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Wide variations in waiting times and outcomes show need for better access to psychological therapies

A new independent report, commissioned by Ieso Digital Health, calls on the Government and NHS England to further improve access to psychological therapies to bring about true ‘parity of esteem’ for mental health patients.

The independent study conducted by healthcare consultancy JMC Partners, ‘Psychological therapies: next steps towards parity of care’, analyses progress to date of the NHS’ flagship ‘Improving Access to Psychological Therapies’ (IAPT) programme. A copy of the report may be downloaded here (PDF, 2mb)

Overall, it judges the IAPT scheme to have been “a remarkable success story”. In its first six years (2008/9-2013/14), the number of people seen under the programme has soared from 40,000 to over 1.1million, while average recovery rates have risen from 37 per cent in 2009/2010 to 45 per cent in 2013/14.

But the report also highlights findings that suggest more can be done to ensure mental health patients in England get equal access to effective psychological therapies. In the current climate of financial constraint within the NHS, it argues this can be done without significant additional investment.

The report lists 21 recommendations cutting across the Department of Health, NHS England, Clinical Commissioning Groups (CCGs), the Health and Social Care Information Centre (HSCIC) and other bodies.

In examining access to psychological therapies, the report uncovers a number of stark findings:

  • A survey of 1,000 GPs across the UK, conducted as part of the report, found that 66 per cent see waiting times for psychological therapy as the biggest barrier to treatment.
  • 21 per cent of English GPs report that prescribing antidepressants is the most accessible treatment option for people with depression, whereas only 11 per cent said referring a patient to local IAPT services was the most accessible option.
  • Almost 37 per cent of total IAPT referrals in 2013/14 did not actually enter treatment – with many more not completing a course of treatment.
  • While 61 per cent of people in 2013/14 accessed IAPT services within 28 days of referral into treatment, 11 per cent - around 76,000 patients - waited for 90 days or more.
  • Despite increases in funding for mental health, physical health expenditure is more than five times that on mental health.
  • There is significant regional variation in mental health spend in England, ranging from under £8.5 million to over £30 million per 100,000 population – with similarly large variations in waiting times and recovery outcomes between the best and worst performing CCGs.

The health, social and economic cost of mental ill-health is estimated at £105 billion each year in England, according to the Mental Health Foundation.

Key recommendations from the report, which features excerpts from interviews with leading figures in mental health nationally, including NHS England Director of Mental Health Geraldine Strathdee and Dr Clare Gerada, Chair of London’s Primary Care Clinical Board, Hurley Group, and former Chair of the Royal College of General Practitioners (RCGP), include:

  • Ensure local IAPT services have an option for self-referral by patients rather than by GPs – still not an option in some areas. In April 2015, 42 per cent of referrals to IAPT were self-referrals
  • Improving triaging of patients to direct them to the service most appropriate to their needs and ensuring triage is managed by an independent third party (rather than a service provider)
  • Develop national standards for new models of care, such as digitally-enabled forms of therapy that enable patients to receive treatment via the internet.
  • Expand information website NHS Choices’ database of psychological therapies, both IAPT and non-IAPT.
  • For the Department of Health to consider bringing all psychological therapies under the IAPT umbrella

The report also notes that in localities where IAPT services are primarily based around face-to-face therapies, services may struggle to meet demand and lead to longer waiting lists. It calls for greater awareness to be made of other options, particularly technological innovations that deliver effective treatment.

Barnaby Perks, CEO of Ieso Digital Health, which commissioned the report, said:

_“The IAPT programme has seen a remarkable increase in the numbers of people being treated for common mental health conditions such as depression and anxiety. Combined with new access and waiting time targets, it is making a reality of the Government’s vision for mental health to have ‘parity of esteem’ with physical illness.

“Six years into the programme, now seems like an appropriate time to evaluate progress and also take an objective look at the evidence to see where access to effective therapies can be improved. In particular, we need to make sure that GPs and patients have access to, and are made aware of, different forms of treatment such as digitally-enabled services that allow patients to be seen quickly and treated effectively by professional therapists.”_

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