National Audit of Psychological Therapies
(NAPT)
Second Round Audit
Report for the public
This report is based on the NAPT national report (2013). It has been put
together in partnership with Mind and with help and input from the
following people:
NAPT Service User Representatives
Rezina Hakim – Policy and Campaigns Officer – Mind
Catherine O’Neill – NAPT Service User Representative
Gareth Stephens – Service User Consultant
The NAPT Project Team
Charissa Bhasi - Project Worker
Rohanna Cawdron – Project Administrator
Melissa Clapp – Project Worker
Lorna Farquharson – Clinical Advisor
Elizabeth Hancock – Deputy Programme Manager
Rachel Marsh – Programme Manager
Lucy Palmer – Senior Programme Manager
The NAPT Leads
Jeremy Clarke – NAPT Clinical Lead
Mike Crawford – Director of the College Centre for Quality Improvement
Please send any email correspondence to: napt@cru.rcpsych.ac.uk
If citing this report, please reference it as: Royal College of
Psychiatrists (2013). National Audit of Psychological Therapies
2013: Report for the public
Publication number: CCQI157
1 | © Healthcare Quality Improvement Partnership (HQIP) 2013
What is in this report?
A note about this report
3
What is the National Audit of Psychological Therapies? (NAPT)
4
How people with anxiety and depression got involved
8
How to read this report
9
Access findings (How easy is it to get psychological therapies?)
10
Appropriateness findings (Are people getting the right type and
14
amount of psychological therapies?)
Acceptability findings (Are people satisfied with the help they get?)
18
Outcomes findings (Are psychological therapies helping people
21
to get better?)
Summary of what we found
25
What recommendations did we make?
26
The future of NAPT
27
Glossary of terms
28
Appendix
31
2 | © Healthcare Quality Improvement Partnership (HQIP) 2013
A note about this report
This report has been developed for members of the public, with support
and guidance from people with anxiety and depression.
Although every effort has been made to simplify the language used, this
report may still contain technical words. In order to make sure this report
is easy to understand a glossary of words and their meanings are included
at the end (page 29). When a word is in italics it means that it is included
in the glossary.
3 | © Healthcare Quality Improvement Partnership (HQIP) 2013
What is the National Audit of Psychological
Therapies? (NAPT)
Background to the audit
The National Audit of Psychological Therapies (NAPT) aims to evaluate
and improve the quality of psychological therapies and the care provided
to people with anxiety and depression in England and Wales.
The first round audit
NAPT was set up and commissioned by the Healthcare Quality
Improvement Partnership (HQIP) in 2008. It is part of the National
Clinical Audit and Patient Outcomes Programme (NCAPOP). The first
round audit included 357 NHS-funded psychological therapy services
across England and Wales. The results were published in 2011 (baseline
reports accessible at www.rcpsych.ac.uk/napt). Some of the key findings
included:






