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IAPT programme struggling to achieve targets

Exclusive The Government’s flagship scheme to expand access to psychological therapies is struggling to achieve its targets, with recovery rates dipping and patients in some areas waiting over a year for treatment.

A Pulse investigation found that CCGs in many areas were struggling to roll out the Improving Access to Psychological Therapies (IAPT) programme to all the intended target groups, and that over two-thirds were reporting waiting times longer than the 28-day maximum target.

Funding for the IAPT programme was also variable, ranging from £1.76 to £14.55 per head of population across CCG areas.

The results come as experts question whether the IAPT programme was cost effective and if it was reaching the right people.

The latest quarterly figures from the Health and Social Care Information Centre on the IAPT programme showed that although the number of patients accessing treatment went up in the first quarter of this year, the proportion of patients moving to recovery slipped back from 47% in the final quarter of 2012/2013 to 43% in the period from April to June this year, against a target of 50% of treated patients.

Overall more than 80,000 people in the system are still waiting for treatment more than a month after they were referred.

Data obtained by Pulse under the Freedom of Information Act from 85 CCGs reveals that 68% report treatment waiting times longer than the 28-day maximum target. Around half of these are down to longer waits for higher intensity therapy, with many areas reporting waiting times of three to five months for higher-intensity therapy while some have waits of over 12 months.

Less than half (44%) of CCGs offered a service that GPs could refer to for severe mental illness. Only 12% of CCGs said they have expanded access to psychological therapies for children through IAPT – a key group the Government wants to access the programme - although a spokesperson from NHS England said that GPs could access additional psychological therapy services for children through Child and Adolescent Mental Health Services (CAMHS) and that IAPT was helping to expand these services in some areas.

The IAPT scheme is being rolled out across England as part of a four-year Government ‘action plan’ started in 2011/2012, which aims to ensure at least 15% of adult patients suffering from common mental health problems who might benefit from appropriate psychological therapies can access treatment.  

The plan set out to reach a further 3.2 million people by the end of 2015 and to expand the programme to reach other key patient groups, such as children and young people and patients with severe mental illness.

But mental health experts questioned whether the programme was achieving the benefits projected when the IAPT programme was first launched.

Professor Tony Kendrick, professor of primary care at Southampton University said: ‘Although it’s effective in those who actually have the treatment, an awful lot of people referred only go along for the assessment, they don’t go on or they drop out. A lot of therapists’ time may be spent treating people who don’t engage with it.’

Consultant psychiatrist Dr David Christmas, from Ninewells Hospital and Medical School in Dundee, is particularly sceptical about IAPT, which he says has prompted psychological therapies to become ‘over-generalised’ to treat all severities and forms of depression, including some where the benefits are less certain.

He told Pulse: ‘It is reminiscent of Abraham Maslow’s quote that “it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail”.’

Dr Christmas said: ‘Most people going into IAPT are economically active and do not resemble the types of depressed patients most GPs see. We know these interventions likely offer little to patients, for example those with chronic depression, that GPs are struggling with. The problem is IAPT is the only game in town.’

But Professor André Tylee, professor of primary care mental health at Kings College London, said that IAPT was a great success.

He said: ‘Nationally, IAPT has been a great success in its first three-year report, having seen over a million patients and achieving 45% response rates and 65% improvement in anxiety and depression.’

He added: ‘Pilot funding to improve access to children and young people has only been available for a couple of years so it is not really that surprising it is taking a while to implement as the scheme is still largely in the pilot phase.’