Bringing evidence-based practice to psychological therapy
12 December 2014
Depression and anxiety in adults together represent the largest proportion of significant mental health problems in the UK population. UCL research has been used to develop a programme supporting speedy access to evidence-based psychological therapies for these problems; that programme has now been used by more than a million people.
In 1996, Professors Anthony Roth and Peter Fonagy (UCL Psychology & Language Sciences) co-authored What works for whom? A critical review of psychotherapy research (WWFW), now a cornerstone for policy and practice in psychological therapy in the UK and around the world. A second edition was published in 2005, and in 2002, Fongay published What works for whom? A critical review of treatments for children and adolescents, evaluating the evidence for the full range of child and adolescent mental health treatments.
The book represented the first systematic and comprehensive review of all quantitative studies of the efficacy of psychological therapy in relation to the major diagnostic categories of mental health disorder; it is unique in its inclusion of a concise review and balanced evaluation of approximately 2,000 clinical studies in the first edition, and 2,500 in the second.
There are strong indications that the IAPT initiative is beginning to not only make a difference to individuals and their families but also to realise economic gains in terms of anticipated savings to the NHS and welfare system alongside increased tax contributions. - Norman Lamb, Minister of State for Care Services
WWFW has had a powerful and profound impact on treatment selection for therapists, service managers, service commissioners and (increasingly) patients. It is now a standard reference and teaching text for psychological therapy, for postgraduate training programmes and academic courses, and for a broad range of professional groups both in the UK, North America, Australasia and increasingly in Europe.
Through its impact on teaching and training it has had a significant influence on clinical practice, including via its inclusion in the UK government's Improving Access to Psychological Therapies (IAPT) programme. Launched in 2008, IATP represented a major strategic development within the NHS, aiming to ensure faster access to evidence-based psychological therapies for depression and anxiety in adults. Its drive through government was led by Lord Layard, whose case for the programme's development was underpinned specifically by evidence in WWFW.
Since its inception, IAPT has delivered benefits including:
- Increased funding for services: During the period 2008-13, NHS funding for psychological therapies increased significantly, from £161 million in 2007-08 to £389 million in 2011-12. When expressed as a percentage of the total NHS adult mental health spend, this is a rise from 4.0% to 6.6%.
- Better availability of therapists: Between 2008 and 2012 (the last date for which reliable figures are available), the IAPT programme had trained, or was training, almost 4,000 therapists, the vast majority in specific techniques for which there is clear evidence of efficacy, with further expansion in training planned.
- Increased number of patients treated: After its first three full years, more than 1 million people had used the new services; recovery rates were in excess of 45% and 45,000 people had moved off benefits.
Alongside its obvious impacts on individual wellbeing, IATP has delivered significant economic gains via NHS savings, reduced welfare spending, and increased return to the workforce.
In 2011 a four-year, £8 million/year investment was made to expand the programme's remit to include interventions for children and adolescents, with Professor Fonagy as the National Clinical Lead. In 2012, ministers agreed significant additional investment for 3 years, and in 2013 a decision was taken to extend the programme to 24 new sites, with services covering 54% of 0-19 year olds in England by the end of 2013.
Delivery of the IAPT programme has necessitated training a large number of additional therapists. To that end, a series of competence frameworks were commissioned from UCL researchers and have since been used to develop national training curricula, making a critical contribution to closing the gap in the 'bench to bedside' journey from the use of therapeutic technologies in research contexts to their implementation in 'routine' NHS settings. The frameworks also constituted the 'statements of evidence' on which the 2010 National Occupational Standards for psychological therapies were based.
More broadly, by espousing and comprehensively explicating the principles of evidence-based practice as applied to the psychological therapies, WWFW was a key driver in shaping the current commitment to evidence-based practice as an organising principle of almost all UK professional training in psychological therapy.