Older people were less likely to receive psychological therapy than
younger people
85% of people were assessed and treated within the audits
standards of 13 and 18 weeks
80% of people reported a good therapeutic relationship with their
psychological therapist
A number of therapists were delivering therapies which they had no
specific training to provide
83% of people were receiving a therapy for their condition or
problem that was recommended by clinical guidelines
81% of people completed questionnaires that could be used to
evaluate how effective the therapy was
The second round audit
The second round audit aimed to see whether the quality of psychological
therapies and the care provided had changed in the 24 months since the
first round audit.
4 | © Healthcare Quality Improvement Partnership (HQIP) 2013
The audit themes
The audit measured four key aspects of quality, which are shown in the
table below.
Table 1. The audit themes
Theme
What is being measured?
Accessibility
How easy is it to get psychological therapies?
Appropriateness
Are people getting the right kind of help for
their mental health problems?
Acceptability
Do people feel satisfied with the help they get?
Outcomes
Are psychological therapies helping people to
get better?
The audit standards
NAPT developed specific audit standards that help to evaluate how
services are performing in relation to each aspect of quality (i.e. access,
appropriateness, acceptability and outcomes). These standards were
developed with support and guidance from organisations that engage with
people with mental health problems, e.g. Mind, Anxiety UK, and bodies
that represent therapists, e.g. the British Psychological Society (BPS) and
the British Association for Behavioural and Cognitive Psychotherapies
(BABCP).
Who took part?
All psychological therapy services that are funded by the NHS and provide
psychological therapies to people with anxiety and depression in England
and Wales were invited to take part in the audit.
One hundred and thirty seven services that took part in the first round
audit did not register for the second round. The most common reasons for
not taking part included; not seeing the audit as appropriate at the time,
a lack of resources and considerable changes to their service.
In total, 220 psychological therapy services took part in the second round
audit.
5 | © Healthcare Quality Improvement Partnership (HQIP) 2013
How did NAPT measure the quality of services?
Four questionnaires were developed to measure how services perform
against the four audit themes.
1. Service Context Questionnaire
This questionnaire collected information about each psychological therapy
service, including the service size, e.g. number of people the service
treats and how many therapists work there, and how it is managed. The
information from this questionnaire was important in helping us to
understand the differences between services.
2. Case Record Audit
This collected information on people who ended therapy in the audit
period (1st July - 31st October 2012) including waiting times, type of
therapy they received, number of therapy sessions received and the
outcomes from the therapy. This information was anonymous and did not
include any information that would identify people. In total, information
from 122,812 case records was included.
3. Therapist Questionnaire
All therapists who were working in a psychological therapy service taking
part in the audit were asked to complete this questionnaire. It collected
information on therapists’ training, the types of therapies that they
provide and whether they received regular support and supervision from
another therapist. Therapists remained anonymous and were not asked to
provide any information that would identify them.
4. Service User Questionnaire
This questionnaire was developed by researchers and people who had
experience of receiving psychological therapies. It collected information to
find out what people using therapy think of the service they receive.
Services posted or handed the questionnaire to everyone receiving
therapy during the audit’s timeframe. Freepost envelopes were included
with the questionnaire to make sure that they were sent back directly to
the NAPT audit team.
Everyone remained anonymous and people were not asked to give any
information that would identify them. It was clearly explained that
completing the questionnaire was optional and that neither the decision to
complete it nor the person’s responses would affect the treatment they
received in the future.
6 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Response rates
The table below highlights the response rates for the therapist and service
user questionnaires.
Table 2. Percentages of people who completed a questionnaire for NAPT
Audit
Number of
questionnaire people asked to
complete a
questionnaire
Number of
people who
completed a
questionnaire
Percentage (%)
of people that
completed a
questionnaire
Therapist
Questionnaires
6,545
4,771
73%
Service User
Questionnaires
76,950
15,078
20%
7 | © Healthcare Quality Improvement Partnership (HQIP) 2013
How people with anxiety and depression got
involved
NAPT representative with lived experience
NAPT employs someone with both lived experience of common mental
health problems and experience of working to engage people in service
development locally and nationally. She is an important member of the
NAPT project team and guides the project on the best ways to involve
people with mental health problems in the audit.
Newsletters
Regular newsletters are added to the NAPT website
(www.rcpsych.ac.uk/napt) for members of the general public, people with
mental health problems and professionals. These newsletters are also
sent to managers working in services so they can display them in
communal areas. The aim of this has been to raise awareness of the audit
and to keep everyone up-to-date with opportunities for involvement.
Service user questionnaires
We received over 15,000 questionnaires from people who were receiving
psychological therapy for anxiety and depression. This information tells us
what people think of the service they receive. The questionnaires were
created and designed with the advice of people with mental health
problems to make sure that the content, language and layout used was
appropriate.
Service user reference groups
Three service user reference groups were held in London, Manchester and
Cardiff as part of the second audit. The aims of the groups were to
discuss the findings and to share ideas for how psychological therapy
services could improve. This feedback has influenced the interpretation of
the findings and the recommendations made. These ideas for
improvement and people’s experiences have been included as anonymous
quotes in this report and the national report (www.rcpsych.ac.uk/napt).
Communication with others
The NAPT project team holds regular meetings with organisations that
represent people with mental health problems (e.g. Mind, Anxiety UK).
This has helped NAPT to communicate with people when developing
questionnaires, materials and reports, and to make sure the views of
people with mental health problems are included.
8 | © Healthcare Quality Improvement Partnership (HQIP) 2013
How to read this report
The following four sections show what we found:
1. Accessibility – How easy is it to get psychological therapies?
2. Appropriateness – Are people getting the right kind of help for
their mental health problems?
3. Acceptability – Do people feel satisfied with the help they get?
4. Outcomes – Are psychological therapies helping people to get
better?
In each section you will find:
 What we found
 Summary of feedback from the service user
reference groups
9 | © Healthcare Quality Improvement Partnership (HQIP) 2013
1. Accessibility:
How easy is it to get psychological therapies?
This section looks at how easy it is for people to get
psychological therapy. It includes information on:
 Who receives psychological therapies
 How long people have to wait for their first
assessment and first therapy appointment
10 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Accessibility: What we found
Standard 1a. Do services routinely collect information on
patients’ age, gender and ethnicity when they access
psychological therapies?
This standard refers to the extent that services collect information about
people’s age, gender and ethnicity when they first enter a psychological
therapy service. It is important that services do this to make sure that
people of all ages, gender and ethnicity are accessing and receiving the
psychological therapies they need.

