England’s pioneering mental health program hits ceiling
FFIFTEEN there is Richard Layard, an economist at the London School of Economics, prepared a pitch. “We now have evidence-based psychological therapies,” he noted. But they were rarely available on the National Health Service. The result was lives lost and, he argued with an eye on the treasury, lost money, as people with poor mental health were often out of work. A new branch of the health service was needed.
This branch is now firmly established. Improve access to psychological therapies (IAPT) grew rapidly. Last year, the service, which helps people with anxiety, depression and similar illnesses, treated 1.2 million people, a number expected to rise to 1.9 million by 2023-24. He inspired imitators in Australia and Norway. And he’s improved in his job, with recovery rates dropping from less than 40% in 2010 to 54% at the start of 2019.
Since then, however, they have refused to budge, staying around the 50% target. The trend predates the covid-19 pandemic, when the number of referrals has dropped by more than half (they have now returned to normal levels). The numbers may be the best one would expect from a service that sucks “anyone and anyone with symptoms of anxiety and depression,” says Helen Gilburt of the King’s Fund, a think tank. This is because they are similar to those in well-funded clinical trials.
David Clark, IAPTThe clinical adviser and chair of experimental psychology at the University of Oxford nevertheless believes that the service “can go further”. Critics lament the “McDonaldization” of therapy. As the hamburger supplier, IAPT pay attention to what’s on their menu, using therapies deemed effective by ATTRACTIVE, equipment that assesses clinical evidence. Improvements are driven by customer data analysis, IAPTin the case of, outcome data, that is the only part of the mental health system to collect.
The targets prompt providers to see patients in six weeks, after which recovery rates plummet. Longer and they “come to therapy quite negative, quite angry,” says Marc McDonagh, the IAPT lead at Somerset Foundation Trust. “They want to sort everything out with the therapist. The first two sessions have this shadow over them, the patient ranting against the service. ” The IAPT The manual urges providers to send appointment reminders via text message to reduce absences and provide diagnosis. The latter’s value is disputed by some therapists, but is associated with better results.
Professor Clark hopes similar prods will further increase recovery rates. Older people are both unlikely to show up for treatment and particularly likely to benefit from therapy, so providers are encouraged to hire ‘older champions’ and to consult booklet libraries, offices. post office and pharmacies. The average number of sessions is slightly lower than the ideal number of nine or ten, suggesting that more should be offered.
In recent years, the number of therapies performed through digital services has increased. These include those from SilverCloud (which offers cognitive behavioral therapy) and Ieso (which offers therapy through an online messaging service). Ieso applies a deep learning model to the transcripts generated by the sessions, to find out what is associated with success (“therapeutic praise” comes first; “therapeutic empathy” last), which is returned to therapists. . These services are convenient and in some cases work as well as the in-person offers, but have yet to prove that they can still outperform them.
They also provide additional competition for staff who are already in demand. In Somerset, it is difficult to recruit advanced therapists, says McDonagh, which makes it difficult to reduce waiting lists. Some areas of the country do not offer the full range of depression treatments recommended by ATTRACTIVE, including counseling and short-term psychoanalytic therapy. Things have improved since Lord Layard’s report, but people are still not getting treatment that would improve their lives. ■
This article appeared in the Great Britain section of the print edition under the headline “Breaking through”