“I want to be very confident that psychological therapy services can be carried by their staff, which is why I take very seriously the findings of the survey on staff wellbeing … I’m very disappointed at elements of the survey … I can’t be on platforms day in day out talking about a world-leading service if I’m standing on something that’s rusting away beneath me … it can’t be done unless you feel valued and unless you feel your wellbeing is taken seriously”.
Rt. Hon. Alistair Burt MP, Minister for Community and Social Care, Feb. 3rd, 2016
Perhaps the most radical and exciting aspect of the IAPT revolution was its ambition not just to reduce the burden of disease from depression, but to improve ‘gross national wellbeing’. Key to delivering this are the staff on the front line. After its first year of national roll-out, therefore, we undertook to measure psychological staff wellbeing having identified this as the “canary in the coal-mine” for whether the IAPT revolution was succeeding, and capable of meeting its targets in a sustainable way. Those targets now include 6-week waiting times. The Mental Health Task Force has recommended:
NHS England should invest to increase access to integrated evidence-based psychological therapies for an additional 600,000 adults with anxiety and depression each year by 2020/21 – which means the throughput target for IAPT will then be 1.5M patients per annum.
The workforce capacity needed to meet these targets is around 10,000 full time staff. IAPT currently has just over 6,000 staff made up mainly of HI CBT, PWP and counsellors. New waiting times targets for other mental health services will require workforce planning to build capacity where the Mental Health Task Force has recommended: There must also be investment to increase access to psychological therapies for people with psychosis, bipolar disorder and personality disorder. At this point Health Education England has no such plans. Against this unsustainable backdrop – increased targets, without increasing capacity – we monitored the impact on staff wellbeing during 2014 and 2015, and will do so again in 2016.
Where are we now? In 2015 we found alarming levels of staff stress (70%), feelings of failure (50%) and depression (46%). Overwhelmingly, staff tell us this is caused by the relentless pressure to meet targets with inadequate resources, as well as loss of autonomy, degrading of the professional role of psychological staff, and excessive managerial control. In response, leading providers, national regulators, regional and national public bodies, as well as politicians, professional bodies and mental health charities have signed up to the new Charter. The Charter collaborative take action to improve psychological staff morale. Central to this will be re-setting the balance between managerial targets and staff wellbeing.