Most of the psychological therapy services that took part were
recording the age and gender of people who were entering therapy

Some psychological therapy services were recording the ethnic
background of people more regularly than others

Information on ethnicity was available for 83% of people receiving
treatment. This was a 7% improvement since the first round audit.
Standard 1b. Are the people accessing psychological therapies
similar to the local population in terms of age, gender and
ethnicity?

Nearly half of people receiving psychological therapies were
between the ages of 25-44 years old

Only 6% of people were over the age of 65, showing that older
adults continue to be less likely to receive psychological therapy

More females were receiving therapy compared to males. However
this is expected as the Adult Psychiatric Morbidity Study in 2007
showed that women are more likely to report experiencing anxiety
and depression than men

83% of people described themselves as White British, which is
similar to the national population

We were not able to evaluate whether the people receiving
psychological therapies reflected the local community in which the
services are based. We recommend that services look at their
information on who is receiving psychological therapy and whether
there are similarities in terms of age, gender and ethnicity to the
local population in their area.
11 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Standard 2. Are people that are referred to psychological
therapy services being assessed within 13 weeks?

The majority of people (92%) had been seen for their first
assessment within 13 weeks of being referred to a psychological
therapy service. This was a 7% improvement since the first round
audit

On average people waited 35 days (five weeks) for their first
assessment appointment.
Standard 3. Are people who require therapy being offered
treatment within 18 weeks of being referred for therapy?

The majority of people (91%) had received a first treatment
appointment within 18 weeks of being referred to a psychological
therapy service. This was a 6% improvement since the first round
audit

On average people waited 52 days (over seven weeks) for their first
treatment appointment.
12 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Feedback from the service user reference groups
Waiting times

People who used psychological therapy services felt that treatment
should be made available much earlier than the 13 and 18 week
standards used by the NAPT audit. They felt that a standard wait of
up to two weeks should be aimed for by services. This feedback fits
with the finding that 28% of people receiving therapy felt that their
waiting time for treatment was too long.

It was felt that contact should be made with people that are on
waiting lists for psychological therapy. Alternatively, a buddy
system could be offered to people. Both options could help to
minimise the uncertainty and feelings of abandonment described by
some people whilst waiting for treatment.
Access

It was felt that services have a responsibility to look into the
reasons why older people are less likely to receive psychological
therapy. Suggestions to improve access included providing home
visits, employing older adult advocates and joint working with Age
UK.

