Online forms open access to mental health care in England

The number of people seeking online help with mental health issues including anxiety, and depression is rising. NHS Digital’s content designer Martine Gallie looks at how teams from NHS Improving Access to Psychological Therapies (IAPT) teams can improve their online self-referral processes. Lessons for us all.

Written by By Martine Gallie. 13 May 2019, First published by NHS Digital.

Online access to psychological therapies is increasing but, as the NHS Digital mental health team recently discovered, there’s no consensus among services on how to do it well.

Our team has covered a lot of miles this year. We’ve been travelling round the country talking to Improving Access to Psychological Therapies (IAPT) services about their online self-referral processes.

More than two thirds of IAPT services now offer people the option of referring themselves online for psychological therapies, including CBT (cognitive behavioural therapy). The number of people choosing this online route is growing steadily. 

Our most striking finding by far has been the huge variation in how IAPT services manage their online self-referrals. This is reflected in the differing design of the services’ self-referral forms, which range from a brief registration form, to a full 10-page clinical assessment.

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“If you are receiving a high level of inappropriate online self-referrals, take a good hard look at your form.”

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One reason for this variation is that there isn’t currently any centralised guidance on designing digital processes for IAPT services (although any NHS service can refer to the NHS Digital service manual). There is also a shortage of digital expertise and support available to services locally. 

While we can’t offer official guidance based on our initial research, we do have some suggestions that we hope IAPT services will find helpful:

Top tips for improving access

1. Test your online self-referral forms with your patients. When we tested IAPT self-referral forms with people who had anxiety and depression, we found that most struggled to complete them. It’s also a good idea to collect data on how many of the people who started your form actually complete it. Two IAPT services we spoke to had done this and both found that more than 50% of people who started their online forms never completed them.
2. Ask yourselves “At what point do we actually need this information?” What information should you gather at the first point of contact to prevent creating barriers to access? What can you collect along the way? Could you, for example, ask people to complete measures such as PHQ9 and GAD7 just before their assessment rather than including them on your self-referral form?
3. If you are receiving a high level of inappropriate online self-referrals, take a good, hard look at your form. You should be able to spot why people who aren’t appropriate for your service are getting through the net. For example, asking potential patients to type the name of their GP into a free-text box won’t filter out people who are out of area.  Asking people to select from a drop-down list that only contains local GPs will weed out this potential for error.
4. Consider setting up an online self-booking system for assessments.One IAPT service we visited saw its rate of online self-referrals grow from 50% to 90% after it shortened the online form and sent people straight through to an online booking system. The ‘do not attend’ (DNA) rate also dropped by 10 to 15%.
5. Send a confirmation email when people submit a self-referral form. This allows you to tell people more about the service and when they can expect to be contacted. You can also signpost them to useful self-help resources if there is likely to be a wait. Finally, it reassures people that their form has been received – one IAPT service reported that people were often driven to phone up to check that their referral had been received.
6. Talk to other IAPT services. Remember, you’re not alone – many services could be wrestling with similar issues around online self-referral.

Back to basics

Access isn’t just about online referrals – make sure your traditional communications methods are also performing well.

1. Have an informative answerphone message. When your phone lines are busy, your answerphone message offers a great opportunity to tell people more about your service. You could include opening hours, eligibility criteria and how people can refer themselves online.
2. Use text reminders and alerts. Lots of people don’t answer phone calls from unknown numbers, especially during working hours, and many don’t check their emails very often. But everyone checks their texts.

However, even if you feel you have all your proverbial ducks in a row with regards to offline communications, we would suggest all IAPT services consider their online routes for self-referral. Some people – those with social anxiety, for example – find it hard to pick up the phone. All the services we visited that have introduced online self-referral have seen it grow in popularity.

Read a copy of the full research report on IAPT online self-referral processes.