How do we improve access to psychological therapies?

Simon Lawton Smith, Head of Policy at the Mental Health Foundation:

"A report from the London School of Economics (LSE) published in June (1) says the NHS in England is failing millions of adults and hundreds of thousands of children with common mental health problems such as anxiety and depression. It claims that only a fraction of people suffering from mental illness have access to treatments, primarily psychological therapies, which would improve their lives and save the taxpayer billions of pounds every year.

The report suggests that NHS trusts are failing to commission evidence-based psychological therapies such as cognitive behaviour therapy (CBT) and family therapy, despite their being recommended by the National Institute for Health and Clinical Excellence (NICE). The costs of psychological therapy are relatively low and recovery rates are high (at around (50%), so investment in psychological therapies will almost certainly pay for itself through higher rates of employment among people with mental health problems, reduced disability benefits and extra tax receipts.

The report focuses largely on the Department of Health’s Improving Access to Psychological Therapy (IAPT) initiative. IAPT was introduced in England in 2007 with a considerable amount of extra funding, and was an important step forward for the provision of psychological therapies. But there are concerns that waiting times for therapies remain long in many parts of the country, and also that there are simply too many people who could benefit from a talking therapy for the current provision to cope. New evidence (2) suggests that the impact of the economic recession over the past four years has been to significantly increase levels of anxiety and depression in the population, adding to pressures on services.

Plans for the future

The Government has made a commitment to expand IAPT services, especially to children and young people and older people. To give this further momentum, the report urges the new NHS Commissioning Board to take on IAPT as one of its high priority projects. From the training perspective, it argues that IAPT should also be a high priority for Health Education England.  

We campaigned for more psychological therapy provision and have welcomed the Government’s commitment and the positive findings from the IAPT work so far. The fact that around two in five people with depression or an anxiety disorder who completed the treatment have recovered from their condition and that others who have not have fully recovered have seen an improvement is a huge achievement.  

But this only highlights that there are many people, including children, older people, and people from certain Black and minority ethnic (BME) communities with mental health needs that remain unmet. Implementation is patchy. There is a real danger that it will remain so unless the new NHS commissioning structure in England, led by local GP-led Clinical Commissioning Groups (CCGs), understand both the high level of need and potential health and economic benefits to continued investment in the programme.

Of course we are not naïve about the challenges faced. Some areas are struggling because of the lack of qualified staff and very tight resources. It is essential that mental health services staff are adequately trained and selected to meet the patients’ complex needs, but this is not going to happen overnight. It’s good news that the Government’s draft mandate for the NHS Commissioning Board includes a commitment to roll out the IAPT programme by 2014/15 so that at least 15% of those with relevant disorders can access services. However this clearly remains a very low proportion of people who could benefit, and we will continue to campaign for psychological therapies to be available to everyone - not just a few - who needs them."


(1) LSE (2012) How Mental Illness Lose Out In The NHS http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf
(2) Insight Research Group (2012) Austerity Britain http://www.insightrg.com/austerity-britain/

Published 06 September 2012 |
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