People felt that they lacked the information about the different
services available to them and the ways that people can refer
themselves. Suggestions were made to improve this by educating
and promoting psychological therapy services in the local
community.
“We need to be ambitious”
“We cannot compromise with people’s lives”
“I was on the waiting list for two years. I got no feedback as to
where I was on the waiting list the whole time”
“GPs tend to refer to IAPT as the cure all. There should be a single
point of referral for all mental health related issues giving
specialists the task of directing the patient to the right place instead
of relying on GPs”
13 | © Healthcare Quality Improvement Partnership (HQIP) 2013
2. Appropriateness:
Are people getting the right kind of help for their
mental health problems?
This section looks at the suitability of therapy for a
person’s mental health problem by finding out:
 How many people are receiving therapy that is
recommended by relevant clinical guidelines?
 How many people are receiving therapy until
they have improved or had the minimum
number of sessions recommended by relevant
clinical guidelines?
 Are therapists formally trained and being
supervised to provide psychological therapy?
14 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Appropriateness: What we found
Standard 4. Are the psychological therapies that are provided
to people recommended by relevant clinical guidelines?
The National Institute for Health and Care Excellence (NICE) produces a
number of clinical guidelines that make recommendations about which
types of therapies and how many treatment sessions are likely to be
effective for the treatment of particular conditions, based on the research
available. The guidelines for anxiety and depression are referenced in the
appendix (page 31).

Nearly 80% of people received psychological therapy that was
recommended by clinical guidelines for their particular mental
health problem. This is similar to the first round audit finding

People who had a diagnosis of Obsessive Compulsive Disorder
(OCD) were most likely to receive a therapy that is recommended
by clinical guidelines

People who had a diagnosis of Post Traumatic Stress Disorder
(PTSD) were least likely to receive a therapy that is recommended
by clinical guidelines.
Standard 5. Does psychological therapy continue until the
person recovers or until the person has received the minimum
number of sessions recommended by clinical guidelines?
It is possible to see how effective therapy is by asking people to complete
questionnaires which assess their wellbeing at the start of therapy, at
every session and at the end of their therapy.
The term recovery is used to describe when a person’s score on a
questionnaire moves from above a particular score (the clinical cut-off
point) to below a particular score. Reliable improvement is used to
describe when a person’s score on a questionnaire at the end of therapy
has reduced but they have not fully recovered.

57% of people receiving therapy either recovered or received the
recommended number of sessions for the treatment of their mental
health problem. This is similar to the first round audit finding

People seeking therapy for panic disorder were most likely to
receive the number of sessions recommended by clinical guidelines
(59%).
15 | © Healthcare Quality Improvement Partnership (HQIP) 2013

People seeking therapy for generalized anxiety disorder (GAD) were
the least likely to receive the recommended number of sessions
(19%)

For people who did not receive the recommended number of
sessions for their condition, 43% recovered, 14% had made
improvements and 43% did not recover or make improvements.
Standard 6. Are therapists providing psychological therapies
under supervision and have they received formal training in the
therapy they provide?

Many psychological therapists (83%) had received formal training in
at least one therapy type and were receiving regular support and
supervision from another therapist within their team

There were seven types of high intensity therapy with more than
30% therapists providing them without specific training in that
particular therapy. These included Eye Movement Desensitization
and Reprocessing Therapy (EMDR), systemic/family therapy,
Interpersonal Therapy (IPT), couples therapy, Cognitive Analytic
Therapy (CAT), Dialectical Behaviour Therapy (DBT) and arts
psychotherapies.
16 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Feedback from the service user reference groups
Number of therapy sessions

People receiving psychological therapies felt strongly about the need
for services to be flexible with the number of sessions they provide
and to make sure that this is tailored to what each person needs.
This feedback fits with the finding that 15% of people receiving
therapy felt that they did not receive the right number of sessions.
Better communication

People felt that both GPs and services should have up to date
knowledge about the clinical guidelines and the types of therapies
offered for different mental health conditions. It was felt that this
would help to avoid inappropriate referrals, too many assessments
and long waiting times.
Training

