Improving Access to Psychological Therapies
Improving Access to Psychological Therapies (IAPT), also known as NHS Talking Therapies, for anxiety and depression, is a
Aims
The aim of the project is to increase the provision of evidence-based treatments for common mental health conditions such as
Evaluation
Initial demonstration sites reported outcomes in line with predictions in terms of the number of people treated (especially with 'low intensity' interventions such as 'guided self-help') and the percentages classified as recovered and as in more employment (a small minority) to ten months later.[2][3] It was noted that the literature indicates a substantial proportion of patients would recover anyway with the passage of time or with a placebo – in fact the majority of those whose condition had lasted for less than six months, but only a small minority of those whose condition had been longer-lasting.[4]
There has been some debate over whether IAPT's roll-out may result initially in low quality therapy being offered by poorly trained practitioners.[5][6]
Beacon UK benchmarked IAPT performance across England for 2011–12 and reported that 533,550 people accessed (were referred to) IAPT services – 8.7% of people suffering from anxiety and depression disorders – with around 60% entering treatment sessions. Most local IAPT services did not reach the target of a 50% 'recovery' rate.[7]
In 2012–2013, 761,848 people were referred to IAPT services. 49% went into treatment (the rest either assessed as unsuitable for IAPT or declined), although around half of those dropped out before completing at least two sessions. Of the remainder, 127,060 people had pre-treatment and post-treatment mental health questionnaires submitted indicating 'recovery' – a headline rate of 43%. A report by the University of Chester indicated that sessions were costing three times more to fund than the original
For 2014-15 there were nearly 1.3 million referrals to IAPT, of which 815,665 entered treatment. Of those, 37% completed sufficient sessions, with 180,300 showing a 'reliable recovery' (on anxiety and depression questionnaires completed before and immediately after treatment) – which was just over one in five of those who entered treatment, just under half of those who completed enough sessions.[9] Opinion on IAPT remained divided. The number of trained IAPT therapists did not appear to have met the government's target of 6000, resulting in high caseloads. Some complained of seeing more 'revolving door' patients and excess complexity of cases, while the NHS has acknowledged problems with waiting times and recovery rates. However Norman Lamb, who championed IAPT within the coalition government 2010-2015, disagreed with picking faults with such an extensive and world-leading advance in evidence-based treatment.[9] Others lauded the success in rising numbers of referrals, but warned of the failure to improve recovery rates.[10] It was noted that both antidepressant prescribing and psychiatric disability claims have continued to rise.[11]
In 2017 fewer than half of the
In July 2021 55,703 appointments out of the total 434,000 which went ahead involved one or more practitioners who did not have an accredited IAPT qualification. There are about 2000 psychological wellbeing practitioners in the service, with another 1,200 trainees. They are supported by high intensity therapists and counsellors of which there are about 4,000 with 700 trainees.[14]
In 2022 less than 40% of people referred to IAPT services in some areas actually attended their initial assessment and first treatment sessions. Only 57% of people who attended for assessment went on to attend the first treatment appointment. People who self-referred were three times more likely to attend the assessment appointment than those who were referred by their GP.[15]
Updates
In December 2010, Paul Burstow, Minister for Care Services, announced an extension to the IAPT project to include Children and Young Peoples services. The government pledged £118m annually from 2015 to 2019 to increase access to psychological therapies services to children and young people.[16]
When the programme officially started in 2008 it was only for working age adults, but in 2010 it was opened to all ages.
In 2015 Clark and fellow clinical psychologist
CYP-IAPT, an application of IAPT model for children and adolescents, was a government-supported initiative in the 2010s.[19] Like its adult IAPT counterpart, CYP-IAPT aimed to improve the availability of, and access to, evidence-based psychological therapies. Unlike its adult counterpart, CYP-IAPT did not involve the recruitment and development of new types of workers; instead, it championed the training of existing staff in evidence-based therapies such as cognitive-behavioural therapy, parenting and interpersonal therapy.[20]
A
History
Layard, with Clark's help, set about campaigning for a new national service for NICE-recommended treatments, particularly CBT. One key argument was that it would be
In 2006 the Mental Health Policy Group at the LSE published 'The Depression Report', commonly referred to as the Layard Report, advocating for the expansion of psychotherapy on the NHS.
