More proof of the dismal failure of IAPT – so what next?

Improving Access to Psychological Therapies (IAPT) is the NHS programme introduced by New Labour to roll out services across England that it was hoped would help people with depression and anxiety disorders more effectively than drug treatments.

It sounds sensible, until you discover three things: how shockingly few patients are being helped by the programme; that it costs three times more than it was originally budgeted for and that it was relying almost solely on Cognitive Behaviour Therapy (CBT) as treatment.

A succinct and damning article in Therapy Today by Barry Mcinnes makes the following points:

In the early days of IAPT, 
a number of performance criteria were established 
for the programme. They included the aspirations 
that, by 2015, the programme should be treating 900,000 patients annually; that it should obtain pre- and post-treatment outcome data for 
at least 90 per cent of people treated, and that by 2010/11 50 per cent of those completing treatment should have moved to recovery. Against those targets, how has it performed?

In the 2012–13 period, 
the headline recovery rate 
for those 'records that 
were eligible for outcome assessment and were at caseness at the beginning 
of treatment' is 43 per cent – seven per cent short of the 50 per cent target. Unfortunately that headline rate is often all we hear of IAPT; there is much more to the story.

A total of 883,968 new referrals were received by IAPT services, representing 761,848 people. Of those referred, just 434,247 (49 
per cent) entered treatment. That's rather short of IAPT's original target of 900,000 people treated annually. With less than one year to go to 2015, more than doubling the number entering treatment seems rather unlikely.

A total of 534,721 referrals were recorded as ended in 
the year, but not all were happy endings – 50 per cent of ended referrals are attributed to patients either declining 
or dropping out of treatment.

The pool of people who could show recovery (defined as those who had two or more treatment sessions, were above the caseness threshold on at least one key measure 
at the start, and below the threshold on the PHQ-9 and anxiety measures at close) was 127,060. It is from this figure that the recovery rate 
is calculated. The actual number achieving recovery 
is 54,430. While this is indeed 43 per cent of those who 
could recover, it is also just 
12 per cent of those entering treatment – quite a contrast with the original aspiration 
of 50 per cent of those completing the programme moving to recovery.

Without getting lost in 
the detail, this suggests 
that a combination of many people either not achieving 
a 'case' level of distress and/
or high levels of drop-out is contributing to the fact that little more than one in 10 of people entering treatment can be shown to have demonstrably improved.
[...]
So not only is IAPT significantly under-performing against its stated aims, but it is costing over three times more than was originally estimated. Parity 
of esteem between mental and physical health may be the coalition Government's stated intention, but it is 
hard to imagine how a level 
of demonstrable benefit as low as this would be tolerated in physical health.

Human Givens practitioners predicted this waste of public money when we realised that IAPT was to naively rely on CBT as a methodology. 

Compare these statements with the main conclusions and recommendations from peer reviewed research into the effectiveness of Human Givens therapy in treating depression which gets results three times faster than control groups receiving conventional counselling, CBT or drug treatment:

1. That the HG model be officially considered by the NHS as a bona fide model of therapy in its own right. This would greatly hasten the implementation of further studies and ease commissioning from managers acquainted with, and confused by, the variety of therapeutic models to choose from.

2. That NICE should be made aware of some of the techniques used by this approach. The most obvious candidate for this would be the imaginal exposure technique known as ‘rewind’, which has much in common with established imaginal exposure techniques used in CBT and already approved by NICE.

3. That training in the HG methodology and concepts be formally accepted as a mainstream option for CPD within the mental health community.

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