1932

Abstract

Empirically supported psychological therapies have been developed for many mental health conditions. However, in most countries only a small proportion of the public benefit from these advances. The English Improving Access to Psychological Therapies (IAPT) program aims to bridge the gap between research and practice by training over 10,500 new psychological therapists in empirically supported treatments and deploying them in new services for the treatment of depression and anxiety disorders. Currently IAPT treats over 560,000 patients per year, obtains clinical outcome data on 98.5% of these individuals, and places this information in the public domain. Around 50% of patients treated in IAPT services recover, and two-thirds show worthwhile benefits. The clinical and economic arguments on which IAPT is based are presented, along with details of the service model, how the program was implemented, and recent findings about service organization. Limitations and future directions are outlined.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-clinpsy-050817-084833
2018-05-07
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/clinpsy/14/1/annurev-clinpsy-050817-084833.html?itemId=/content/journals/10.1146/annurev-clinpsy-050817-084833&mimeType=html&fmt=ahah

Literature Cited

  1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. 2014. Guided Internet-based versus face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 13:288–95 [Google Scholar]
  2. Barkham M, Margison F, Leach C, Lucock M, Mellor-Clark J. et al. 2001. Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. J. Consult. Clin. Psychol. 69:184–96 [Google Scholar]
  3. Blackburn IM, James IA, Milne DL, Baker C, Standart S. et al. 2001. The Revised Cognitive Therapy Scale (CTS-R): psychometric properties. Behav. Cogn. Psychother. 29:431–46 [Google Scholar]
  4. Chambless DL, Caputo GC, Jasin SE, Gracely EJ, Williams C. 1985. The mobility inventory for agoraphobia. Behav. Res. Ther. 23:35–44 [Google Scholar]
  5. Clark DM, Canvin L, Green J, Layard R, Pilling S, Janecka M. 2017. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet press. https://doi.org/10.1016/S0140-6736(17)32133-5 Publicly available data is used to understand differences in outcome among IAPT services. [Crossref]
  6. Clark DM, Fairburn CG, Wessely S. 2008. Psychological treatment outcomes in routine NHS services: a commentary on Stiles et al.; 2007. Psychol. Med. 38:629–34 [Google Scholar]
  7. Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B. 2009. Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav. Res. Ther. 47:910–20Shows that when services have missing outcome data they overestimate how well they perform. [Google Scholar]
  8. Clark DM, Wells A. 1995. A cognitive model of social phobia. Social Phobia: Diagnosis, Assessment and Treatment ed. RG Heimberg, MR Liebowitz, DA Hope, FR Schneier 69–93 New York: Guilford [Google Scholar]
  9. Connor KM, Davidson JRT, Churchill LE, Sherwood A, Foa E, Weisler RH. 2000. Psychometric properties of the social phobia inventory (SPIN): new self-rating scale. Br. J. Psychiatry 176:379–86 [Google Scholar]
  10. Creamer M, Bell R, Failla S. 2003. Psychometric properties of the Impact of Event Scale–Revised. Behav. Res. Ther. 41:1489–96 [Google Scholar]
  11. Delgadillo J, Asaria M, Ali S, Gilbody S. 2015. On poverty, politics and psychology: the socioeconomic gradient of mental healthcare utilisation and outcomes. Br. J. Psychiatry 209:429–30 [Google Scholar]
  12. DH (Dep. Health) 2011.a No health without mental health: a cross-government mental health outcomes strategy for people of all ages Ment. Health Serv. Reform Rep., Dep Health, London, UK:
  13. DH (Dep. Health) 2011.b The IAPT data handbook NHS Rep. v2.0.1 Dep. Health London, UK:Detailed specification of all the variables in the IAPT dataset.
