A report on the new government programme to help people with anxiety and depression recover has claimed an overall 42% success rate in its first year.
Improved Access to Psychological Therapies is the brainchild of London School of Economics professor Richard (Lord) Layard. He is also co-author of the new report.
In the 'Depression Report' Lord Layard imagined something like a national mental health service made up of two hundred and fifty teams providing Cognitive Behavioral Therapy in GP surgeries, job centres, workplaces or premises provided by voluntary organisations.
The service would pay for itself in people lifted out of unemployment or retained in work. Research showed that 'The typical short-term success rate for CBT is about 50%. In other words, if 100 people attend up to sixteen weekly sessions one-on-one lasting one hour each, some will drop out but within four months 50 people will have lost their psychiatric symptoms over and above those who would have done so anyway.'
It is to Lord Layard's great credit that this service has come into existence, though it seems at the moment to be somewhat short of his vision. With the recovery benchmark set at 50%, this was only achieved with Generalised Anxiety Disorder (52% recovered after a course of IAPT). The recovery rate was as low as 35% for recurrent depression and 27% overall in some areas of the country. On the other hand 63% showed reliable improvement across all conditions after at least two sessions of IAPT.
Whereas Lord Layard imagined up to sixteen sessions of CBT per case, the average number for the first year was only four sessions for so-called 'Low intensity CBT '- guided self-help, structured exercise and computer-based CBT - and five sessions for 'High Intensity CBT,' which is actual one-to-one therapy. The report found a person was more likely to recover if they received more therapy, indicating more resources are needed in this area.
A goal of IAPT was to widen access to therapy - not just in the number of therapists available (which are thin on the ground in the NHS), but also in providing ways for employees to be referred from work or for people to refer themselves without going through a GP. Bearing in mind the strain on GPs of patients with depression and anxiety and the high error rate in diagnosis, this seemed like a good idea.
Disappointingly the report found that only 7% self-referred with 85% coming through GPs and the rest through services such as A & E. There was no evidence that employers had referred employees at all.
Perhaps this is through a lack of awareness that the service exists, or because services offering IAPT are generally only accepting referrals from GPs. My small test using NHS Choices seemed to indicate that therapists were mainly only taking GP referrals. It also the case that employers tend to shy away from discussing mental health with their employees, to the detriment of both.
The recent DWP reports on mental health at work indicate that depression and anxiety are the leading causes of workplace illness, costing a minimum of £1,000 per head of the workforce per year according to the Centre for Mental Health.
Further investment in IAPT would seem to be one way the government could help.
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