What do the ex-Chancellor of the Exchequer Kwasi Kwarteng and the founding principles of the Improving Access to Psychological Therapies Programme (IAPT) have in common? Answer: A hopeful start, after which both have failed to survive contact with reality. The difference? One has had a vanishingly short half-life, while the other, despite recovery rates falling to their lowest for five years, limps on.

Estimated reading time: 4 minutes

In which Kwasi encounters reality

Kwasi Kwarteng, remember him? The man who, as Chancellor of the Exchequer in his Growth Plan 2022 speech, promised “…..a new approach for a new era.” The man who, through a combination of reduced taxes and deregulation, promised to so turbocharge our economy that it would grow to fill the gap between taxation and spending commitments.

Superficially, it made for a compelling argument. Unfortunately for Kwasi, it didn’t survive contact with the markets. Potential investors took one look and said ‘no thanks’. The value of the pound fell, the cost of government borrowing rose, and the hole in the nation’s balance sheet widened further.

IAPT: The promise we were sold

IAPT was sold to the last Labour government by Professor Lord Richard Layard as a means of alleviating the burden of common mental health conditions such as anxiety and depression, one that would be cost-effective and eventually pay for itself by increasing productivity and reducing state benefits.

Again, a compelling argument. The broad premise is illustrated below. Take a very large cohort of people with the most common mental health problems and give them a NICE approved course of treatment. Two-thirds will complete treatment. Of those, one-half will recover. A significant proportion of those on benefits will move off them.

As we’ve highlighted before, the reality has been rather different. For 2020 – 21, nearly four in ten clients that started treatment had one session only. Clients that achieved recovery represented just 21.3% of those that were referred to IAPT, and 29.9% of those that started treatment.

As with Kwasi Kwarteng’s Growth Plan, the idea that IAPT is a success seems to reside only in the minds of those who conceived it. And now, according to latest IAPT Annual Report, the programme’s recovery rate has fallen to its lowest rate for five years.

IAPT: The reality it’s delivering

I take no pleasure in bringing you the picture presented by the latest IAPT performance data. It’s pretty dispiriting, so I’m going to keep this brief.

Of those clients that entered treatment, the proportion of those that ended treatment having had two or more sessions was 57.7%. Put another way, more than four in ten clients didn’t end treatment. That figure, as shown below, is a full four percentage points below that of the previous year. The proportion of clients finishing treatment is falling.

Not surprisingly, the proportion of clients that achieve recovery at the end of the treatment is also falling. For the year 2021 – 22, it stands at more than two and a half percentage points lower than the previous year.

The headline recovery rate most often shown for IAPT is based on the percentage of clients that start treatment at ‘case’ level and end below it. The rate shown in the 2021 – 22 annual report is 50.2%. Having filleted the numbers myself I come up with a figure of 50.3%, but I’m not going to quibble over the difference.

Whichever it is, the recovery rate for the past year has fallen to its lowest level for five years.

Are we doomed never to learn?

There’s an old saying – if it looks too good to be true, it probably is. Had Kwasi, and our erstwhile Prime Minister Liz Truss,  not been so ideologically driven, they might have realised that its implementation would be infinitely more challenging than they imagined.

Similarly, the premise behind IAPT is, on paper at least, a seductive one. Take a manualisable psychological therapy, deploy it on an industrial scale, alleviate a lot of misery, and recoup the costs. What’s not to like?

Where human processes are concerned, however, real life delivery is so much more complex than producing widgets. The gap between IAPT’s aspirations and reality is stark. As well as woeful attrition levels and mediocre outcomes, one estimate puts the true cost of IAPT as at least 5 times greater than has been claimed. All very predictable, all very avoidable.

It’s high time for a full independent audit of IAPT. Just don’t hold your breath…………….

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Posted by:Barry McInnes

4 replies on “When ideology meets reality

  1. Hi Barry,
    well, depressing, for sure. Do the BACP know about this? – I’m not sure I’ve seen them making much of a fuss about it.
    Anyway, I guess there’s little to be said. I saw that no-one else had commented, and wondered if, like me, they just couldn’t think of anything to say, although the information is helpful to me.
    You mention the costs of treatment. Did you come up with an estimate?

    1. Hi David and thanks for the comment. Sadly I think that people are getting a little desensitised to news of IAPT’s poor performance. I’m among them to be honest, which is why I kept the blog briefer than usual. As for BACP I can’t believe they don’t know, but perhaps don’t feel able to be overly critical, preferring to influence from within? Better in the tent than out? I really don’t know any more.
      On the issue of costs I haven’t seen much of great value since the Radhakrishnana M., Hammond G., et al study in 2013. https://mentalhealthpartnerships.com/resource/cost-of-improving-access-to-psychological-therapies-iapt-programme-an-analysis-of-cost-of-session-treatment-and-recovery-in-selected-primary-care-trusts-in-the-east-of-england-region/

      The estimated average cost of a high intensity session was £177 and the average cost for a low intensity session was £99.

      The average cost of treatment was:

      £493 (low intensity)
      £1416 (high intensity)
      £699 (stepped down)
      £1514 (stepped up), and
      £877 (All)
      The cost per recovered patient was:

      £1043 (low intensity)
      £2895 (high intensity)
      £1653 (stepped down)
      £2914 (stepped up),
      and £1766 (All)

      Bear in mind now way out of date!

  2. When are they going to take action? It’s incredibly demoralising to work within a system that is not working due to it’s design.

    1. Hi Janet and thanks for your comment. IAPT should have been subjected to an independent audit long ago, but I think there are too many vested interest to make this likely.
      Keep hoping!

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