IAPT services play a role in preventing suicide by treating depression, which is a major risk factor for suicide. IAPT services provide talking therapies for depression and anxiety using a stepped care approach. They screen for suicide risk using standardized measures and directly ask clients about suicidal thoughts and plans. For those at risk, IAPT therapists develop safety plans that provide coping strategies and identify sources of support to help prevent suicide crises. They document risk assessments, management plans, and follow up arrangements to coordinate care.

1. THE ROLE OF IAPT SERVICES IN
SUICIDE PREVENTION
Jacqui Howard and
Tracey Murden
17 May 2013

2. Policy framework
What do Increasing Access to Psychological
Therapies (IAPT) services do?
Role of IAPT services in:
 preventing suicide
 identifying and responding to risk
Contents

3. Policy framework
HM Government (2011) No health without mental health
 More people will have good mental health
 More people with mental health problems will recover
 More people with mental health problems will have good physical health
 Fewer people will suffer avoidable harm
DH (2011)Talking therapies: A four year plan of action
 Complete roll out of IAPT services for adults
 Improve access for older people and black & minority ethnic communities
 Stand-alone programme for children and young people.
DH (2012) Preventing suicide in England
 Reduce risk of suicide in key high risk groups
 Tailor approaches to improve mental health in specific groups
NHS Outcomes framework 2013-14
 Treating and caring for people in a safe environment and protecting them
from avoidable harm

4. Preventing suicide in England 2012
Relevant pointers for IAPT services…….
 Those who work with men in different settings, especially
primary care, need to be particularly alert to the signs of
suicidal behaviour.
 Accessible, high quality mental health services are fundamental
to reducing the suicide risk in people of all ages with mental
health problems.
 Depression is one of the most important risk factors for suicide.

5. What do Increasing Access to Psychological
Therapies (IAPT) services do?
IAPT services:
Provide primary care based talking therapies services that offer a
range of treatments for depression and anxiety disorders approved
by NICE
Are organised through a stepped care approach (least intrusive
interventions first)
Are delivered by trained therapists:
 Step 2- Psychological Wellbeing Practitioners (guided self help)
 Step 3- High Intensity Therapists, including cognitive behavioural
therapists; counsellors; interpersonal psychotherapists; brief
psychodynamic psychotherapists.
Monitor outcomes at each session

6. What does Inclusion Matters Liverpool do?….
Covers Liverpool City (Population: 465.7 thousand; 95 GP practices)
Provides primary care psychological therapies (IAPT) services for
depression and anxiety, combined with alcohol interventions
Now has over 100 trained therapists working at Step 2 and Step 3 levels of
intervention
Works closely with a range of community and social inclusion agencies,
including the wider mental health system.

7. Role in preventing suicide

8. High risk groups who are priorities for prevention of suicide:
young and middle aged men; people in care of mental health services; people with a
history of self harm; people in contact with the criminal justice system; &
specific occupational groups, including doctors and nurses.
Profile of people engaging with the service

9. The early identification and prompt effective treatment for depression has a
major role to play in preventing suicide across the whole population
Treating depression

10. Treating depression
During my darkest days of depression, I began my
sessions with IML. With stress and anxiety having
taken over my life, Mike listened carefully to my fears
and feelings… his understanding, care and compassion
were a lifeline… I still use the techniques (we
developed) and the dark days are slowly lifting…

11. Initial assessment (usually by telephone)
Step 2 : Low intensity intervention
Step 3: High intensity intervention
……….continually
Identifying and responding to risk:
When do we assess risk?

12. Standardised measures: Patient Health Questionnaire
(PHQ-9)
Q 2: “Feeling down, depressed, or hopeless”
Q9: “Thoughts that you would be better off dead or of
hurting yourself in some way”
How do we assess suicide risk?

13. • Ask directly:
“ Have you got thoughts of killing yourself?”
“ Have you got a plan?”
• Explore specifics:
“ Why, how, when……..?”
How do we assess suicide risk?

14. Reasons for dying
• Loss
• Hopelessness
• Crisis
• Mental state
Reasons for living
• Hope
• Future plans
• Other people
• Fear
Explore…….

15. Previous self harm/suicide attempts
History of mental illness
Alcohol/substance misuse
Risk factors

16. Family/friends
Formal support network- e.g.
Professionals
Informal support network-
e.g. Church, community groups
Pets
Support factors

17.  Recognising warning signs that a suicide crisis may be
approaching
 Identifying coping strategies that can be used by
person to soothe emotions and avert crisis
 Using family and friends that can be contacted to
distract from suicidal thoughts and urges without
discussing these
 Contacting friends and family who may help resolve a
crisis and with whom suicidal thoughts can be
discussed
 Contacting emergency / crisis services
 Reducing access to lethal means (disabling suicide
plan)
As the plan is developed, write each step down on
paper so that the person can take this home
Safety plan (‘crisis response plan’): six steps

18. We document the following: (on an electronic clinical record /
information system)
 suicide risk assessment
 management plan (including future monitoring of risk)
 communications with person’s GP and other agencies involved; for
example, psychiatry
 emergency/crisis care
 follow up arrangements.
We have a direct referral pathway with the local access/ crisis
response home treatment team
Documentation and follow up

19. Increased training of own staff and other care givers
(e.g. ASIST)
Training and education for the community
Health Promotion and awareness to improve the
psychological and emotional wellbeing of the
community
IAPT: further possibilities for prevention

20. Any
questions?