Clients are waiting less time than ever to access IAPT services, and recovery rates have reached their highest ever level at 50.8%. So why am I not throwing my hat in the air? In a nutshell, the astonishingly high levels of attrition. With less than one in five that are referred and one in four that enter therapy achieving recovery, what is the experience of those that IAPT is serving less well?

First, the headlines. In the year 2017 – 18, the report and supporting datafile show that:

Headlines aside, there’s a story behind the numbers which I’ve broken down into four chapters. They are:

In each chapter I’ll show data for 2015 – 16, 2016 – 17 and 2017- 18.

The journey from referral – 30% of referrals don’t enter treatment

The journey starts with all referrals for the three years. The table below shows those referrals as 100%. Subsequent stages in the process, and the proportion of clients referred that still remain are also shown. In 2017 – 18, 70% of those referred entered therapy. This is defined as having one or more sessions of therapy. The proportions in both of the previous two years were broadly the same.

As we progress through their journey we can see an emerging story of attrition. By the end of therapy, only 39% of clients that were referred now remain (down from 41% in 2016-17) Those that reach recovery represent just 18% of the total referred . That’s less than one in five clients.

Why did only seven in ten referrals enter therapy? I can only speculate, but in doing this it’s important to note that nearly nine in ten referrals were seen within six weeks. Hence length of wait may not be the most important factor. Otherwise, they may no longer have needed therapy, their referral may not have been appropriate, or they may simply not have liked what was offered to them.

Chapter 2: The journey from entering therapy – 45% of clients that enter therapy don’t complete

We begin this chapter with all clients that entered therapy. That is, all those that had one or more therapy sessions. In 2017 – 18, 55% of those entering therapy are recorded as ending it. This figure is down 4% from 2016 – 17. Whichever year we’re talking about, however, the fact that more than four in ten clients do not complete should be a concern.

Following the journey through, we can see that just 26% of those entering therapy achieved recovery. In other words, clients entering therapy appear to stand just over a one in four chance of recovering.

Why are only 55% of clients recorded as ending therapy? Again, it’s hard to know. In my experience, however, clients more commonly drop out because they feel that therapy isn’t working for them for some reason. Often, they simply disappear without the opportunity to explore this with their therapist, and make adjustments that may better serve their needs.

 Chapter 3: The outcome at therapy ending for all clients – 53% of clients don’t achieve  recovery

Here we start with all the clients that are recorded as finishing a course of treatment. The first point to note is that not all clients were at a case level of symptoms or distress at the outset. No matter how much improvement they make, therefore, they cannot achieve recovery. In the 2017 – 18 population, 93% of clients were at case level, and could potentially recover. This is the same as in the previous year.

Those reaching recovery represent 47% of all those that finished treatment. For 2017 – 18, this is an increase of 1% over the previous year.

The outcome at therapy ending for clients that were at case level at the start – 51% of clients achieve recovery

The final leg of the journey, starting with clients who finished treatment that were at case level at the point they started. In this population we have all the clients who have the potential to achieve recovery.

In 2017 – 18, 51% of clients achieved recovery, of those that finished therapy and were at case level at the start. To be precise, the figure given in the IAPT report is 50.8% (against 49.3% for 2016-17).

The figure for those achieving recovery for 2016 – 17 is 1.5% higher than in the previous year. This is the first time that the recovery rate has exceeded the target of 50% that was established for the IAPT programme.

While this improvement is clearly welcome, however, it remains the case that almost as many clients do not recover as do. At nearly 51:49, the odds of recovering or not recovering are almost even.

Not all services perform equally

Using the tools that accompany the IAPT annual report, it’s possible to explore local and regional performance. Sadly, the datasheet which houses all of the raw data is now structured in such a way that it’s no longer possible to get a single improvement rate for each Clinical Commissioning Group (CCG) area and easily filter those to see the range of performance.

What I am loving, however, in this new reporting structure, is the IAPT Interactive Dashboard, which you’ll find at the foot of the Resources section of the summary page.  It’s the tool from which the image of the interactive map (main blog image at the top) is taken, and also the screenshot below.

The interactive tool allows you to filter performance data at a local level, either by hovering over the map or entering the CCG or commissioning region, for example. In the image above right, I’ve selected two CCG areas towards the lower and higher ends of the improvement range. If you’re interested in finding the performance for your local area I’d encourage you to go and have a play.

To summarise

In summary, then, there is some good news and some bad news. The good news is that clients are able to access services more rapidly than before and that for those that end therapy, their chances of recovery are more than one in two for the first time.

The bad news is that attrition is alive and well. 30% of referrals do not enter therapy. Only 39% of referrals reach the end of therapy, and only 18% achieve recovery. In that context, I find it hard to find too much to celebrate.

How do services improve?

I concluded the previous blog with a simple five-point plan that will assist any therapy service, IAPT included, to improve on its current performance. Rather than repeat myself here’s a link that will take you straight here.

I’d love to hear your thoughts on what you’ve read, whether you have a personal connection with IAPT or otherwise. Leave a comment below and please let us have your thoughts.