People were surprised at the finding that for seven psychological
therapies, more than 30% of therapists were delivering them
without formal training. It was felt that therapists and GP training
should be kept up to date. More therapists with lived experience
should be employed as well as people with mental health problems
to support the treatment process.
“One size does not fit all”
“I didn’t know what the recommended treatment for my condition
was”
“Just because a therapist has training doesn’t mean that they are up
to date”
“GP training in mental health is inadequate both in terms of knowing
what treatments to refer to and competence in prescribing”
“You trust the people providing care and expect them to be competent
to deliver treatment”
17 | © Healthcare Quality Improvement Partnership (HQIP) 2013
3. Acceptability:
Do people feel satisfied with the help they get?
This section looks at how satisfied people are with
their treatment. This includes information about:
 Are people being given enough information and
choice about the therapies they receive?
 Are people satisfied with the treatment they
receive?
18 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Acceptability: What we found
Standard 7. Are people being given enough information and
choice about their treatment?

75% of people reported that being offered choice about the time of
their appointments was important to them. 82% of people who
wanted this option said that they were given enough choice

17% of people reported that having a choice about the gender of
their therapist was important to them and that they were not
offered the choice.
Standard 8. Do people report high levels of satisfaction with
the treatment they receive?

People reported being most satisfied with the time and the location
of their appointments (over 90%)

People reported that they were satisfied with their experience of
therapy and felt that it had helped them to understand their mental
health problems (nearly 90%)

Two out of three people felt that their waiting time between being
referred and their first treatment appointment was reasonable

Two out of three people felt that they had received the right
number of sessions

5% of people reported that they had experienced lasting negative
effects as a result of receiving psychological therapies
 80% of people reported a positive experience with the
psychological therapy they received
 82% of service users had a positive experience of accessing
psychological therapies

Similar to the first round audit, the areas of least satisfaction
included the waiting time for the first treatment to start and the
number of sessions provided. 67% of people were satisfied with
these things.
It is possible that people with more negative or positive experiences of
therapy may not have completed the questionnaire and returned it to us.
19 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Feedback from the service user reference groups
Feedback from people receiving treatment

It was felt that services should be routinely evaluating their services
by taking part in compulsory audits and seeking anonymous
feedback from people about their services, being clear that this
feedback would not impact on their therapy or care.
More choice and information

People felt strongly that services should take action to reduce
dissatisfaction and improve the level of choice that people receive
about the gender of their therapist, and the time and location of
their appointments. This feedback is consistent with the finding that
17% of people receiving therapy had not been given enough choice
about the gender of their therapist. It was felt that services should
employ enough staff to be able to offer this level of choice and felt
that it would be important for therapists to review how satisfied
people are with this choice.

People felt that more should be done to understand why people may
experience lasting negative effects from therapy.

People agreed that it is essential that they know how to get access
to their own information and what confidentiality means. This
feedback is consistent with the finding that 18% of people receiving
therapy did not know where their information is kept. They
suggested that therapists should be clearer about the sharing of
information between themselves and GPs.
“Choice of therapist is crucial”
“There is a lack of clarity about the types of therapies and treatments
available – the service user therefore can’t make an informed choice”
“I was quite happy with the therapy I received in most cases, but I felt
the number of sessions was woefully inadequate in my most recent
experience and I found it difficult to comply with CBT requirements”
“My current therapist is attempting a different therapy to the one I was
referred for I still don’t understand its aims and she seems uncertain
too.”
20 | © Healthcare Quality Improvement Partnership (HQIP) 2013
4. Outcomes:
Are psychological therapies helping people to get
better?
This section looks at how effective psychological
therapies are for people. This includes information
about:
 Do people complete questionnaires assessing their
wellbeing at the first assessment and then at the
end of their therapy?
 Do people improve or recover as a result of
therapy?
 Do the numbers of people who drop out of therapy
differ from service to service?
21 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Outcomes: What we found
Standard 9a. Do psychological therapy services collect
information to see how effective therapy is for people?
It is possible to evaluate how effective psychological therapy is by asking
people to complete questionnaires which assess their wellbeing at the
start of therapy, at every session and at the end of their therapy

