None of us are immune to the possibility of suffering mental illness in our lifetimes. If we or those close to us ever experience psychological problems, our initial distress should at least be mitigated by knowing how and where to seek help.
As a sector, we talk a lot about improving the range and quality of mental health services, but that means nothing if the health and care system fails to signpost those services and make them easy to access. The Improving Access to Psychological Therapies programme (IAPT), formally launched in 2008, exists with the purpose of improving health outcomes through effective and timely treatment based on robust and continuous evidence gathering.
The programme’s comprehensive use of aggregated data has already transformed the treatment of anxiety disorders and depression in England. Its remit has now expanded to include common mental health problems with armed forces veterans and other cohorts. Some of the key principles of adult IAPT have also been used in the development of a service transformation programme for existing child and adolescent mental health services.
The most recent data released last week was particularly encouraging. The previous Government’s original target, that by the end of 2014/15 more than 15 percent of people with relevant conditions should be accessing services, has been exceeded in the final quarter. In those same three months, more than 355,000 people were referred for psychological therapies. That increased referral rate has led to more people entering and completing treatment – and while the recovery target of 50 percent has not yet been reached across the piece (45.5 percent), 70 clinical commissioning groups (CCGs) are reporting recovery rates above that published target. The percentage of people showing a reliable improvement after treatment continues to be over 60 percent.
There is good news about waiting times too. Of those people completing treatment in April 2015, 79.9 percent waited less than six weeks and 96.2 percent waited less than 18 weeks. These are above the 2015/16 targets of 75 and 95 percent respectively. While that is no cause for complacency (we want all services to achieve this ambition by March 2016 and for many more people to be seen within six weeks), it adds to the proof that evidence-based and timely psychological therapies, when deployed and monitored on a large scale, really do make a positive difference.
The programme is rich for adaptation and combination. For example, the programme has encouraged services to offer employment support, making sure a person’s recovery plan includes helping them return to work with confidence. This has a financial benefit for individual and State, raising our overall productivity, but it also addresses a more fundamental truth that a decent job in a supportive working environment is good for psychological health.
Likewise, for children and young people, the IAPT programme has promoted a strong focus on involving both the young person and their family. It seems self-evident to me that such approaches, with their emphasis on support and respect for the individual, encourage recovery beyond clinical interventions.
Looking ahead, the psychological therapies programme will continue to develop specialised services addressing particular mental health needs. For example, in respect of veterans, there are already 10 mental health teams across England, an online mental health counselling service (the Big White Wall) and a 24-hour mental health helpline provided by Combat Stress and Rethink, the mental health charity. The inclusion of the Armed Forces Covenant in the NHS Constitution this week can only help promote this work further within the care and support system.
Rolling out psychological therapies within the justice system is another priority for the national programme. Until recently, the emphasis has been on treating people with more serious mental disorders who are serving prison sentences. However, when you consider more than three quarters of the prison population experience some form of mental health problem, this suggests a need for a wider range of therapies to be available. The goal is to restore good mental health, reduce re-offending rates (an obvious benefit) and improve quality of life – for ex-prisoners and their families. NHS England is therefore working on adapting IAPT for use in custodial settings and I look forward to seeing the outcomes of this work soon.
Time is the enemy of progress and when it comes to mental health, the more we can do to speed access to therapies and, thereafter, keep people in recovery, the better. In a short time, IAPT has become something of a gold standard for this type of work, garnering international interest, and we will continue to promote its benefits to those working within local health and care networks.
We should not be satisfied with any of our results to date. What constitutes the gold standard will continue to evolve. We should always keep in mind that for many of the almost 1 million people who will benefit from the programme in the coming year, it will represent a life raft in turbulent waters. It is there, at the level of the individual encounter and experience that the programme really counts. Its most important number is ‘one’.
