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Mental Health and the NHS

August 28, 2015

The Improving Access to Psychological Therapies (IAPT) initiative provides short-term therapy to the general population presenting with mild-severe common mental health problems.  The initiative was set up following an economics paper written by Lord Richard Layard in 2005, who highlighted the impact of mental ill-health on the economy, particularly regarding the amount of people off sick from work due to anxiety and depression.  Lord Layard highlighted the lack of equitable provision for psychological therapies including long waiting times, a ‘postcode lottery’ system and inconsistent provision of evidence-based therapies.  Lord Layard maintained that if the Government were to invest in nationwide short-term therapy services for the general population, this would have overwhelming benefits, including economical benefit, savings to the DWP, an increase in skilled-worker jobs, and an improvement in the general wellbeing and mental health of society.



This was a magnificent initiative that has had a huge impact on NHS Services and individuals.  By 2011 alone, over 50% of the population of England had access to psychological therapies, 3,660 Cognitive Behavioural Therapists had been trained and over 120,000 people had accessed services and recovered from anxiety or depression.  I was provided training in CBT through the IAPT initiative and have worked within IAPT for over five years.  When I consider statistics such as these I feel very proud to be part of a service that provides so much support and help to individuals, and I am able to witness these improvements in peoples’ lives through my own work and the work of my colleagues.


However there is an increasing consensus that these underlying principles are being lost within the NHS, with a move from a focus on patient care and recovery to target-driven initiatives such as access rates, waiting list times and a reduction in session numbers and frequency.  Nationwide government targets are squeezing the quality out of services.  It is very important that individuals wait as little time as possible, however with the increasing goals and financial penalties for not meeting the targets set by the Government; provision is beginning to slip.


NICE recommended treatments such as 16-20 sessions of CBT delivered over three to four months for depression is now provided in some services at a reduced 8 – 12 sessions.  Due to the restraints of Payment by Results (PBR) many services are tightening up their acceptance criteria which leaves many clients falling between the gaps if they find their difficulties too severe for ‘mild to moderate’ services, but not chronic or disabling enough for community teams.  Therapists rarely have the luxury of working with people with chronic difficulties for longer in IAPT, even if it is to alleviate a little of their difficulties and help them understand their presentations further – as these individuals will not meet the ‘recovery’ criteria due to chronic health conditions or social difficulties.


Any Qualified Provider (AQP) has been introduced in some areas to encourage healthy competition and patient choice.  Instead, AQP has fostered a marketplace where employee health is the last priority, where target-specific payments necessitate services to compete using the only leverage available to them – shorter waiting lists (e.g. fewer therapy sessions).  The Government announced in March a £1.25 billion increase in spending on mental health – specifically in children’s and veteran’s services.  While I feel any spending in mental health is a positive move, I would love the Government to address the direction in which IAPT services are moving for the general adult population (  Recent reports have shown that CCG's intend to cut mental health spending in 2015/2016, rather than increase it (


Despite these difficulties, there is no doubt that people are still benefitting from accessing good quality therapists in IAPT services.  And despite the difficulties faced with new targets; the opportunity for the general public to access psychological therapies has never been higher.  I still remain positive and proud of the work that my colleagues and I deliver within the NHS, however I feel if the trend continues, something has to give.  The balance between patient care, staff care and targets is becoming increasingly uneven (



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