Increasing Access to Psychological Therapies
New integrated services that bring together mental health and physical health care have been created and are achieving substantial savings in health care costs.
Post-traumatic stress disorder (PTSD) is a disabling anxiety disorder caused by extremely frightening or distressing events. These can include; warfare, terrorism, road accidents, natural disasters, sudden deaths and violent personal assaults, such as sexual assault, mugging or robbery. It is estimated that 1-1.5 million adults in the UK suffer from PTSD. The condition can severely affect people’s relationships and ability to work and, if left untreated, often leads to other health problems.
Research by Professor Anke Ehlers and her colleagues in the Department of Experimental Psychology led to the development of an effective cognitive therapy for PTSD that targets the central psychological factors behind the condition. This has been approved by the National Institute for Health Care and Excellence (NICE) as one of the first line treatments for PTSD. The success of the therapy has been recognized both in the UK and worldwide and led to the creation of the Government’s Improving Access to Psychological Treatments (IAPT) programme.
Professor David Clark’s group at Oxford were asked to train local clinicians in Northern Ireland in cognitive therapy for PTSD so they could treat traumatized survivors of the 1998 Omagh car bomb. As part of the initiative, they created a simple session-by-session outcome monitoring system that ensured almost everyone who was treated between 1999 and 2001 had a pre and post treatment measure of the severity of their symptoms. This was a radical improvement on the data completeness rates normally reported in NHS mental health services. The Oxford team’s session-by-session outcome monitoring system was subsequently adopted with great success in the IAPT programme.
The almost complete dataset generated by IAPT showed that there was considerable variability in the outcomes achieved by different services even though they are ostensibly delivering similar treatments with a workforce who are all trained according to consistent standards. In an analysis in 2013 of the first wave of IAPT services, David Clark and colleagues showed that certain types of treatment and ways of delivering those treatments were associated with better patient outcomes. In a subsequent study they analysed publicly available aggregate data and showed that key organisational features of IAPT services accounted for a substantial amount of the between service variability in outcomes during 2014/15. Furthermore, change in these features between 2014/15 and 2015/16 was shown to explain over 40% of the improvement in outcomes during the same period of time. Dissemination of these findings helped IAPT services to substantially improve the outcomes they achieve with patients.
Between mid 2013 and the end of 2020, the IAPT programme has trebled in size. From seeing 434,000 people a year with depression and/or anxiety related problems in 2012/13, it now sees approximately 1,200,000 people per annum and the NHS Long-Term Plan is committed to increase this further. Outcome data is collected from an unprecedented 99% of treated patients. The England-wide recovery rate for individuals who receive a course of psychological treatment improved from 43% to 52% during this period, meaning 230,000 more people recover each year. New integrated IAPT services that bring together mental health and physical health care have been created and are achieving substantial savings in physical health care costs. IAPT is being copied in other countries and provinces (Norway, Ontario, Israel, Australia). The work of David Clark’s research group has played a critical role in all of these developments.