Accessing innovative medicines and services is extremely important in the healthcare system and it is at the heart of what we do day-to-day at Aurora. Mental health is a key area to ensure patient access as one in four people have a common mental health disorder in the UK. Recently, NHS England pledged to make the biggest transformation across mental health care by investing more than a billion pounds a year by 2020, helping a further one million people with mental health issues. With this in mind, we talked to Emma, a psychological wellbeing practitioner to understand how you obtain access to important services.
1. Thank you for taking the time to speak with us. Please tell us what you do and the service you work in?
I work for a service called Improving Access to Psychological Therapies (IAPT) which is a nationwide NHS service aimed at helping people who suffer from mental health conditions. Common mental health problems disorders such as depression, stress and anxiety (including generalised anxiety disorder, phobias, panic attacks, social anxiety, obsessive-compulsory disorder etc.) are very prevalent in the UK population and it is necessary that we offer help to these people. The main therapy that is used in the IAPT service is cognitive behavioural therapy (CBT) and my role is to treat people in either one-to-one or group sessions, using this therapy, to give them the skills to manage their own mental health on a long term basis.
2. Can you explain exactly what CBT is and how it works?
In simple terms, your thoughts, plus how you behave, equates to how you feel. When people develop a common mental health problem, the way they think and behave can become unhelpful which means they can begin to feel anxious or depressed. CBT is a therapy that teaches people to alter their behaviours and unhelpful thinking habits to bring about a more balanced emotion. Many people think therapy is just a ‘Freudian’ concept with people lying on a sofa talking about their past. However, CBT is about the ‘here and now’, looking at what changes people can make going forwards to improve their mental health. We look to break down how people are feeling into triggers, emotions, physical sensations, thoughts and behaviours and look at implementing measures to break vicious cycles that can develop.
3. How effective is CBT in combating these mental health issues?
NICE recommends CBT as a therapy in treating common mental health disorders as it has the most amount of evidence in bringing people into recovery. CBT isn’t a quick fix but it works. It does however, require a person to commit to the programme. People are expected to attend all session of the course as well as completing homework tasks and if this is completed, we see a general recovery rate of around 65% in our service. From my own experience as a therapist, I have seen numerous people recover and get back to a happier and less stressed life and it is a wonderful part of my job. I love seeing that ‘light bulb’ moment in people that is the turning point in their recovery.
4. Mindfulness is a technique that is being used frequently by celebrities, can you explain what this is and how it differs from CBT?
Mindfulness is based on CBT but is only currently being used in the NHS for recurrent depression. However, there is more evidence showing that this is effective in other disorders, particularly in excessive worrying. The idea around mindfulness is that people don’t spend a lot of time in the present. People’s minds wander to things that have happened in the past and their body reacts to this in the present. For example, if I was to think about something bad that happened in the past, I would begin to feel sad, maybe anxious or depressed. Mindfulness helps to train people to focus on the present. For people who have practised mindfulness on a regular basis, brain scans have shown that we develop more neural pathways making it easier for us to be in the present, resulting in a happier mood. There is a great website and app called Headspace that demonstrates how this works.
5. If I am someone who feels like I get easily stressed at work, what tips would you give me to help manage this?
Stress arises because we feel we don’t have the resources i.e. time, energy, knowledge, to cope with the external (work, family etc) or internal pressures (high expectations or targets). Prioritising tasks is extremely important and a great way to reduce the stress, as well as scheduling a balance of necessary, routine and pleasurable activities into the day and week. When we are stressed, looking after ourselves goes out the window and this can exacerbate how we are feeling. It is also very important to exercise as this has huge implications when managing stress. Exercise has exactly the same effect as anti-depressants and is evidenced to breakdown cortisol (the stress hormone) in the body. It also increases serotonin production which improves a person’s mood and belief that they are coping.
6. It was recently mental health awareness week with the theme of relationships. In your opinion, how important are relationships with friends and family on helping people to recover?
Mental health can be very isolating as sometimes it may feel that we are the only one experiencing these emotions and thoughts. Friends and family (in a supportive environment) are extremely important for a person’s recovery as it gives them the opportunity to talk about how they are feeling. The more people supporting a person the better this is. Some people may have a lack of understanding or experience about how mental health problems affect us, so it can be helpful to tell them about the symptoms and how they can be supportive in recovery. Equally, if a person feels that all they do is speak to their friends about their symptoms and this is putting a strain on their relationships, they may want to engage in therapy.
7. At Aurora, we always want to show how people can receive access to important services. Are you able to share your top tips on how someone would gain access to your service or one similar?
Frequently, people don’t receive access to treatment and services because they feel too embarrassed to talk about their symptoms or normalise them altogether. I can’t stress enough that if you are constantly feeling worried or have long periods of low mood, please seek help.
IAPT services are now nationwide and if someone is able to go to their GP and let them know how they are feeling, the GP should refer to them to a local IAPT service. People are also able to self-refer to an IAPT service by going onto your areas website and simply filling in a form. In either approach, you will have an assessment and you will be offered suitable treatment.
As with most NHS treatment, CBT therapy will be free. However, there are also private therapists that offer CBT too. A good website to access private therapy is British Association for Behavioural and Cognitive Psychotherapies (BABCP) which provides details of accredited therapists.