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Doubt cast on government claims for talking therapies programme

High drop-out rates for IAPT programme not taken into account, say researchers

Caroline White

Wednesday, 26 June 2013

Government claims for the success of its £400m talking therapies programme are “optimistic,” claims the director of a new research centre in Public Service Review: Health and Social Care.

Commissioners need to know the full facts if they are going to commission services to get the best outcomes for patients, he says.

The Improving Access to Psychological Therapies (IAPT) programme was launched in October 2008, since when it has supported services and commissioners to increase access to talking therapies, in a bid to change the way in which services are delivered.

In the 2010 Spending Review, the government committed an additional £400 million to IAPT over the four years to 2014/15.

But data from the University of Chester’s new Centre for Psychological Therapies in Primary Care suggest that ministerial claims made for the success of the programme have been overstated.

Norman Lamb, the care services minister, repeated the claim that recovery rates for the programme are “in excess of 45%” in his foreword to the Department of Health’s recently published three year progress report on the scheme.

But Professor Patrick Pietroni, the Centre’s director, takes issue with the way in which success rates have been measured.

He writes: “The preferred measure of Key Performance Indicators for IAPT is the percentage of patients ‘moving to recovery’ as a proportion of those who completed treatment—at first sight, an impressive percentage of 44%.”

But CCGs, now responsible for commissioning mental health services, will want to know what happens to all the patients GPs refer, not just the far lower proportion of patients who complete treatment, Professor Pietroni argues. And the claims do not take account of a high dropout rate.

“If claims are to be made about population health outcomes, then the denominator should be the widest possible,” he writes.

The Centre applied the denominator ‘patients referred’. Using this, ‘the moving to recovery’ outcome rate works out at a rather less impressive 12%.

Pietroni points out that a 2012 report by the Centre for Social Justice came to a similar conclusion, but presented it more negatively.

“IAPT figures claim recovery as over 40 per cent… but from the point of view of commissioners and referring GPs, 86 per cent are not being helped by the IAPT service,” this report noted.

Professor Pietroni concludes: “These points are not trivial. An earlier study of progress made by sites in the first rollout year of the programme (2008/9) suggests that 53% of referrals had one or fewer contacts with the programme, including 42% who were not assessed.”

Recognition and understanding of the needs and experience of these patients is as important as measuring the outcomes of those who completed more than one treatment session, he says.

“Commissioners of psychological therapies in primary care will want to exercise their own judgement as to which of these figures offers transparency to support analysis of outcomes,” he continues.

And he adds: “given the level of investment and the claims made, it is imperative that outcome data should be widely available in a form that helps commissioners to understand the nature of the patient journey through IAPT from referral.”

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