Nearly everyone (95%) was asked to complete a questionnaire to
assess their wellbeing at their first assessment appointment and at
their last treatment appointment. This is a 14% improvement since
the first round audit.
Standard 9b. Are services reporting the information showing
how effective the therapy they provide is and is this
comparable to the effectiveness of therapy in clinical trials?
The term recovery is used to describe when a person’s score on a
questionnaire moves from above a particular score (the clinical cut-off
point) to below a particular score. Reliable improvement is used to
describe when a person’s score on a questionnaire at the end of therapy
has reduced but they have not fully recovered.

The services which took part showed recovery and improvement
rates that were similar to the ones reported in clinical trials

There have been no changes in the proportion of people recovering
or significantly improving as a result of therapy since the first round
audit.
Standard 9c. Is the information reported about the
effectiveness of therapy for people receiving psychological
therapy comparable to those in similar services?

Results showed that 48% of people who received psychological
therapy in primary care services recovered as a result of therapy
compared with 35% of people receiving therapy in secondary care
services

A greater number of people receiving psychological therapy in
smaller sized services recovered as a result of therapy (51%),
compared to medium (45%) or larger sized services (46%)
22 | © Healthcare Quality Improvement Partnership (HQIP) 2013

The proportion of people who did not recover but showed significant
improvement was higher for secondary care services (36%) than
primary care services (13%)

The proportion of people who did not recover but showed significant
improvement was also higher for smaller services (20%) compared
to medium (13%) and larger services (13%).
Standard 10. Does the proportion of people who drop out of
therapy in an unplanned way differ from service to service?

24% of people ended their psychological therapy in an unplanned
way (e.g. they did not return for their next appointment or finish
the course of therapy as originally planned). This remains similar to
the first round audit finding

The average number of sessions attended before dropping out of
therapy was three. 10% of people did not attend their first
treatment appointment.
23 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Feedback from the service user reference groups
Improve engagement

People were surprised by the amount (24%) of people who ended
therapy in an unplanned way. They felt that there could be a
number of reasons for this including: a) lack of rapport with their
therapist or feeling that they could not progress any further with
their therapist; b) the type of therapy they were getting; c) long
waiting times for treatment; or d) their assessment or therapy was
too intense and brought up difficult emotions.
Follow up evaluation of therapy

It was felt that the effectiveness of the long term benefits of
therapy should be looked into by services. It was suggested that
follow-up questionnaires should be given to people in order to
measure whether their mental health had been maintained,
improved or got worse since they had left the service.

