Did England's Ambitious Mental Health Care Experiment Deliver?

By Lyford, Chris | Psychotherapy Networker, January/February 2018 | Go to article overview

Did England's Ambitious Mental Health Care Experiment Deliver?


Lyford, Chris, Psychotherapy Networker


Almost 10 years ago, England embarked on what would become one of the nation's largest expansions of mental health care coverage. The architects of the Improving Access to Psychological Therapies (IAPT) initiative had an ambitious goal: to expand mental health care to as many people who needed it as possible, through evidence-based methods like cognitive behavioral therapy (CBT). In 2005, when the plan was first pitched to Parliament, one in four adults suffered from at least one diagnosable mental health problem, according to statistics from the National Institute for Clinical Excellence (NICE), the government body that sets standards on clinical treatments. And according to research published a year earlier in The British Journal of Psychiatry, depression alone was costing the English economy nearly nine billion pounds annually in lost productivity and unemployment benefits. If at least some suffering people recovered and went back to work, proponents argued, unemployment payouts would drop and the program would pay for itself. But could psychotherapy-at its core, most clinicians would argue, a process based on the development of relationships-really be systematized on a nationwide scale?

What began as a highly anticipated experiment quickly fell flat. To start, retention rates have been low: reports released in 2015 by the National Health Service (NHS) revealed that only 37 percent of those who'd entered the IAPT program-after going through the required referrals from their general practitioners-completed the allotted 12-session treatment, while those providing treatment have been criticized as unprepared. Exclusively green-lighting methods like CBT has also caused an uproar among many in the clinical community. An October 2014 article in The Daily Mail, "Is the NHS's Therapy for Depression a Total Waste of Time?" was just one to take IAPT to task. In the piece, contributing psychologist Oliver James offered a withering critique. "Cognitive behavioral therapy is all about marketing-it is a cheap, quick fix," he wrote, citing research that claimed those who received CBT showed no more signs of recovery than those who forewent treatment.

IAPT also took heat for its multitiered treatment system, including many practitioners with little training. Clients can eventually see therapists in person, but the first gatekeepers in IAPT are call center workers with little professional experience and only one year of CBT training. A January 2016 article in The Guardian, "Can Call Center Therapy Solve the Mental Health Crisis?" profiled a "cramped call centre" in Oxford, painting a picture of overworked staff, some of whom called the program a "clumsy cure-all for complex and profound traumas." Another critic referred to the call centers as "the clinical equivalent to online dating."

So how did a program like IAPT even get off the ground? The principal architect is Richard Layard, an economist, professor, and director of England's Centre for Economic Performance. When he developed the IAPT initiative, Layard was nearly five years into his tenure as an honorary peer in the House of Lords. During the 1990s, he'd become captivated by happiness economics, the study of forces that lead people to a happy or unhappy life. After a chance encounter at a party in 2003 with clinical psychologist David Clark, a leading CBT researcher, Layard was won over by the potential that Clark touted CBT had to stem the nation's growing depression and anxiety rates. Knowing the issue of mental health care would be a hot topic in the 2005 general elections, the two co-wrote a manifesto on behalf of the Labour Party, vowing "to invest in and improve our services for people with mental health problems at primary and secondary levels, including behavioral as well as drug therapies."

After the Labour Party won by a narrow margin, the two set about reinventing British mental health care, the goal being not "wealth creation," but "wellbeing creation," Clark said in a 2016 study published by the London School of Economics. …

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