Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them.

BACKGROUND: To determine: whether young adults (aged 18-24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET. METHODS: A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment. RESULTS: Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63-0.74), for deterioration = 1.41 (1.25-1.60), and for attrition = 1.31 (1.19-1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08-1.12), deterioration = 0.94 (0.91-0.98), and attrition = 0.68 (0.66-0.71). CONCLUSIONS: Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.

The barriers, benefits and training needs of clinicians delivering psychological therapy via video.

BACKGROUND: Due to the COVID-19 pandemic, mental health services have had to offer psychological therapy via video with little time to prepare or mitigate potential problems. Identifying the barriers, benefits and training needs highlighted by clinicians may support the effective delivery of care. METHOD: Changes in the mode therapy sessions were delivered in during 2020 were assessed in two high-volume psychological therapies services. Sixty-six therapists completed a survey about their experiences of delivering therapy via video. RESULTS: The lockdown in March 2020 precipitated a dramatic shift from face-to-face to telephone and video-delivered sessions. Most clinicians (89%) found video-based sessions acceptable. Barriers to effective delivery included technological issues, problems with online platforms, and feeling more tired after sessions. Benefits included generalised learning from behavioural work, improvements in efficiency and in the therapeutic relationship, particularly in comparison with telephone-based sessions. Tutorials and support guides were recommended to maximise use of sessions via video. CONCLUSIONS: Video-delivered therapy was liked by clinicians and preferred to telephone-based sessions. Issues with platforms, internet connections and access for patients need addressing, local troubleshooting guides, video-based tutorials and greater support for low-intensity therapists to maximise uptake of video sessions where appropriate, may be beneficial.

Trends in depression & anxiety symptom severity among mental health service attendees during the COVID-19 pandemic.

BACKGROUND: General population surveys have shown that some groups, particularly young women, experienced increased distress during nationally mandated restrictions to control the spread of COVID-19. However, there has been limited research on such trends among people with pre-existing mental health conditions, leaving mental health services ill equipped to plan for current and future lockdowns. METHODS: Mean weekly scores on the GAD-7 and PHQ-9 between 01/01/2020-22/06/2020 (n=9,538 individuals) for all patients of two psychological treatment services (Improving Access to Psychological Therapies) in London, were compared to mean weekly scores from the same time periods in 2017-2019 (n=37,849). The proportion of scores which were above the clinical thresholds for 'caseness' each week were compared, and scores between groups based on gender, age group, and ethnicity, were also compared. RESULTS: Confirmed community transmission in the UK (26/02/2020-03/03/2020) and the announcement of the national 'lockdown' (23/03/2020) were associated with significant increases in anxiety symptom scores. 'Lockdown' was associated with a decrease in depression scores. These changes were not maintained during lockdown. Significant increases in depression and anxiety were observed at week 23, as restrictions were eased. LIMITATIONS: This was an exploratory analysis in two services only. Residual confounding and selection biases cannot be ruled out. CONCLUSIONS: Differences in the weekly average symptom scores were short-term; they did not continue throughout 'lockdown' as might have been expected, except among older people. Replication of this study in other settings and investigating the potential benefits of more regular reviews or more intensive treatments for at-risk groups, are warranted.