People felt that services should contact those who have ended their
therapy abruptly or in an unplanned way to explore and better
understand their reasons for this.
“I have never been asked to provide outcome data or comment on the
therapy I have received”
“I found the questionnaires useful as when the scores showed an
improvement I felt pleased that I was doing better. If it was worse that
would form the basis of the session which was really helpful”
“My experience of clinical governance is they focus on ‘must have’
outcomes like targets etc; rather than quality”
“The term recovery can make people feel like a failure – improved or self
managed is better”
“Assessment can be quite traumatic and upsetting so people might not
want to go back after the first session – you end up walking around with
your head full of your past problems and nowhere to go with it”
24 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Summary of what we found
There have been some improvements since the first audit. More people
are being seen for a first assessment and starting therapy within the time
specified (13 and 18 weeks). More services are collecting information
from questionnaires that help them to evaluate the effectiveness of the
therapy provided as well as information about the ethnic background of
people receiving therapy.
Despite these improvements, there are specific areas of concern that
require more focused quality improvement work by those involved in
providing psychological therapies for people with anxiety and depression.
We found that older adults continue to be less likely to receive
psychological therapy, highlighting that more needs to be done to offer
therapy to those that need it.
Further improvements are needed to make sure that psychological
therapy is continued until people recover or until they have received the
minimum number of sessions recommended by clinical guidelines for their
mental health problem.
Finally, more needs to be done to make sure that all therapists have
received training in the psychological therapies they are providing and
that they are supervised in their practice.
Overall, we can be pleased about the progress shown since the first round
audit. However, we continue to see wide differences in performance
between services. This may be due to differences in service size, the
geographical area, the level of care they provide and the type of funding
they receive. We need to support the efforts of healthcare professionals in
local quality improvement of services to close this gap so that more
services can meet the standards across the four aspects of quality.
25 | © Healthcare Quality Improvement Partnership (HQIP) 2013
What recommendations did we make?
The NAPT project team invited professionals and people with lived
experience to feed back on the audit findings through a number of
meetings and reference groups. This feedback has helped to develop a
number of key recommendations aimed at all psychological therapy
services and form a basis for future quality improvement. These include
the following themes:
1. Improve communication
There is a need for better communication between services, people
receiving psychological therapies and GPs to make sure that referrals are
made to the service which is best able to meet the person’s needs, and
that these referrals are made quickly to avoid inappropriate referrals, too
many assessments and long waiting times.
There also needs to be clearer communication about the level of choice
offered to people, other sources of support, policies on information
sharing and confidentiality, strategies to improve the rates of people who
are currently less likely to seek and receive therapy e.g. older adults and
managing the end of therapy.
2. Ensure that therapists are trained and supervised
There is a need to make sure that all psychological therapists have
received appropriate training for the types of psychological therapy that
they provide. Therapists who provide support and supervision for other
therapists need to make sure that they have received specific training to
provide this level of support.
3. Collect and act on feedback from people with lived
experience
There is a need for services to take active steps to improve the
satisfaction of people receiving psychological therapies and have systems
in place to obtain anonymous service user feedback on an ongoing basis.
4. Understand and improve outcomes
It is important that services take steps to make sure that the
psychological therapies provided adhere to clinical guidelines, continue for
long enough to have a positive and therapeutic effect, and are delivered
by psychological therapists who are trained to provide that particular
therapy. Services also need to understand why people may drop out of
therapy in an unexpected way and take steps to reduce the likelihood of
that happening.
26 | © Healthcare Quality Improvement Partnership (HQIP) 2013
The future of NAPT
At the time of going to print the possibility of another audit of
psychological therapies is being considered by the Healthcare Quality
Improvement Partnership (HQIP).
Although the future of the audit is uncertain, the information and
knowledge gathered through the NAPT pilot, first audit, second audit and
communication with external organisations have all fed into the
development of a new Accreditation Programme for Psychological Therapy
Services (APPTS). Further information is available at: Website details to
be confirmed.
27 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Glossary of terms
Acceptability – Whether a service or therapy type meets the person’s
needs.
Accessibility – The extent to which people are able to seek and receive
psychological therapy.
Anxiety – A common mental health problem that can include feelings of
