Article: Lancet, "Improving access to psychological therapies in England", 2017, Thornicroft

[Andy]

My summary, "CBT, it's great and cures everything, but we still need more money"

Summary.
Most people with mental illness worldwide receive no treatment at all.1 The number benefiting from effective treatment is even fewer—eg, as low as one in six people with major depression receive effective care in high-income countries, and one in 27 people in low-income or middle-income countries.2 For mild-to-moderate depression, the treatments of choice are psychological therapies.3,4 Are there any examples of a health-care system successfully scaling up evidence-based practice for such common mental disorders? Yes: evidence is emerging that the Improving Access to Psychological Therapies (IAPT) programme in England fits this bill as reported by David M Clark and colleagues in The Lancet.

Full text: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32158-X/fulltext

 

[Esther12]

The accompanying piece is very pleased with itself over IAPT's collection of subjective self-report outcomes to assess efficacy.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32133-5/fulltext

Their criteria for reliable recovery doesn't sound that reliable:

Patients are reliably recovered if they reliably improve and their scores on both depression and anxiety are below the clinical cutoff scores9 at the end of treatment. ... The scores used to calculate reliable improvement and recovery are the last available after baseline scores, usually from the final therapy session but occasionally from an earlier session.

So someone could move just over the cut-off at one point in time and then be classed as 'reliably recovered'? Awesome.

 

[Trish]

''The original prospectus for IAPT relied heavily on delivering a strong return on investment from reductions in “presenteeism and absenteeism”, namely greater workplace productivity as a result of the treatment of employed people with anxiety or depression. However, little evidence has emerged that such productivity gains have been realised.''

This seems very significant to me. The whole project was sold to government as a cheap way of getting people back to work. He is saying this has not been successful. So does that mean the government will scrap it and put in something more useful. Of course not, because that would cost more.

And these cheaper treatments enable the government to claim they are treating more mental health cases than ever, while at the same time closing beds in psych units desperately needed for acute cases in crisis.

 

[Esther12]

While they cut benefits and push people into poverty it has become useful for the government to pretend that they're a world leader at empowering people to move away from a culture of dependency on benefits, regardless of the truth of the matter.