Most people with mental illness worldwide receive no treatment at all.1 The number benefiting from effective treatment is even fewer—eg, as low as one in six people with major depression receive effective care in high-income countries, and one in 27 people in low-income or middle-income countries.2 For mild-to-moderate depression, the treatments of choice are psychological therapies.3,4 Are there any examples of a health-care system successfully scaling up evidence-based practice for such common mental disorders? Yes: evidence is emerging that the Improving Access to Psychological Therapies (IAPT) programme in England fits this bill as reported by David M Clark and colleagues in The Lancet.5
Launched in 2008, the IAPT programme provides psychological treatment centres across the country and these centres offer individual or group therapies—largely cognitive-behavioural treatment (CBT) approaches—to people with anxiety or depressive diagnoses.6 Initial assessment, often by phone, determines whether a client is suitable for IAPT, needs low-intensity or high-intensity therapy, or needs to be referred to specialist mental health services.
The programme is unusual because of several features. First, standardised and manualised evidence-based intervention protocols are used, with intensive clinical supervision. Second, routine outcome monitoring occurs at each clinical session with the results fed back to staff and clients. Third, treatment is free at the point of care with the service funded by the tax-based National Health Service, with 209 teams distributed across the country (with an investment of £400 million from 2011 to 2015).7 Fourth, clients might receive both psychological and pharmacological treatment at the same time. Finally, the IAPT programme aims to achieve quantified access and recovery rates. The scale of the programme is remarkable, with the latest data showing that about 950 000 people a year access IAPT for an initial assessment and advice, of whom more than 537 000 receive a course of therapy.8