fear, agitation, restlessness, shortness of breath, chest pain, dizziness or
intense worry.
Appropriateness – Whether a service or therapy provides psychological
therapy in line with what is recommended by clinical guidelines (NICE).
Arts psychotherapy - A form of psychotherapy that uses art media as
its primary mode of communication.
Audit - Clinical audit is a quality improvement process which seeks to
improve patient experience and outcomes. It does this by evaluating how
services are performing against specific criteria and trying to bring about
change.
Audit standard – A standard is a specific criterion which the services
current practice is measured against.
Average – Refers to the mean, which is calculated by adding up all of the
numbers and dividing them by the total amount of numbers.
Clinical trial - A study to determine whether a treatment is safe and
effective. The trial is set up to answer one or more questions.
Clinical guideline (NICE) – Specific guidance on the treatment and care
of people.
Cognitive Analytic Therapy (CAT) – A type of therapy which looks at
the way a person thinks, feels and acts, childhood events and the
relationships linked with these experiences.
Couples therapy - A type of therapy that can help people with their
relationships and the emotional difficulties that can arise when there are
problems between partners.
Depression – A common mental health problem that can include feelings
of low mood, hopelessness, poor concentration, memory and a loss of
interest in usual activities or hobbies.
28 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Dialectical Behaviour Therapy (DBT) – A type of therapy that aims to
help people who have extreme difficulties managing their emotions.
Ethnicity - The fact or state of belonging to a social group that has a
common national or cultural tradition.
Eye Movement Desensitisation and Reprocessing Therapy (PTSD)
– An anxiety disorder which may develop following traumatic events that
involve actual or threatened death, or serious injury.
Generalised Anxiety Disorder (GAD) – An anxiety disorder in which
the sufferer feels in a constant state of high anxiety and is often known as
chronic worrying.
High intensity therapy - Therapy that is offered to those with more
complex needs and it allows for a greater number of sessions. Examples
include Cognitive Behavioural Therapy and Eye Movement Desensitisation
Reprocessing therapy.
Interpersonal Therapy (IPT) – A type of therapy that focuses on
conflict with another person, life changes that affect how you feel about
yourself and others, grief and loss, difficulty in starting or keeping
relationships going.
National Institute for Health and Care Excellence (NICE) – An
independent organisation responsible for providing national guidance on
promoting good health and preventing and treating ill health.
Obsessive Compulsive Disorder (OCD) – An anxiety disorder that can
include obsessions – these are repetitive, obtrusive, unwanted thoughts
that are experienced and result in fears, and compulsions – acts or rituals
carried out in response to fears.
Outcomes – Refers to how effective treatment (e.g. psychological
therapy) is for people.
Panic disorder - A panic attack is a rapid build-up of overwhelming
sensations, such as a pounding heartbeat, feeling faint, sweating, nausea,
chest pains, breathing discomfort, feelings of losing control, shaky limbs
and legs turning to jelly.
Primary and secondary care – Primary care is centred around a GP and
usually refers to initial or first contact/ treatment. Secondary care is
provided by specialists who are not usually the initial point of contact and
tend to offer treatment to people with more severe mental health
problems.
29 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Psychological therapy – A type of therapy used to treat emotional
problems and mental health conditions.
Post Traumatic Stress Disorder - An anxiety disorder which may
develop following exposure to any one of a variety of traumatic events
that involve actual or threatened death, or serious injury.
Recovery and Reliable Improvement Rates – The term recovery is
used to describe when a person’s score on a questionnaire moves above a
particular score (cut-off point) to below a cut-off point. Reliable
improvement is used to describe when a person’s score at the end of
therapy has reduced but not fully recovered.
Response rate - In survey research this refers to the number of people
who answered the survey divided by the number of people in the sample.
Systemic/family therapy – A type of therapy that focuses on the group
dynamics and interactions between people.
Therapeutic relationship – The relationship between the therapist and
the person receiving therapy.
30 | © Healthcare Quality Improvement Partnership (HQIP) 2013
Appendix
Clinical Guidelines
The National Institute for Health and Care Excellence (NICE) produces a
number of guidelines that identify the types of treatment and care that
should be provided for people based on the research evidence available.
The following clinical guidelines are relevant to the NAPT second round
audit.
NICE (2009). Depression in adults: quick reference guide. Clinical
guideline 90. London: NICE. Accessible at: http://www.nice.org.uk/cg90
NICE (2011). Anxiety: quick reference guide. Clinical guideline 113.
London: NICE. Accessible at: http://www.nice.org.uk/cg113
NICE (2005). Obsessive-compulsive disorder: quick reference guide.
Clinical guideline 31. London: NICE. Accessible at:
http://www.nice.org.uk/cg031
NICE (2005). Post-traumatic stress disorder (PTSD): quick reference
guide. Clinical guideline 26. London: NICE. Accessible at:
http://www.nice.org.uk/cg026
31 | © Healthcare Quality Improvement Partnership (HQIP) 2013