IAPT stands for ‘Improving Access for Psychological Therapies’, the flagship programme of the NHS UK initiated in 2008. The programme now named ‘Talking Therapies’ is built on the idea of bettering the opportunity to get evidence-based, NICE recommended psychological therapies for depression and anxiety disorders in adults and other common mental health problems.
What is the IAPT PROGRAMME-PK?
Being introduced as a pilot project which targets four rural towns in
the province of Sindh, Pakistan aiming at
- offering a realistic and routine first-line treatment for mental health disorders combined, where appropriate, with medication in both community and primary care (PHCs) settings in four districts (Sukkur / Qambar-Shahdadkot / Larkana and Shikar Pur) in Sindh, Pakistan.
- To train High Intensity (HI) and Low Intensity (LI) therapists to provide culturally adapted IAPT services.
- To provide supervised support for professional growth and training of screening tools and interventions to healthcare professionals for quality assurance and measure their effect.
- To explore the experience of stakeholders (such as clinicians, service users, and service providers) with increased access to psychological therapies and its perceived usefulness and barriers in the delivery of interventions.
Being introduced as a pilot project which targets four rural towns in
the province of Sindh, Pakistan aiming at
Sukkur city situated by the Indus River in Pakistan, is a metropolitan city and home to over 0.6 million people, but with a healthcare workforce of only 1126 which comes to 0.00019 workers per person. This meagre healthcare workforce includes physicians, surgeons, doctors, dentists, nurses, midwives, dispensers, lady health workers (LHWs), paramedic staff, and other technical personnel and paraprofessionals, working across both public and private settings.
the rural district has a mixed population of Sindhis, Balochis, and other diverse groups 1.3 million. This population is served by a health force of 800 Lady health workers (LHW) and 400 other medical professionals including doctors, nurses, and other healthcare workers.
- Qambar,
- Miro Khan,
- Shahdadkot,
- Warah,
- Sija Wal Junejo,
- Nasirabad
- Qubo Saeed Khan.
Back Drop
In the wake of 2022 floods Pakistan was left devastated with over 1200 deaths and millions of homes lost. As the floods hit the rural areas the already marginalised population was rendered traumatised and homeless. The province of Sindh located in the southern part of Pakistan was especially hit hard with 1.8 million homes destroyed with millions exposed to flood waters, disease, no access to clean water and food. Along with malaria, dengue and diarrhoea cases, the region faced a rise in mental health issues such as PTSD, survivors’ guilt, and depression, affecting both adults and children. It became evident that a serious health emergency had also taken place along with physical health, calling for immediate action.
As mental ill-health is not a priority for resource scarce countries of the world (LMICs) the problem has escalated, PILL with help of Sindh Government and other collaborators have developed an Integrated Mental Health Programme (IMAGINE) incorporating the IAPT-PK services to address the mental health crises, and to develop pathways and interventions for: Accessing mental health therapies for depression and anxiety at the primary health centres located in rural areas, thereby reducing the treatment gap, raise awareness and educating the populace on issues of mental health, and to develop interventions through the IMAGINE Pilot programme
OUR VISION
We aspire to succeed in developing
and providing evidence-based
physical and mental health services
in rural areas by bridging gaps in
delivery of physical and mental
health services.
OUR MISSION
To achieve optimal mental and
physical well-being of individuals
through accessible evidence-based,
culturally adapted health services at
the primary level by empowering
local health practitioners,
community workers and medical
staff.
THE THREE ASPECTS OF IAPT-PK
The programme is based around 3 principles:
delivered by trained and accredited
practitioners, matched to the mental health
problem and its intensity and duration
designed to optimise outcomes.
This will involve routine monitoring and
supervision so that the person delivering
therapy has up-to-date information on an
individual’s progress. This supports the
development of a positive and shared
approach to the goals of therapy and as
this data is anonymized and published this
promotes transparency in service
performance encouraging improvement.
-
Counselling and psychological interventions (talking therapies) in primary care
-
Improving access to primary care through the establishment of IAPT psychological and counselling (stepinterventions)
-
Support IAPT service users in retaining current employment and seeking alternative employment
How will the IAPT-PK be delivered?
- By developing a culturally appropriate IAPT programme
- By instituting local and equitable access to therapy services within primary care settings to reduce the treatment gap
- By delivering the culturally suitable version in the community through trained community workers
- By raising awareness of mental ill-health in the community and beyond
- By referring individuals needing specialist care to suitable medical treatment
Who are the IAPT services for?
The IAPT services are a part of an integrated health services which
addresses counselling for depression and anxiety in adults and older
adults, for serious and severe mental health issues, and also if they
occur along with other long-term health conditions under a holistic
health service, Integrated Health Services (IMAGINE) in rural Sindh.
The Proposed IAPT-PK
Low-Intensity interventions are for
| Disorders | Culturally adapted Intervention |
|---|---|
| Anxiety Disorders | Khushi & Khatoon |
| Depressive disorders | Khushi & Khatoon & LTP |
| Physical symptom disorders | STreSS CBT Manual |
| Substance Misuse | 1. Brief education (lower risk)- Participants with ASSIST 2. Brief intervention (moderate risk)- Culturally Adapted Motivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) (MICBT) 3. Brief intervention Plus referral for specialised care (high risk) |
| Post Traumatic Disorders (PTSD) | BASID (Baad Az Sadma Zehni Dabao) Ki Kahani (Chaudhry et al., 2022): |
| Phobias | Khushi & Khatoon |
High Intensity intervention for Severe
Mental Disorders:
| Disorders | Culturally adapted Intervention |
|---|---|
| Suicide & Self harm Bipolar Affective disorders Schizophrenia and Psychosis |
1. Culturally Adapted Manual-Assisted Problem Solving Intervention (CMAP) 2. Management protocol for a medically serious act of self-harm 3. Management protocol if there is an imminent risk of self-harm or suicide 4. Youth Culturally Adapted Manual Assisted Problem Solving Intervention (YCMAP) 5. Saving and Empowering Young Lives (SEPAK) Interventions |
| Bipolar Affective disorders | Culturally adapted Psychoeducation |
| Schizophrenia and Psychosis | 1. Culturally Adapted Cognitive Behaviour Therapy (CaCBT) for psychosis: 2. Culturally adapted Family Intervention (CulFI) for psychosis |