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How one behavioural health intervention has reached over 7M UK citizens

March 28, 2019

    Demand for mental health care in on the rise around the world. In the UK alone, mental health is the largest single cause of disability—an estimated one-in-four UK citizens will experience a mental health crisis each year, contributing nearly 23% of the country's total disease burden. At the same time, WHO reports that nearly two-thirds of people with a known mental health disorder will never see treatment for their condition.

    In countries around the world, including England, Canada, and Australia, governments have announced plans to boost mental health funding to make it easier for patients to seek out care. Amongst these pushes is one of the most widespread behavioural health interventions ever seen: England's "Improving Access to Psychological Therapies" programme. This programme has trained more than 10,500 therapists to ensure patients have access to treatment, and last year over one million people began a course of treatment within it—bringing the total number of patients treated since its launch to over 7 million.

    An overview of England's IAPT

    In 2008, England introduced Improving Access to Psychological Therapies, or IAPT. As the name implies, the programme was designed to make it easier for patients with common conditions, such as anxiety, depression, and OCD, to receive treatment. A phone screen system helps determine the appropriate level of talk-based, proven therapeutic support for each patient—ranging from phone-based consultations to group sessions to in-person, one-on-one treatment.

    The type of intervention depends on the level of patient need. Patients with mild-to-moderate symptoms may first be provided with self-help materials and low-intensity therapeutic support. Meanwhile, patients suffering from more severe symptoms will receive high-intensity support, such as cognitive behavioural therapy or behavioural activation.

    The programme has been, by many measures, an unqualified success. Since 2008, the number of people screened by the programme has grown every year, and today more than one million people are screened each year (proposals in the Long Term Plan will increase investment so that 1.5 million patients can be screened annually by 2020/21).  

    One truly unique feature of IAPT is that 99% of people who undergo a course of treatment have their anxiety and depression measured at both the beginning and end of treatment. This assessment allows the service to monitor its impact and progressively improve its services. When the programme was introduced, the founders set a target of 50% recovery for people who complete treatment. Last year, IAPT reported that 50.8% of patients who completed treatment—more than 250,000 people—had moved to some level of recovery.

    Still more work to do

    The system, however, is not without challenges. Nearly 30% of patients do not make it past the initial phone screen, leaving mental health advocates concerned that those requiring help are not able to access it. And patients who do continue past the initial screening continue to face long waits or shortened courses of therapy as a result of extremely high demand. Further, there are often no clear pathways for how patients can or should continue care after their course of treatment has been completed. 

    Despite this, IAPT has dramatically increased the number of people across England who seek out support, and the NHS has indicated its interest in growing the programme. Over the next several years, IAPT will focus on providing care for the ~25% of English citizens living with anxiety and depression, and integrating physical and mental health services to provide comprehensive, long-term support for patients, including co-locating mental health therapists in primary care clinics.

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