The Five Year Forward View for Mental Health (FYFVMH) 2014, and the NHS Long Term Plan (LTP) 2019 both include ambitions for a significant expansion of IAPT service delivery, including the requirement that from 2018, all CCG areas commission IAPT services for Long Term Conditions (IAPT-LTC) incorporated into integrated pathways with physical health services.
The NHS Long Term Plan commits to an additional 380,000 people accessing IAPT each year to reach a total of 1.9 million nationwide by 2023/24. Furthermore, the numbers of people requiring access to IAPT services is projected to increase significantly due to an increase in the prevalence of common mental health disorders [Adult Psychiatric Morbidity Survey (APMS) 2014] thus increasing IAPT access rate from the 22% in 2019/20 to 25% from the 2020/21 financial year. Additionally, IAPT services are required to maintain existing standards for recovery rates (50%) and referral to treatment times (75% seen within 6 weeks and 95% within 18 weeks of referral).
By April 2021 the LTP requires all Sustainability and Transformation Partnerships (STPs) to become Integrated Care Systems (ICS). Primary Care Networks (serving a population of 30-50K) are the fundamental building blocks of ICSs, and build on existing primary care services to work with community MH, social care, pharmacy and CVS partners.
The NHS Long Term Plan’s commitment to create new and integrated models of primary and community mental health care will see a major expansion in the adult and older adult community mental health workforce. The Community Mental Health Framework for Adults and Older Adults sets out how the vision for a new place-based community mental health model can be realised; although this is primarily for people with more severe mental illnesses than IAPT usually treats. Further expectations are set out in the NHS Mental Health Implementation Plan 2019/20–2023/24.
The LTP states an expectation for all systems to set out specific measurable goals and mechanisms by which they will contribute to narrowing health inequalities by 2023/24, addressing inequalities in access, experience and outcomes.
London is the second largest region in England with a population of 8.96 million people. It is the most ethnically diverse region in England, and the 2011 census revealed that 40.2% of residents identified as belonging to either the Asian, Black, Mixed or Other ethnic groups. The London region as a whole has historically faced significant challenges in consistently delivering IAPT targets and standards. Contributory factors include its high population density with high levels of ethnic diversity, a high prevalence of common mental health disorders, as well as issues with IAPT workforce recruitment and retention. The unprecedented and ongoing COVID-19 pandemic has placed additional pressures on the system.
In spite of the challenges highlighted above, IAPT service providers and commissioners are encouraged to work collaboratively and innovatively to develop interventions to achieve the IAPT standards as set out in the NHS LTP Mental Health Implementation Plan 2019/20 – 2023/24 as well as demonstrate impact on the population.
One of the ambitions set out in the Mayor’s London Vision (2019) was to ‘Improve mental health and progress towards zero suicides’. In addition, the Healthy Minds mayoral action within the London Health Inequalities Strategy highlights that Londoners’ mental health and physical health are equally valued and supported and the Mayor will argue for Londoners to have fair and improved access to mental health services (including psychological therapies), and demand better access to mental health support for those who need it.