Increasing access to psychological therapies will cost NHS nothing, says report
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4250 (Published 19 June 2012) Cite this as: BMJ 2012;344:e4250All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The Cost of IAPT Is At Least 5 Times Greater Than Claimed
Six years ago a News headline in the BMJ proclaimed ‘Increasing access to psychological therapies will cost NHS nothing’ BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4250, citing a report of Lord Layard of the Mental Health Policy Group of the Centre for Economic Performance http://cep.lse.ac.uk/_new/research/mentalhealth/default.asp, that claimed ‘after an average of 10 sessions half the people with anxiety conditions will recover, most of them permanently, and half the patients with depression will recover’. Far from being substantiated an independent assessment by Scott (2018), http://journals.sagepub.com/doi/pdf/10.1177/1359105318755264, using a standardised diagnostic interview, suggest a 10% recovery rate. This represents a five-fold increase of the cost of treatment per cured person.
The progenitors of IAPT, Clark and Layard in their book Thrive (2015) claim that the cost of treatment in IAPT is £650 per person, for people having attended 2 or more treatment sessions. This leaves out of account the 40% of its clients who attend only one treatment session [IAPT (2018)] and the costs of the initial assessments which totalled £92 million in 2016-2017, with total costs of £367,219,192 in that period. This means that the true cost of IAPT is at least 5 times greater than alleged, all without any government funded independent audit. Further average session attendance for those ‘treated’ in IAPT is 6.6 [IAPT (2018)] not the average of 10 sessions that Lord Layard deemed necessary, so that the average patient in fact receives a sub-therapeutic dose of treatment.
In 2012 Lord Layard claimed ‘the average improvement in physical symptoms is so great that the resulting savings on NHS physical care outweigh the cost of the psychological therapy’. This claim remains unproven and what limited evidence is available points in the opposite direction. How do Clinical Commissioning Groups justify paying such inflated sums? how can they be sure another agency could not achieve the same for less? how do they know that GPs simply tracking clients with depression and anxiety disorders would not achieve the same outcomes? NHS England should surely advise CCG's to ask searching questions and organise a long overdue government funded independent audit of IAPT focusing on real world outcomes, such as loss of diagnostic status..
BMJ (2012) ;344:e4250 Increasing access to psychological therapies will cost NHS nothing, says report
Clark, D.M and Layard, R (2015) Thrive: The Power of Evidence-Based Psychological Therapies London: Penguin.
IAPT (2018) Psychological Therapies: Annual report on the use of IAPT services England, 2016-17 Data Tables. NHS Digital: Community and Mental Health Team.
Mental Health Policy Group of the Centre for Economic Performance (2012) How mental health loses out in the NHS. http://cep.lse.ac.uk/_new/research/mentalhealth/default.asp.
Scott, M.J (2018) IAPT: The Need for Radical Reform. The Journal of Health Psychology, 23, 1136-1147.
Dr Michael J Scott
Liverpool
Competing interests: No competing interests
Increasing access to psychological therapy is an important intervention particularly for those who are severely depressed. Access to psychotherapy is only useful when given in primary care and before the patient becomes treatment resistant. It is well documented that CBT is ineffective when a patients' get to the point of needing to be referred to a consultant psychiatrist. That said, there are two other important issues regarding improved access and suceesfull outcomes.
First is that the effective outcome of psychotherapy depends on the quality of the psychotherapist;the one who has the ability to tailor psychotherapy to the needs of each individual patient.
Secondly, improving access due to the increase in the number of available psychotherapists is likely to mean that there is a potential for infinitely expandable demand. The greater the provision made, the more likely it is that the increase in provision will itself create an expanding demand.
Competing interests: No competing interests
Re: Increasing access to psychological therapies will cost NHS nothing, says report
Nowadays, Religious CBT and group interventions with the help of spiritual leaders are recognized effective psychological therapies, so encouraging patients to get involved in religious practices will have zero costs to the NHS.
References
https://www.ncbi.nlm.nih.gov/pubmed/26200715
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921896/
https://www.ncbi.nlm.nih.gov/pubmed/23420279
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474022/
Competing interests: No competing interests