Nearly six in ten CCGs missing talking therapies targets

Almost six in ten clinical commissioning groups are missing targets on access to talking therapies, according to official figures | OnMedica

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Mental health charity Mind said this morning that the “unacceptable” figures reflect years of mental health services being “woefully underfunded”, and insisted that it is vital that quality, timely services must be in place to meet increasing demand.

Mind said the new data, from NHS England’s mental health dashboard on how CCGs are performing with regard to delivering talking therapies, highlight the proportion of CCGs meeting and missing their targets. These most recent available data, which are for Q3 (October-December) 2016, showed that 120 out of 209 CCGs in England (57%) are failing to meet the target for the proportion of people in their area that should be accessing talking therapies – currently set at 15.8% of the local population who have been identified as being able to benefit from talking therapies. By 2021, this target is set to rise to 25%.

The figures also revealed that barely half (52%) of CCGs met the recovery rate target for talking therapies – 101 out of 209 CCGs missed the current recovery target, which is set at 50%.

Mind pointed out that these data specifically focus on therapies available through the Improving Access to Psychological Therapies (IAPT) programme, which is supposed to increase accessibility of talking treatments to those identified as potentially benefitting from receiving them (typically, people with common mental health problems such as depression and anxiety disorder).

Psychological Interventions for Children with Functional Somatic Symptoms

Bonvanie, I.J. et al. The Journal of Pediatrics | Published online: 14 April 2017

Objective: To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects.

Conclusions: Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.

Read the full abstract here

New ways to treat depression in teenagers

By Ian Michael Goodyer (University of Cambridge) for The Conversation | Published online: 6 March 2017

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Image source: Mary Lock – Flickr // CC BY-NC-ND 2.0

Around one in 20 teenagers suffers from depression. Episodes can last for several months. Unfortunately, about 50% of teenagers who have a depressive episode are at risk of falling ill again, increasing the likelihood of relationship difficulties, educational failure and poor employment prospects. It’s important that treatments have a lasting effect to reduce the risk of becoming ill a second time.

My research investigates the causes of and treatments for adolescent mental illnesses, with a particular focus on depression. One of our key projects is evaluating the importance of various psychological treatments that are effective in helping young people with depression.

Only one treatment – cognitive behavioural therapy (CBT) – is approved by the UK’s National Institute for Health and Care Excellence (NICE) for treating depression in teenagers. Unfortunately, there is a shortage of CBT therapists in the UK. This means that many young people with depression are placed on a waiting list, increasing their risk of worsening mental health.

Read the full blog post here

Group mindfulness for adolescent anxiety

Crowley, M.J. et al. Child and Adolescent Mental Health | Published online 4 March 2017

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Background: Group Mindfulness Therapy (GMT) is a program tailored for adolescents that targets anxiety with mindfulness skills including present moment awareness, mindfulness in everyday life (breathing, eating, walking), body scan, loving-kindness, and self-acceptance. Youth with anxiety may benefit from mindfulness exercises precisely because they learn to redirect their mind, and presumably their attention, away from wandering in the direction of worry and negative self-appraisals and toward greater acceptance of internal states. This open trial assessed the feasibility and initial effectiveness of GMT in a school setting.

Conclusions: We demonstrate that GMT is feasible and acceptable to adolescents presenting with anxiety as a primary concern. We provide further support for the use of a mindfulness-based intervention for anxiety reduction. The group format suggests a cost-effective way to deliver services in a school setting.

Read the full abstract here

Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression

Hetrick, S.E. et al. (2016) BMJ Open.6:e011024

Objective: To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm.

Design: We conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect.

Data sources: A comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed.

Eligibility criteria for selecting studies: Randomised controlled trials of psychological and psychosocial interventions for adult self-harm patients.

Results: Forty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects.

Conclusions: Consideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive–behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required.

Read the article here

Innovations in Practice: a pilot study of interpersonal psychotherapy for depressed adolescents and their parents

Gunlicks-Stoesselm, M. & Mufson, L. Child and Adolescent Mental Health. Published online: 9 May 2016

Background: Problems in adolescents’ relationships with their parents are a significant risk factor for the development and maintenance of depression. The purpose of this pilot study was to examine the feasibility and acceptability of an adaptation of interpersonal psychotherapy for depressed adolescents (IPT-A) who were also experiencing problems in their relationships with parents. The adaptation includes greater and more structured parent involvement in the treatment (IPT-AP).

Method: Fifteen adolescents (age 12–17) who were diagnosed with depression and were also experiencing conflictual or emotionally disengaged relationships with their parents (based on adolescent or parent report on the Conflict Behavior Questionnaire) participated in a 16 week randomized clinical trial of individually delivered IPT-A versus IPT-AP. Data regarding the feasibility and acceptability of IPT-AP were collected. Assessments of depression and family functioning were completed at baseline and weeks 4, 8, 12, and 16 by evaluators blind to treatment condition.

Results: IPT-AP was feasible to implement, and adolescents and parents reported high treatment satisfaction. Adolescents demonstrated significant improvements in depressive symptoms, general functioning, and family functioning. IPT-AP was more efficacious than individual IPT-A in improving adolescents’ perceptions of father–adolescent relations and mothers’ perceptions of mother–adolescent relations.

Conclusions: Interpersonal psychotherapy for depressed adolescents and their parents was feasible to implement and acceptable to families, indicating that a full-scale randomized controlled trial to evaluate its efficacy is warranted.

Read the abstract here