Innovation summary

A comprehensive training program was launched for new therapists, providing training in psychological treatments which have strong evidence of effectiveness from clinical trials. Individuals with mild to moderate symptoms are first offered a low-intensity intervention, such as guided self-help. If they fail to benefit from the low-intensity intervention, or have a severe disorder, they are offered high-intensity, face-to-face therapy.

A comprehensive monitoring and evaluation system collects performance data on service access, treatment provision and routine session-by-session service user-reported outcomes.

Impact summary

  • More than 1.7 million people have used the service1
  • Of the people who have completed a course of psychological therapy, two-thirds showed reliable improvement and 43% recovered completely1
  • 71,000 people treated by IAPT have moved off sick pay and benefits1
  • It is estimated that the cost of the service is fully recovered in savings to the government; through reduced incapacity benefits, increased taxes and reduced expenditure on physical healthcare2

I hear GP colleagues saying that [IAPT] is the single most positive change to their medical practice in the last 20 years, and I echo this… They have filled a huge gap in need, and are a force for good.


– UK General Practitioner

Innovation details

IAPT is  a comprehensive training program for new psychological therapists in evidence-based psychological therapies recommended by the National Institute for Clinical Excellence (NICE); including Cognitive Behavioural Therapy (CBT), interpersonal psychotherapy, couples therapy and brief dynamic therapy. Training follows national curricula aligned to agreed competencies. People with depression and/or an anxiety disorder are either referred to IAPT therapists from primary care, or self-refer.

Specialist (IAPT) psychological therapy services for depression and anxiety disorders have been established based on stepped care principles. All patients receive an initial assessment and guidance. Around 60 -70% are considered in need of a full course of treatment within the IAPT service. In line with NICE’s recommendations, many individuals with mild to moderate symptoms are first offered a low intensity intervention (such as guided self-help). If they fail to benefit from this intervention, they are “stepped-up” to high intensity face-to-face therapy. More severe cases plus those with posttraumatic stress disorder or social anxiety disorder go straight to high intensity therapy, as NICE does not recommend stepped care for such individuals.

A comprehensive monitoring, supervision and evaluation system is core to the IAPT model. The system collects performance data on service access, treatment provision and routine patient-reported outcomes, with the latter recorded using validated symptom scales at every therapeutic session. An unprecedented pre- and post-treatment data completeness rate of over 90% has been achieved. The data is collated nationally, presented on a public website, and analysed to identify important lessons that can facilitate further service improvement, as well as providing a case for further scale-up of the program.

Key drivers

Evidence-based Clinical Guidelines

  • NICE has published clinical guidelines based on evidence from RCTs that demonstrated the effectiveness of certain psychological therapies for treatment of common mental disorders

Economic Support and Political Commitment

  • Economists and clinical researchers demonstrated that increasing access to psychological therapies would pay for itself through a reduction in depression and anxiety related costs (welfare benefits and medical costs) and increasing revenues (taxes from return to work, increased productivity etc.)
  • These developments lead to a political commitment by the UK Government to IAPT in 2007

Successful Pilots

  • Two pilots were funded, which demonstrated the effectiveness of the approach on the ground
  • These led to a series of recommendations for how IAPT could be most effectively implemented on a national scale

Challenges

  • Insufficient numbers of trained therapists to deliver talking therapies
  • General reluctance of clinicians to routinely collect data on the effectiveness of their interventions

Continuation

  • The UK government is expanding IAPT to children and adolescents, and to adults with long-term physical health problems or medically unexplained symptoms
  • A payment-by-results model is currently being piloted, using the database to incentivise improved outcomes rather than simply activities
  • Norway, Sweden, Canada and Australia are at various stages of adopting aspects of the IAPT model

Partners

Funders:

Evaluation methods

  • A comprehensive monitoring, supervision and evaluation system is core to the IAPT model
  • The system collects performance data on service access, treatment provision and routine patient reported outcomes with the latter recorded using validated symptom scales at every therapeutic session
  • An unprecedented pre and post treatment data completeness rate of over 90% has been achieved
  • The data is collated nationally, presented on a public website, and analysed to identify important lessons that can facilitate further service improvement, as well as providing a case for further scaling up of the program

Cost of implementation

The IAPT programme has been allocated a total of approx. $1, 150 million USD between 2008 and 2015, increasing the percentage of the total NHS adult mental health spend on psychological therapies from 3.2% to 6.6%.1 Cost-benefit modelling conducted before IAPT was rolled out estimates that as the cost per patient treated is small ($1,225 USD), the cost to the government would be fully covered by savings in state benefits and increases in tax revenue taxes. Experience confirms these estimates. Increasing evidence suggests that there were also significant savings on physical healthcare. Further benefits in terms of increased workplace output and reduced costs for other healthcare provision have also been highlighted.

Impact details

By July 2013 IAPT had trained over 5,000 new therapists.1 The number of areas with an IAPT service has increased year on year, and by August 2012, IAPT services were commissioned by every Primary Health Care Trust in England. It is estimated that 60% of the population potentially has access to the services.1 More than 1.7 million have used the service and it is intended that, by 2015, around 900,000 people will be using the services each year – roughly 15% of those who suffer from depression or anxiety disorders. 1

Approximately two-thirds of the people who used the services were offered and completed a course of psychological therapy. Of these, two thirds showed reliable improvement and 43% recovered completely. In addition, 71,000 people treated by IAPT have moved off sick pay and benefits. As services mature, recovery rates are increasing and in 2013 averaged 46%. Between-service variability in outcomes is strongly related to the extent to which services stick to the IAPT model in terms of offering NICE compliant treatment in an adequate dose and delivered by appropriated trained and supervised clinicians.3

It is estimated that the cost of the service is fully recovered in savings to the government, in terms of savings in incapacity benefits, lost taxes and expenditure on physical healthcare.2

References

1. Department of Health (2012) IAPT three-year report: The first million patients.

2. LSE Centre for Economic Performance’s Mental Health Policy Group (2012) How mental illness loses out in the NHS. London: London School of Economics and Political Science.

3. Gyani AR et al. (2013) Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research and Therapy, 51: 597-606.

Research

Tools

Multimedia

Reports
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Country

United Kingdom of Great Britain and Northern Ireland

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