See also
- Child and Adolescent Mental Health Services
- National Mental Health Development Unit
- Troubled Families scheme
General:
References
- ^ "IAPT policy and guidance". Department of Health. Retrieved 26 April 2009.
- PMID 19208291.
- PMID 19647230.
- ^ Improving Access to Psychological Therapy: Initial Evaluation of the Two Demonstration Sites Archived 18 April 2016 at the Wayback Machine David M Clark, Richard Layard, and Rachel Smithies. LSE Centre for Economic Performance, 2008
- ^ "UKCP response to Andy Burnham's speech on mental health". Retrieved 5 May 2015.
- ^ "Cognitive-Behavioral Therapy: Proven Effectiveness". Retrieved 17 December 2014.
- ^ "Have we improved access to mental health services?". Health Service Journal. 4 February 2013. Retrieved 15 March 2015.
- ^ One in two is pretty poor odds Therapy Today, March 2014, Vol. 25 / Issue 2, Barry McInnes
- ^ a b Can call centre therapy solve the NHS mental health crisis? The Guardian, Robert Booth, 25 January 2016
- ^ IAPT and Targets: What has been achieved and where next? Felicity Dormon, The Health Foundation, 23 June 2015
- ^ PMID 26191433.
- ^ "Over half of CCGs fail to meet talking therapies target under IAPT". Healthcare Leader. 28 June 2017. Retrieved 17 July 2017.
- ^ Cuffe, R (2021) A readability analysis of the PHQ-9: How much of the general public may struggle to understand it? Clinical Psychology Forum, 347. ISSN: 2396-8664
- ^ "Unaccredited IAPT practitioners carrying out thousands of counselling sessions". Health Service Journal. 28 October 2021. Retrieved 8 December 2021.
- ^ "More work needed to help people access mental health support". York University. 14 November 2022. Retrieved 17 November 2022.
- ^ "Chancellor outlines £1.25bn mental health package". Local Government Chronicle. 18 March 2015. Retrieved 22 March 2015.
- PMID 26755970.
- PMID 26755971.
- ^ "What was CYP IAPT?". Anna Freud. Retrieved 24 March 2024.
- PMID 33073242.
- ^ Improving Access to Psychological Therapies payment: an introduction Monitor and NHS England, 27 July 2015]
- ^ a b Richard Layard on happiness, CBT and Christianity April 19, 2013. Interview by Jules Evans, Centre for the History of the Emotions at Queen Mary, University of London
- ^ Their Good Life Aeon magazine, 30 May 2013, Jules Evans
- ^ Depression, a disease that we must defeat Richard Layard, The Guardian, 18 June 2006
- ^ "The Depression Report. A new deal for depression and anxiety disorders" (PDF). London School of Economics. Retrieved 26 April 2009.
- ^ "Fit for purpose". The Guardian. London. 18 February 2009. Retrieved 26 April 2009.
- ^ The challenge of the Layard initiative John Marzillier and Prof John Hall, The Psychologist, May 2009, Vol 22 Pg 396-399.
- ^ Sarah Marzillier in conversation with her father John Marzillier The Psychologist, February 2011, Vol.24 (pp.118-119)
- S2CID 27822327.
<25>Scott, M.J (2018). "IAPT - The Need for Radical Reform". Journal of Health Psychology.</ref>
<26>Scott, M.J (2021). "Ensuring IAPT Does what It Says On the Tin". British Journal of Clinical Psychology. 60 (1): 38–41.
Further reading
- Common mental health problems: identification and pathways to care NICE guidelines, May 2011
- Some perspectives on improving access to psychological therapies (IAPT) Charlotte Thomas, 2013.
- The sorry state of NHS provision of psychological therapy. Paul Atkinson, 2014