Understanding care pathways for people with common mental disorders including psychotic experiences (CMD-PE)

Development work questions: Regarding people with common mental disorders including psychotic experiences (CMD-PE) participating in our randomised controlled trial (RCT) of a tailored talking therapy: Have they previously sought help from early intervention in psychosis (EIP) or related early detection services?

Do they transfer to these care pathways, and is receipt of CBT-tailoring for severity (CBT-ts; the RCT intervention) associated with that being less likely?

Are their past and future health care pathways different from people without psychotic experiences who receive standard CBT?

Can health service contacts indicate difficult-to-treat depression that might be identified much earlier than currently conceived, be reformulated as CMD-PE, and so offer opportunities for earlier intervention and improvement of outcomes?

Background: We have discovered that a third of people seeking help from higher-tier NHS talking therapy services (previously called IAPT) present with depression and/or anxiety together with psychotic experiences. We call this presentation CMD-PE.

Our theoretical approach and empirical data suggest that the PE are markers of more severe CMD that, hitherto, has been unacknowledged and unmeasured. With current standard care, the routinely used symptomatic recovery criteria are seldom met.

We established cut-off values for a practical tool (CAPE-P15) to measure PE and developed a new blend of cognitive behaviour therapy-tailoring for severity (CBT-ts) that we are currently testing in a stepped-wedge cluster RCT currently recruiting to target.

Aim: To increase knowledge about CMD-PE by exploring healthcare service use by people in higher-tier IAPT services, with and without this clinical condition, one year before and after the RCT CAPE-P15 measurement.

Objectives: To link RCT participant data to routinely collected NHS data to answer our questions, to explore whether such data can enhance the RCT health economic analysis and support future linkage between primary and secondary care data. This will increase programme impact and lay foundations for a new PGfAR application.

Development work plan: We shall work with our lived experience advisors and host trust (CPFT) acting as sponsor to seek ethical and governance approval to obtain: Permission from the RCT sites to submit their participant ID (PID) file to CPFT that will collate and send a single file to NHS England for linkage.

Section 251 approval by the HRA Confidentiality Advisory Group (CAG).

Approval for release of NHS England data from the Independent Group Advising on the Release of Data (IGARD) via the Data Access Request Service.

This will allow linkage of the RCT dataset to: the Mental Health Services Data Set (MHSDS), Hospital Episode Statistics Accident & Emergency and to Civil Registrations of Death. A linked, pseudonymised dataset will be transferred to Norwich Clinical Trials Unit for analysis. Timeline: We anticipate completion of permissions, linkage and analysis within 16 months from June 2024.

Impact and Dissemination: Findings will be impactful, regardless of our RCT result, facilitating identification and care for this hitherto unrecognised group.

Dissemination will be led by the McPin Foundation while our implementation strategy will be developed with NIHR ARC East of England and Eastern AHSN.