Tailoring evidence-based psychological therapY for People with common mental disorder including Psychotic EXperiences (TYPPEX)

Aims and objectives We aim to improve the prospects of recovery for people with common mental disorder including psychotic experiences attending Improving Access to Psychological Therapies (IAPT) services (http://www.iapt.nhs.uk/). Working with our service-user advisory group, our objectives are to: Explore attitudes in IAPT settings towards identification and treatment of people with psychotic experiences; introduce a simple tool to identify them; and measure their outcomes. Tailor evidence-based psychological therapy (TYPPEX) for these people, and develop effective training for higher-tier IAPT therapists. Implement a stepped-wedge cluster-randomised controlled trial (cRCT) of TYPPEX. Define best practice in policy and commissioning regarding care pathways for people with psychotic experiences and ensure its adoption and diffusion. Establish a blueprint for evaluating further innovations in therapies deployed in IAPT. Background and rationale Psychotic experiences are common, often indexing the severity of underlying common mental disorder; only rarely do they indicate incipient psychotic illness. People with common mental disorder including psychotic experiences are poorly served by mental health services, and would prefer to be helped in primary care or IAPT services. Our preparatory work in IAPT services has shown that psychotic experiences are not routinely measured in IAPT services but are common in the people they serve. In addition, psychotic experiences were associated with poor response to conventional IAPT psychological therapies. The lack of effective therapies allows psychopathology and disability to evolve, negating recovery. Research plan We propose five workpackages implemented across 12 separate IAPT teams provided by large IAPT services (provider sites) in Cambridgeshire and Peterborough, Norfolk and Suffolk, and Sussex. We shall: Explore service-users , IAPT therapists and managers views on the identification and treatment of people with "common mental disorder including psychotic experiences" in IAPT services; and conduct a systematic review of psychological therapies for these phenomena. Tailor evidence-based psychological therapY for People with common mental disorder including Psychotic EXperiences (TYPPEX), and develop a training package regarding TYPPEX for IAPT therapists. Determine the prevalence of common mental disorder including psychotic experiences in the higher-tier of IAPT services; establish the response to current treatments; and confirm effectiveness and sample size prior to a stepped-wedge cRCT of TYPPEX. Implement a stepped-wedge cRCT of TYPPEX in the higher-tier of IAPT services. This will also demonstrate a means of evaluating other treatment innovations in IAPT settings. We shall test the hypothesis that TYPPEX is more effective and cost-effective than treatment-as-usual. We shall randomise training in TYPPEX to IAPT teams with ~15 higher-tier IAPT therapists each, measuring patient-reported outcomes within the service-users seen by therapists before and after training. Inclusion criteria for service-users will be age ≥16 years, consenting to additional assessment and possible allocation to a trained higher-tier IAPT therapist, and presence of psychotic experiences. The only exclusion criterion will be mental disorder meriting referral to secondary care (usual IAPT practice). Accordingly, we estimate that at least 2,700 service-users would agree to take part over 20 months of recruitment. Each IAPT therapist will treat at least three at any one time. The primary outcome will be "Reliable Recovery" based on the routine IAPT patient-reported outcomes (http://www.iapt.nhs.uk/silo/files/measuring-recovery-2014.pdf/). We shall analyse it at the beginning and end of treatment (last therapy session), and one year after treatment initiation. The primary effectiveness end-point will be obtained at the last therapy session, as per routine practice. In our prepar