Sustaining Recovery After Low-Intensity Treatment for Anxiety and Depression in NHS Talking Therapies: A Multiphase...

Anxiety and depression affect over 500 million people globally. Despite the availability of effective low-cost treatments, like those provided by NHS talking therapies (TT), over half of patients relapse within a year, highlighting the need to co-develop solutions to maintain wellbeing and optimise healthcare. This study used a multiphase participatory design to synthesise evidence on relapse prevention and collaboratively develop evidence-informed strategies for sustained mental health following low-intensity treatment. The three-phase project began by synthesising evidence from diverse sources. Phase 2 involved two patient and two NHS professional/key stakeholder co-design workshops, using the RAND/UCLA appropriateness method. A sustained patient and public involvement (PPI) group reviewed and refined findings, co-designing content for phase 3, which involved a mixed-stakeholder online meeting to finalise key recommendations and priorities. Phase 1 identified 41 evidence-based solutions for rating during phase 2. Across the four phase 2 workshops (n = 18), 24 solutions were rated as appropriate and necessary and ranked for priorities. These were refined with the PPI group into 13 core recommendations. These recommendations were incorporated into a relapse prevention model during the final workshop, forming a foundation to enhance post-treatment support and inform clinical practice, service design, workforce training and policy. Preventing relapse and supporting wellbeing are essential for improving patient outcomes and reducing health inequalities. Identifying priorities across multiple levels lays the groundwork for a robust relapse prevention model that promotes sustained recovery. Future research should implement and evaluate the feasibility and impact of these recommendations in routine care.