More work needed to help people access mental health support

A new study by researchers at the University of York suggests that a substantial number of people with common mental health problems in England may go untreated.

The researchers found that in some areas, less than 40% of people referred to NHS Improving Access to Psychology Therapy (IAPT) services actually attended their initial assessment and first treatment sessions.

Introduced in 2008, IAPT offers talking therapies for common mental health problems, such as depression, anxiety and obsessive compulsive disorder, and is widely regarded as having transformed NHS primary care mental health services in England.

But the study, by researchers from the University’s Department of Health Sciences, Hull York Medical School, and the University of Sheffield, suggests that the performance indicators for IAPT, which receives more than 1.5 million referrals annually, mask a significant shortfall in treatment of psychological disorders in the population.

Change needed

Lead author Dr. Jenny Sweetman, from the University of York’s Department of Health Sciences, said, “Our findings are in line with data from NHS Digital which show that over the last five years only between 36% and 43% of people referred went on to attend these first two IAPT appointments.

“The study suggests a need for changes to IAPT reporting. We need to better understand individual reasons behind non-attendance to these initial appointments to help more people to access appropriate mental health support.”

IAPT services offer an initial assessment, often by telephone, to determine whether IAPT treatment is suitable followed by a course of around seven treatment sessions.

Unclear percentages

Performance indicators for IAPT focus on service delivery and treatment outcomes but do not address non-attendance rates for initial appointments. As a result, the percentage of referrals that are not appropriate remains unclear, as do the reasons why so many people choose not to attend these first service appointments.

The research used detailed data involving nearly 100,000 referrals in five IAPT services across the North of England between 2010 and 2014. It found that 34% of people referred did not attend their initial assessment appointment. Only 57% of people who attended for assessment went on to attend the first treatment appointment.

Data included a range of population characteristics such as age, ethnicity, employment status and social deprivation. The analysis took account of whether an individual was referred for IAPT by a GP, other health professional or was self-referred.

Self-referral

The researchers found that people who self-referred were three times more likely to attend an assessment appointment than those who were referred by their GP. Younger people, those from ethnic minorities or from socially deprived areas were less likely to attend assessment appointments.

Individuals who were unemployed, long-term sick or disabled, caregivers or retired were significantly more likely to not attend an initial treatment session. Generally, people with anxiety disorders were more likely to attend treatment sessions than those with depression.

Drop-out

Dr. Peter Knapp, from the University of York’s Department of Health Sciences, said, “If people withdraw from the service for whatever reason and they continue to be symptomatic, that is a problem.

“The success of IAPT does not take account of the significant number of people who drop out. When only 39% of people referred go on to receive treatment, that suggests a waste of resources.

“Our concern is for the significant numbers of people who have been sufficiently symptomatic to warrant referral for IAPT but haven’t pursued treatment for whatever reason.”

The study is published in Psychotherapy Research. The researchers say that further work is needed to make it easier for people to access IAPT services and to understand the reasons for the high proportion of people referred by GPs who do not attend assessment or initial treatment appointments.