Shared learning database

Berkshire Healthcare NHS Foundation Trust, University of Reading, Charlie Waller Memorial Trust
Published date:
September 2009

A joint initiative between a mental health trust, university and charity has resulted in a unique centre of excellence to train therapists to deliver the evidence-based psychological therapies recommended by NICE.

Improving Access to Psychological Therapies is an NHS programme rolling out services across England offering interventions approved by the National Institute of Health and Clinical Excellence (NICE) for treating people with depression and anxiety disorders. CG123 recommends using "a diagnostic or problem identification tool or algorithm, for example, the Improving Access to Psychological Therapies (IAPT) screening prompts tool" (Recommendation

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the initiative is to increase the number of therapists able to deliver NICE-recommended psychological therapies by setting up a centre of excellence. This centre of excellence is a unique partnership between Berkshire Healthcare NHS Foundation Trust, the University of Reading and the Charlie Waller Memorial Trust. It aims to only train clinicians in psychological treatments recommended by NICE, to evaluate the efficacy of the training, to only have world renowned expert clinicians who developed the treatments provide the training and to undertake research to add to the evidence-base.

Reasons for implementing your project

Mental illness has the second greatest impact on the health of the population after heart disease and stroke. It affects one in six adults, over 700,000 young people and 1.3 million older adults. 16% of working adults are estimated to suffering from clinical depression and/or anxiety at an estimated cost of £12 billion a year[1]. Evidence-based psychological therapies such as cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) are effective forms of treatment and are recommended by NICE for a range of mental health problems such as post-traumatic stress disorder, depression, bulimia nervosa, and schizophrenia. A major problem, however, was that it appeared that such interventions were not being delivered. Fewer than 4% of general practitioners use published guidelines for the treatment of eating disorders[2]. For the schizophrenia guideline, fewer than 50% of patients receive the recommended interventions [3]. One major reason for the failure to implement NICE guidelines for psychological therapies is the lack of appropriately trained clinicians. This was reflected in waiting lists of 9-18 months across the country for cognitive behaviour therapy. The problem was recognised by the Government who invested ₤170million to establish a new service ('Improving Access to Psychological Therapies') [4]. This new service implements NICE guidelines for depression and anxiety but does not train the existing workforce in primary, secondary and tertiary care to deliver the interventions, and it is limited to anxiety and depression. In recognition of the need to train the existing workforce to deliver NICE-recommended therapies, Berkshire Healthcare NHS Foundation Trust, the University of Reading and the Charlie Waller Memorial Trust have formed the Charlie Waller Institute of Evidence-Based Psychological Treatment. Its primary goal is to increase the number of therapists trained to deliver the psychological therapies recommended by NICE.

How did you implement the project

(1) The Charlie Waller Institute of Evidence-Based Psychological Therapies was launched in January 2008 by Lord Layard and Professor David Clark. Since its launch, it has provided certificate and diplomas in evidence-based psychological treatment, short workshops and one-day conferences. Last year alone, 113 clinicians from Berkshire Healthcare NHS Foundation Trust and 361 other clinicians attended the short training courses. (2) Each workshop is evaluated by giving a knowledge quiz and a clinical vignette before and after the workshop. Participants have to answer the questions and these are made anonymous and marked to establish whether such skills change as a result of the workshop. The world leaders who have developed and evaluated the treatments have come to the Charlie Waller Institute and provided the training across the full range of psychological disorders. (3) We have obtained funding from the MRC/ESRC Studentship competition to evaluate (a) how frequently NICE guidelines for psychological treatment are being implemented and (b) to develop an intervention to decrease the barriers to the implementation of NICE treatment for psychological disorders. We were able to achieve these objectives because we were a new organisation bringing together different stakeholders. Clinicians had preconceptions about NICE recommended therapies as being rigid and we overcame such preconceptions by personal attendance at psychological therapies meetings and widespread communication at all levels of the NHS including managers as well as clinicians.

Key findings

By evaluating the impact of the workshop on clinician knowledge and skills before and after the training we were able to establish its efficacy. The training did improve clinician knowledge and skills and this will have the result of improving outcome as the therapists are now able to properly deliver the specific NICE recommended intervention. A preliminary report has been published [5] and further publications are planned in the British Journal of Clinical Psychology. References: [1] Bell S, Clark D, Knapp M, Layard R, Meacher MC, Priebe S, Thornicroft G, Turnberg LA, Wright B. The Depression Report: A New Deal For Depression and Anxiety Disorders. London: London School of Economics. 2006 June. [2] Currin L, Waller G, Treasure J, Nodder J, Stone C, Yeomans M & Schmidt U. The use of guidelines for dissemination of 'best practice' in primary care of patients with eating disorders. Int J Eat Disorder. 2007; 40 [3] The Healthcare Commission and Commission for Social Care Inspection. Improvement review of adult community mental health services 2005/2006. July 2007. Available from: [4] Department of Health. Commissioning a brighter future: improving access to psychological therapies - positive practice guide. DOH Publications. 2007 May. [5] Shafran, R. (2008). Learning the Psychological therapies recommended by NICE. Mental Health Occupational Therapy, 13, 131-4.

Key learning points

The key learning point is about successfully bringing together different organisations and sectors, and ensuring a quality product. At the beginning, each of the stakeholders' goals were clearly established and a time-line set up. Steering groups and progress reviews were put in place immediately. We severely underestimated the administrative load that was involved and had to rectify the amount of time on this to ensure that the administration side was as successfully delivered as the training. We also underestimated the goodwill of the world leaders who were pleased to be able to support such a venture and were therefore willing to provide the training at reasonable cost. Evaluation of the effectiveness of our training was based on published report from substance misuse and being able to adapt this for our own needs ensured that our evaluation was integral to the training process and unobtrusive. Utilising all our resources has been an important learning point - including the Director of Teaching and Learning at the University and the finance director within Berkshire Healthcare NHS Foundation Trust. We've put a great deal of effort into our relationships and this has paid off and made the work enjoyable as well as effective. What to avoid? Overwork and burnout - it does nobody any favours in the end.

Contact details

Roz Shafran
Charlie Waller Chair in Cognitive Behaviour Therapy
Berkshire Healthcare NHS Foundation Trust, University of Reading, Charlie Waller Memorial Trust

Is the example industry-sponsored in any way?