Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data

Abstract

SummaryBackgroundInternationally, the clinical outcomes of routine mental health services are rarely recorded or reported; however, an exception is the English Improving Access to Psychological Therapies (IAPT) service, which delivers psychological therapies recommended by the National Institute for Health and Care Excellence for depression and anxiety disorders to more than 537 000 patients in the UK each year. A session-by-session outcome monitoring system ensures that IAPT obtains symptom scores before and after treatment for 98% of patients. Service outcomes can then be reported, along with contextual information, on public websites.MethodsWe used publicly available data to identify predictors of variability in clinical performance. Using β regression models, we analysed the outcome data released by National Health Service Digital and Public Health England for the 2014–15 financial year (April 1, 2014, to March 31, 2015) and developed a predictive model of reliable improvement and reliable recovery. We then tested whether these predictors were also associated with changes in service outcome between 2014–15 and 2015–16.FindingsFive service organisation features predicted clinical outcomes in 2014–15. Percentage of cases with a problem descriptor, number of treatment sessions, and percentage of referrals treated were positively associated with outcome. The time waited to start treatment and percentage of appointments missed were negatively associated with outcome. Additive odd ratios suggest that moving from the lowest to highest level on an organisational factor could improve service outcomes by 11–42%, dependent on the factor. Consistent with a causal model, most organisational factors also predicted between-year changes in outcome, together accounting for 33% of variance in reliable improvement and 22% for reliable recovery. Social deprivation was negatively associated with some outcomes, but the effect was partly mitigated by the organisational factors.InterpretationTraditionally, efforts to improve mental health outcomes have largely focused on the development of new and more effective treatments. Our analyses show that the way psychological therapy services are implemented could be similarly important. Mental health services elsewhere in the UK and in other countries might benefit from adopting IAPT's approach to recording and publicly reporting clinical outcomes.FundingWellcome Trust.

Dose‐response patterns in low and high intensity cognitive behavioral therapy for common mental health problems

“…Conversely, extending therapy beyond these dose‐response intervals (up to 24 sessions; Robinson, Delgadillo, & Kellett, 2020) is warranted for patients who have shown signs of RCSI, and we strongly caution against the arbitrary restriction of treatment sessions for these cases. Prior research has shown that IAPT services that offer a low mean number of treatment sessions tend to attain poorer clinical outcomes (Clark et al, 2018), and therefore offering an adequate dose of therapy is central to effective and ethical practice (National Collaborating Centre for Mental Health, 2018). Although observing remission of symptoms is an important milestone in therapy, it is certainly not the optimal endpoint of treatment, since it is important to ensure that symptoms stabilize in the subclinical range before completing treatment.…”

Implementing cognitive behavioral therapy‐enhanced in a routine inpatient and outpatient setting: Comparing effectiveness and treatment costs in two consecutive cohorts

“…This study also contributes to enhancing transparency by making clinical outcome gathered over several years and numerous patients, public. Studying and learning from the variation in service outcomes can help develop more effective health care (Clark et al, ).…”

“…With regard to the clinical outcome, beside remission rates, results on reliable and clinical significant change were reported.This study also contributes to enhancing transparency by making clinical outcome gathered over several years and numerous patients, public. Studying and learning from the variation in service outcomes can help develop more effective health care(Clark et al, 2018).…”

Challenges of residual symptoms and functioning in management of MDD

“…4 IAPT services also use a unique session-by-session outcome-monitoring system to guide clinicians' choice of procedures and assess the overall outcome of a course of therapy. 5 Within primary care, QOF rewards practices for provision of 'quality care'. 6 Under QOF, primary care is only reimbursed for one review of a patient with depression (10-35 days after diagnosis) even though regular review (every two-four weeks in the first three months and then at longer intervals) is recommended.…”