Adult psychological therapies service (APTS)

Why a professional should choose the service

• The service provides a wide range of evidence-based psychological therapies appropriate for the needs of people with severe and complex psychological difficulties in accordance with NICE guidance.
• Psychological therapies are delivered by appropriately trained and accredited psychological therapists from different disciplines who support their work with clinical supervision and continuous professional development. Therapies are delivered in a number of ways including individual, group and family therapy.
• Since July 2011, the service has a track record of consistently meeting the commissioner agreed quality access standard of more than 95% of service users accessing treatment within 18 weeks of receipt of the referral. This has ensured timely access to psychological therapies which is known to produce better clinical outcomes. Performance indicators related to this standard are reported for each month to the commissioners at the end of each financial quarter.
• Enhanced access is given to people with perinatal mental health issues, ex-service personnel (where the issue is related to their service in the armed forces), and low weight anorexics and severe bulimics.
• The service routinely collects and evaluates clinical outcomes using nationally recognised measures (e.g. CORE-OM) and consistently achieves high percentages of clinically significant change.
• The service and the ‘service user critical path’ have been designed according to LEAN principles and are subject to the discipline of regular formal review and continuous improvement.
• The co-location of the service alongside other mental health teams ensures that there is a seamless pathway for service users both to and from other mental health teams. Collaborative working between the teams ensures that where clinically indicated a coordinated multidisciplinary care package can be provided in accordance with the Mental Health Cluster Tool and the Assigned Clinical Package of Care.
• The service has a strong reputation within the Yorkshire and Humber Region for the development of innovative approaches to therapy in order to best meet service user need, and for its contribution to educational programmes involved in the training of psychological therapists.
• The service has a strong reputation for its contribution to service evaluation and formal research.
• The service is committed to the training of psychological therapists from across the region and we provide clinical placements and teaching for several university training courses.
• All service activities are routinely audited and evaluated including clinical interventions and teaching/training in order to maintain a high quality, evidence-based service. Some staff undertake additional research and/or supervise the research activities of others.

Support offered

• An assessment of an individual’s needs through discussion of their difficulties with the therapist. From this, an understanding of what is troubling them can be developed along with a clearer picture of their needs.
• A range of individual and group therapies.
• For some difficulties, one type of therapy may be more beneficial than another. However, there are certain things that all therapies have in common. For instance, all therapy involves talking to a therapist and working with them to develop a greater understanding of a person’s difficulties so that they can manage them differently and bring them to a new resolution.
• The range of individual therapies includes cognitive behavioural therapies, cognitive analytic therapy, integrative therapies, systemic and family therapy, psychoanalytic psychotherapy.
• The group therapies include mindfulness-based CBT, dialectical behavioural therapy, groups for survivors of childhood sexual abuse and psychoanalytic psychotherapy groups. (A full description of these and other therapies can be found on https://www.gov.uk when you enter the words: ‘choosing talking therapies’ into the website search facility).
• On occasions, we may be asked by other professionals who are already involved in a person’s care, to provide a second opinion to help with the understanding of difficulties and to think about what might be the most appropriate form of support at this time.
• Sometimes after contact with our service, we will agree that another service may be better able to meet the person’s needs and this might lead to an onward referral to another service. In addition, carers of those referred to our service can be assisted in accessing carer’s support also through onward referral.

Outcomes

• To provide an assessment that enables either: an offer of therapy, or signposting/onward referral to another more appropriate service, or advice to those already involved in a person’s care.
• The service gives those engaging in therapy the opportunity to develop a greater understanding of their difficulties, how these have developed, what perpetuates them and what they can do to change them.
• Service users should potentially be able to leave therapy having had the opportunity to explore their difficulties and gain new insight, develop skills to improve functioning, better manage relapse and continue the process of self-management.
• To enable carers of people using our services to have appropriate access to carers’ support services.
• To increase psychological awareness and psychological thinking in staff and promote psychological approaches to care through training, consultation and supervision.

Referrals accepted from:

CMHTs, Consultants, GP staff, GPs, Other Trust services

Referral criteria:

The service works with people who are experiencing severe and persistent common mental health conditions including:

• Depression
• Anxiety disorders e.g. panic disorder, generalised anxiety disorder, phobias
• Post-traumatic stress disorder
• Eating disorder
• Obsessive compulsive disorder

Plus severe and complex disorders including:

• Disorders arising from sexual/physical/emotional abuse in childhood.
• Pervasive (widespread) interpersonal problems: conflicts and difficulties in establishing and maintaining relationships (the service is not suitable for marital/partnership breakdown).
• Somatoform disorders: Somatisation (disorders which cause bodily symptoms but no physical cause can be found) and body dysmorphic disorder.
• Complex adjustment disorders: when a person is unable to cope with a major life event (persistent and not resolving with the passage of time).
• Personality disorders
• Severe and complex disorders involving co-morbidity (presence of one or more disorder) where specialist assessment and consultation is required to provide a second opinion, or where an assessment would help to determine the most appropriate intervention.
• Psychosis (internal referrals from within the Care Management Pathway only).
• Medically unexplained physical symptoms and acute responses to medical conditions (internal referrals from within the Kirklees/Calderdale mental health liaison team only)

Referrals will be accepted when:

• The person is motivated and prepared to consider a psychological approach to treatment, i.e. people who are curious to understand their difficulties and do not just want them removed.
• The person has requested help themselves rather than those who are responding to pressure from others – however, the service does recognise that people experiencing the above types of conditions are often hesitant to receive help.

Where the person referred is seeking help with specific age-related difficulties, the service will discuss options with older people’s services.

Enhanced access is given to people with perinatal mental health issues, ex-service personnel (where the issue is related to their service in the armed forces), and low weight anorexics and severe bulimics.

External referrals are made to the Kirklees single point of access.

Referrals will not be accepted when:

• The person is at immediate risk of self-harm or suicide
• The person’s level of risk or level of instability requires more immediate community-based interventions