  14. Foa EB, Kozak MJ, Salkovskis PM, Coles ME, Amir N. 1998. The validation of a new obsessive-compulsive disorder scale: the Obsessive-Compulsive Inventory. Psychol. Assess. 10:206–14 [Google Scholar]
  15. Gillespie K, Duffy M, Hackmann A, Clark DM. 2002. Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behav. Res. Ther. 40:345–57Early demonstration that psychological therapies can do as well in routine settings as in research trials. [Google Scholar]
  16. Griffiths S, Steen S. 2013. Improving Access to Psychological Therapies (IAPT) programme: setting key performance indicators in a more robust context: a new perspective. J. Psychol. Ther. Primary Care 2:133–41 [Google Scholar]
  17. Gyani A, Shafran R, Layard R, Clark DM. 2013. Enhancing recovery rates: lessons from year one of IAPT. Behav. Res. Ther. 51:597–606Identifies predictors of variation in recovery rates within IAPT services. [Google Scholar]
  18. Hollon SD, Stewart MO, Strunk D. 2006. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annu. Rev. Clin. Psychol. 57:285–315 [Google Scholar]
  19. Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. 2003. Role of surgeon volume in radical prostatectomy outcomes. J. Clin. Oncol. 21:401–5 [Google Scholar]
  20. Kroenke K, Spitzer RL, Williams JB. 2001. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 16:606–13 [Google Scholar]
  21. Labour Party. 2005. Britain forward not back: manifesto 2005 http://www.politicsresources.net/area/uk/ge05/man/lab/manifesto.pdf
  22. Lambert MJ. 2013. Bergin and Garfield's Handbook of Psychotherapy and Behavior Change New York: Wiley
  23. Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. 2009. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance San Francisco: Jossey-Bass
  24. Layard R. 2005. Mental health: Britain's biggest social problem? Presented at No. 10 Strategy Unit Semin Ment. Health, Jan. 20 London:
  25. Layard R, Bell S, Clark DM, Knapp M, Meacher M. et al. 2006. The depression report: a new deal for depression and anxiety disorders Cent. Econ. Perform. Spec. Pap London Sch. Econ. Polit. Sci London:
  26. Layard R, Clark DM. 2014.a Thrive: The Power of Psychological Therapy London: PenguinOutlines the clinical and economic arguments for the IAPT program.
  27. Layard R, Clark DM. 2014.b Thrive: How Better Mental Health Care Transforms Lives and Saves Money Princeton, NJ: Princeton Univ. PressOutlines clinical and economic arguments for IAPT (North American edition).
  28. Layard R, Clark DM, Knapp M, Mayraz G. 2007. Cost-benefit analysis of psychological therapy. Natl. Inst. Econ. Rev. 202:90–98 [Google Scholar]
  29. Marcus SC, Olfson M. 2010. National trends in the treatment for depression from 1998 to 2007. Arch. Gen. Psychiatry 67:1265–73 [Google Scholar]
  30. McHugh RK, Barlow DH. 2012. Dissemination and Implementation of Evidence-Based Psychological Interventions Oxford, UK: Oxford Univ. Press
  31. McHugh RK, Whitton SW, Peckham AD, Welge JA, Otto MW. 2013. Patient preference for psychological versus pharmacologic treatment of psychiatric disorders: a meta-analytic review. J. Clin. Psychiatry 74:595–602Meta-analysis demonstrating that patients prefer psychological therapies to medication in a 3:1 ratio. [Google Scholar]
  32. McManus S, Bebbington P, Jenkins R, Brugha T. , eds. 2016. Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014 Leeds, UK: NHS Digit
  33. McManus S, Meltzer T, Brugha P, Bebbington P, Jenkins R. , eds. 2009. Adult Psychiatric Morbidity in England—2007, Results of a Household Survey Leeds, UK: NHS Digit
  34. Mental Health Found., Mind, Rethink, Salisbury Centre Mental Health, and Young Minds 2006. We need to talk: the case for psychological therapy in the NHS Rep London: https://www.centreformentalhealth.org.uk/we-need-to-talk
  35. Moriana JA, Galvez-Lara M, Corpas J. 2017. Psychological treatments for mental disorders in adults: a review of the evidence of leading international organizations. Clin. Psychol. Rev. 54:29–43 [Google Scholar]
  36. Mundt JC, Marks IM, Shear MK, Greist JH. 2002. The work and social adjustment scale: a simple measure of impairment in functioning. Br. J. Psychiatry 180:461–64 [Google Scholar]
  37. Nathan PE, Gorman JM. 2015. A Guide to Treatments That Work Oxford, UK: Oxford Univ. Press
  38. NHS Digit. 2015. Psychological Therapies: Annual Report on the Use of IAPT Services—England, 2014/15 Leeds, UK: Health Soc. Care Inf. Cent
  39. NHS Digit. 2016. Psychological Therapies: Annual Report on the Use of IAPT Services—England, 2015–16 Leeds, UK: Health Soc. Care Inf. Cent
  40. NHS Engl. 2015. 2015 adult IAPT workforce census report Health Ed. Engl. Rep., NHS Engl London:
  41. NHS Engl. 2016.a The five year forward view for mental health Rep., NHS Engl. Ment. Health Taskforce London:
  42. NHS Engl. 2016.b Implementing the five year forward view for mental health Rep., NHS Engl London:Describes NHS's future plans for expanding the IAPT program.
