal of General Practice 57, 650–652.Google Scholar
Grace, A, Rowe, M, Saunders, J, Cullen, W (2012). Drugs or dialogue?: An audit of the management of sub-threshold, mild and moderate depression in an urban general practice. In A picture of general practice research in Ireland 2010–2011, Irish College of General Practitioners (ed. C. Collins), 28pp. Dublin.Google Scholar
Gyani, A, Shafran, R, Layard, R, Clark, DM (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy 51, 597–606.Google Scholar
Haug, T, Nordgreen, T, Ost, LG, Havik, OE (2012). Self-help treatment of anxiety disorders: a meta-analysis and meta-regression of effects and potential moderators. Clinical Psychology Review 32, 425–445.Google Scholar
Hogarth, T, Hasluck, C, Gambin, L, Behle, H, Li, Y, Lyonette, C (2013). Evaluation of Employment Advisers in the Improving Access to Psychological Therapies Programme. Department for Work and Pensions: Sheffield.Google Scholar
Hughes, M, Byrne, M, Synnott, J (2010). Prevalence of psychological distress in General Practitioner adult attendees. Clinical Psychology Forum 206, 33–38.Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.Google Scholar
Kazdin, AE, Blase, SL (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science 6, 21–37.Google Scholar
Kierans, J, Byrne, M (2010). A potential model for primary care mental health services in Ireland. Irish Journal of Psychological Medicine 27, 152–156.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB (2001). The Phq‐9. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB, Monahan, PO, Lowe, B (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine 146, 317–325.Google Scholar
McHugh, P, Brennan, J, Galligan, N, McGonagle, C, Byrne, M (2013 a). Evaluation of a primary care adult mental health practitioner delivered service: year 2. Mental Health in Family Medicine 10, 53–59.Google Scholar
McHugh, P, Byrne, M, Vision for Change Mental Health in Primary Care Implementation Subgroup (2013 b). Profile of the shared care activities of mental health teams in Ireland. Health Service Executive (http://www.lenus.ie/hse/handle/10147/305845). Accessed 18 October 2014.Google Scholar
McHugh, P, Gordon, M, Byrne, M (2014). Evaluating brief cognitive behavioural therapy within primary care. Mental Health Review Journal 19, 196–206.Google Scholar
McHugh, RK, Whitton, SW, Peckham, AD, Welge, JA, Otto, MW (2013 c). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. Journal of Clinical Psychiatry 74, 595–602.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2009). Depression: The Treatment and Management of Depression in Adults. NICE: London.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2011 a). Generalised Anxiety Disorder and Panic Disorder (With or Without Agoraphobia) in Adults: Management in Primary, Secondary and Community Care. NICE: London.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2011 b). Commissioning Stepped Care for People with Common Mental Health Disorders. NICE: London.Google Scholar
O’Brien, A, Fahmy, R, Singh, SP (2009). Disengagement from mental health services. Social Psychiatry and Psychiatric Epidemiology 44, 558–568.Google Scholar
Oldham, M, Kellett, S, Miles, E, Sheeran, P (2012). Interventions to increase attendance at psychotherapy: a meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology 80, 928–939.CrossRefGoogle ScholarPubMed
O’Shea, G, Byrne, M (2014). The improving access to psychological therapies programme (IAPT): opportunity knocks? The Irish Psychologist 40, 164–171.Google Scholar
Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, Rahman, A (2007). No health without mental health. The Lancet 370, 859–877.Google Scholar
Rabin, R, Charro, FD (2001). EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine 33, 337–343.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB, Lowe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092–1097.Google Scholar
Swift, JK, Callahan, JL (2011). Decreasing treatment dropout by addressing expectations for treatment length. Psychotherapy Research 21, 193–200.CrossRefGoogle ScholarPubMed
Swift, JK, Greenberg, RP, Whipple, JL, Kominiak, N (2012). Practice recommendations for reducing premature termination in therapy. Professional Psychology: Research and Practice 43, 379–387.Google Scholar
Szende, A, Oppe, M, Devlin, N (2007). EQ-5D Value Sets: Inventory, Comparative Review and User Guide. Springer: Berlin.Google Scholar
Stiles, WB, Barkham, M, Mellor-Clark, J, Connell, J (2008). Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample. Psychological Medicine 38, 677–688.Google Scholar
Twomey, C, Byrne, M, McHugh, P (2013). Show me the money: improving the economic evaluation of mental health services. Irish Journal of Psychological Medicine 30, 163–170.Google Scholar
White, J, Joice, A, Petrie, S, Johnston, S, Gilroy, D, Hutton, P, Hynes, N (2008). STEPS: going beyond the tip of the iceberg: a multi-level, multipurpose approach to common mental health problems. Journal of Public Mental Health 7, 42–50.Google Scholar