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A guide to Improving Access to Psychological Therapies services

The Improving Access to Psychological Therapies (IAPT) Manual is the definitive source of information on how to set-up and deliver excellent IAPT services, says Professor David M Clark.

Depression and anxiety disorders can have a devastating effect on individuals, their families and society. Thankfully, considerable progress has been made in developing effective psychological therapies. This progress has been recognised by the National Institute for Health and Care Excellence (NICE) which now recommends particular psychological therapies as first choice interventions for depression and anxiety disorders. In most countries few members of the public benefit from these advances as there are insufficient appropriately trained therapists. England is an exception. Starting in 2008, the NHS has trained and employed an increasing number of clinicians to work in IAPT services. People treated in these services can expect to receive a course of NICE-recommended psychological therapy from an appropriately trained individual and to have their clinical outcomes monitored and reported.

From small beginnings a decade ago, the IAPT programme has grown so it now sees over 900,000 people a year. Around 550,000 have a course of psychological therapy. The others receive an assessment, advice and signposting (if appropriate). A unique monitoring system ensures over 98% of treated individuals have their depression and anxiety assessed at the beginning and end of treatment. Some attenuation of clinical outcomes might be expected when treatments are delivered outside the artificial environment of clinical trials. However, IAPT set itself the ambitious target of achieving similar results. Specifically, at least 50% of people who have a course of treatment (two or more sessions) should recover.

Initially, this was an elusive target but it was finally achieved in January 2017. Currently, one in two people who have a course of treatment in IAPT recover and two out of three people show worthwhile improvements in their mental health.

Achieving such excellent results has not been easy. Psychological treatments are more difficult to deliver than medication. However, much has been learned from the experience of IAPT services, therapists, patients, and trainers, as well as from analyses of the national data. The IAPT manual brings this learning together in a single document that covers workforce, measures, outcomes, supervision, investment, and service improvement.

The Five Year Forward View for Mental Health commits the NHS to further expand IAPT so up to 1.5 million people a year are seen by 2021. The IAPT Manual has been written to help commissioners, managers and clinicians expand their local IAPT services while maintaining quality and ensuring that patients receive effective and compassionately delivered care. Readers will find invaluable guidance on setting up and running an efficient IAPT service that achieves good outcomes while creating an innovative and supportive environment. Among other things the manual is clear on the importance of ensuring:

  • All staff have been properly trained and benefit from regular supervision.
  • Patients are treated promptly, receiving the appropriate NICE recommended treatment(s) for their particular clinical condition and up to the NICE recommended number of therapy sessions.
  • Patients have the option to self-refer, and are given a choice about their therapy and how it is delivered.
  • Services encourage and respond to patient feedback; have a focus on ensuring the well-being of their staff; and ensure that therapists can join their patients in the out-of-the office therapy assignments that are a critical part of most NICE recommended treatments for anxiety disorders.

The Manual also dispels some myths. For example, national data show that IAPT is not just for mild to moderate problems. Around half of the people with depression have moderate to severe symptoms.

IAPT is a work in progress. Much more can be learned about how to effectively deliver psychological therapies at scale. For this reason, the IAPT manual also provides guidance on how to use local and national data to better understand the strengths and limitations of a service, along with advice on developing and evaluating service innovation projects.

Read more information about the history of IAPT and how it has developed.

David Clark

Professor David M Clark holds the Chair of Experimental Psychology at University of Oxford and is the National Clinical and Informatics Advisor for the IAPT programme. Along with Lord Richard Layard and other colleagues, he is one of the original architects of the programme. He is well-known for his research on the understanding and treatment of anxiety disorders, especially panic disorder, social anxiety disorder and post-traumatic stress disorder. Recognition of his work includes Lifetime Achievement Awards from the British Psychological Society and the American Psychological Association.

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