ENHANCING UNDERSTANDING OF THE EXPERIENCE OF PEOPLE WITH COMMON MENTAL HEALTH DISORDERS AND CO-MORBID PERSONALITY DISORDER TRAITS WHO PRESENT TO PRIMARY CARE IAPT SERVICES

Abstract

Background: There is strong evidence that many individuals presenting to primary care mental health services through Improving Access to Psychological Therapies (IAPT) services have mild to moderate personality disorder traits and are less likely to benefit from routine IAPT treatment. Currently there are no specific treatments made routinely available to this patient group in IAPT services. Aim: To understand the service provision for people who present to primary care IAPT services with common mental health disorders and co-morbid traits of personality disorder. Methodology: The Medical Research Council (MRC) guidelines for developing and evaluating complex interventions with an emphasis on the theory and modeling phases were followed with three inter-related studies. These included a scoping study literature review and two qualitative studies exploring health professionals (IAPT Healthcare Professional) and service users (Patients) perspectives of working in, and using IAPT services. Analysis of the qualitative interviews was achieved using a thematic framework analysis approach. Results: The scoping study literature review identified a lack of evidence based treatments and understanding of this patient group and their treatment in primary care IAPT services. Qualitative interviews were conducted with 28 health professionals and identified skills deficits for working with this patient group. A treatment gap was described between the interface of primary care and secondary care services for this patient group. Adaptions to clinical practice are suggested however significant deviation from IAPT core business was not supported. Qualitative interviews were conducted with 22 patients and found that this patient group valued flexible approaches to care and individualised treatment plans. A lack of choice and collaborative decision making process was described. Step 3 interventions appear to be preferred due to increased treatment duration, skill and flexibility of therapist. Patients commonly reported a deterioration in their mental health before seeking referral to IAPT services, often reaching points of crisis. Conclusions: The scoping study literature review provided a rationale for further qualitative investigation of primary care IAPT treatments that led to studies 2 and 3. A synthesis of these results provides the necessary insight and depth of information required to provide recommendations for practice and identifies areas for future research. Four key recommendations have been proposed: (1) Education of the IAPT workforce (2) Clinical Interventions (3) Provision of Treatment at the Right Level and (4) National Recommendations.

Date of Award	1 Aug 2018
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Karina Lovell (Supervisor), Baker (Supervisor) & Dickinson (Supervisor)