  43. NICE 2004.a Anxiety: management of anxiety (panic disorder, with and without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care Clin. Guidel. 22, Natl. Inst. Clin. Excell London:
  44. NICE 2004.b Depression: management of depression in primary and secondary care Clin. Guidel. 23, Natl. Inst. Clin. Excell London:
  45. NICE 2005.a Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder Clin. Guidel. 31, Natl. Inst. Clin. Excell London:
  46. NICE 2005.b Post-traumatic stress disorder (PTSD): the management of PTSD in adults and children in primary and secondary care Clin. Guidel. 26, Natl. Inst. Clin. Excell London:
  47. NICE 2006. Computerized cognitive behaviour therapy for depression and anxiety Technol. Apprais. 97, Natl. Inst. Clin. Excell London:
  48. NICE 2009.a Depression in adults with chronic physical health problem: treatment and management Clin. Guidel. 91, Natl. Inst. Clin. Excell London:
  49. NICE 2009.b Depression: treatment and management of depression in adults Clin. Guidel. 90, Natl. Inst. Clin. Excell. London:
  50. NICE 2011. Common mental health disorders: identification and pathways to care Clin. Guidel. 123, Natl. Inst. Clin. Excell London:Summary of many of the clinical guidelines that underpin the IAPT program.
  51. NICE 2013. Social anxiety disorder: recognition, assessment and treatment Clin. Guidel. 159, Natl. Inst. Clin. Excell London:
  52. Pimm J. 2016. Plan, do, study, act: a methodology for enhancing recovery in your service Presented at IAPT Natl. Enhanc. Recovery Workshop, Birmingham, UK, March 16
  53. Pybis J, Saxon D, Hill A, Barkham M. 2017. The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: evidence from the 2nd UK National Audit of psychological therapies. BMC Psychiatry 17:215 [Google Scholar]
  54. Rapee RM, Heimberg RG. 1997. A cognitive-behavioral model of anxiety in social phobia. Behav. Res. Ther. 35:741–56 [Google Scholar]
  55. Richards DA, Suckling R. 2009. Improving access to psychological therapies: phase IV prospective cohort study. Br. J. Clin. Psychol. 48:377–96 [Google Scholar]
  56. Roth A, Fonagy P. 2005. What Works for Whom? A Critical Review of Psychotherapy Research New York: Guilford Press
  57. Roth AD, Pilling S. 2008. Using an evidence-based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behav. Cogn. Psychother. 36:129–47 [Google Scholar]
  58. Salkovskis PM, Rimes KA, Warwick HM, Clark DM. 2002. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol. Med. 32:843–53 [Google Scholar]
  59. Shear MK, Rucci P, Williams J, Frank E, Grochocinski V. et al. 2001. Reliability and validity of the Panic Disorder Severity Scale: replication and extension. J. Psychiatr. Res. 35:293–96 [Google Scholar]
  60. Spitzer Rl, Kroenke K, Williams JW, Löwe B. 2006. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 166:1092–97 [Google Scholar]
  61. Stiles WB, Barkham M, Mellor-Clark J, Connell J. 2008. Effectiveness of cognitive-behavioural, person centered, and psychodynamic therapies in UK primary care routine practice: replication in a larger sample. Psychol. Med. 38:5677–88 [Google Scholar]
  62. WHO (World Health Organ.) 1992. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines Geneva: WHO
/content/journals/10.1146/annurev-clinpsy-050817-084833
Loading
/content/journals/10.1146/annurev-clinpsy-050817-084833
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error