Improving access to psychological therapy: initial evaluation of two UK demonstration sites
Open accessAbstract
Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.
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Previous studies found that self-referral and more particularly non-stigmatising self-referral increased access for ethnic minority communities.
“Of note is that previous studies found that self-referral and more particularly non-stigmatising self-referral, increased access for ethnic minority communities [39,40].”
From Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care (2014) · cites this paper as [39]
The Results (Newham; page unavailable) report that Black patients were more prominent among self-referrals than GP referrals, and conclude that self-referral improved access for this underrepresented group. The paper does not identify a non-stigmatising form of self-referral or show that it was particularly effective; its specific comparison also does not establish the same effect across ethnic minority communities generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBoth the PHQ-9 and GAD-7 have been shown to be sensitive to change when treatment response is monitored.
“Moreover, both measures have proven sensitive to change when monitoring treatment response.20;33-36”
From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [34]
In the Improving Access to Psychological Therapies project, cognitive-behavioral approaches were packaged as low intensity versus high intensity to expand workforce capability and ensure that people with less severe problems could receive care from less intensively trained practitioners.
“in the Improving Access to Psychological Therapies project, cognitive-behavioral approaches were explicitly packaged as low intensity versus high intensity to efficiently expand workforce capability and ensure that people with less severe problems could receive care from psychological wellbeing practitioners with less intensive training (Clark et al., 2009; Glover, Webb, & Evison, 2010)”
From User‐centered design for psychosocial intervention development and implementation. (2016) · cites this paper as Clark et al., 2009
In the Newham evaluation, social phobia and obsessive compulsive disorder were significantly more common among self-referrals than among GP referrals.
“Another finding of note was that social phobia and obsessive compulsive disorder (OCD) were found to be significantly more common among self-referrals than among GP referrals.”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
In the final 3 months of the Newham evaluation, the proportion of self-referrers increased to 42%.
“In the final 3 months of the evaluation, the proportion of selfreferrers had increased to 42%.”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
In the Newham evaluation, GP referrals and self-referrals did not significantly differ in the severity of their psychological problems.
“One key finding of the evaluation was that GP referrals and self-referrals did not significantly differ in the severity of their psychological problems.”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
In the Newham IAPT demonstration site, 203 people (22.8%) self-referred and 688 (77.2%) were referred by GPs.
“While the Doncaster site decided not to offer self-referral as an option, the Newham service did offer a selfreferral route and 203 people (22.8%) self-referred and 688 (77.2%) were referred by GPs.47”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
In the Newham evaluation, those who referred themselves more closely matched the ethnic mix of the community and were significantly more likely to be from black and minority ethnic groups than other referrals.
“Second, those who referred themselves more closely matched the ethnic mix of the community and were significantly more likely to be from black and minority ethnic groups than other referrals.”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
In the Newham evaluation, self-referrals had a slightly longer duration of their conditions (7.5 years versus 6.9 years), but this difference was not statistically significant.
“Finally, while self-referrals had a slightly longer duration of their conditions (7.5 years versus 6.9 years), this difference was not statistically significant.47”
From Can a self-referral system help improve access to psychological treatments? (2010) · cites this paper as [47]
Ireland is far behind its European neighbors in developing and implementing stepped-care models for mental health service delivery that involve both low-intensity and high-intensity interventions, despite it being recommended as best practice and its demonstrated success.
“Ireland is far behind its European neighbors in developing and implementing stepped-care models for mental health service delivery that involve both low-intensity (such as bibliotherapy) and high-intensity (such as face-to-face therapy) interventions, despite it being recommended as best practice [36] and its demonstrated success to date [37].”
From Low-intensity internet-delivered treatment for generalized anxiety symptoms in routine care: protocol for a randomized controlled trial (2014) · cites this paper as [37]
The UK Improving Access to Psychological Therapies program using a stepped-care model has proven successful.
“The experience of our neighbours in the UK through the Improving Access to Psychological Therapies program that uses a stepped-care model, introducing both low- and high-intensity interventions, has proven successful [31].”
The GAD-7 is increasingly used in large-scale studies as a generic measure of changes in anxiety symptomatology, using a cut-off score of 8.
“The GAD-7 is increasingly used in large-scale studies as a generic measure of changes in anxiety symptomatology, using a cut-off score of 8 [31,58].”
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- Authors
- Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B.
- Affiliations
- King's College London (GB)
- London School of Economics and Political Science (GB)
- University of Exeter (GB)
- East London NHS Foundation Trust (GB)
- Corresponding author
- Clark, David M.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 47
- Issue
- 11
- Pages
- 910-920
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC3111658
- OpenAlex
- W1990798545
- Cited by
- 599
- References
- 23
- Citations by year
- 2026: 18 · 2025: 14 · 2024: 18 · 2023: 31 · 2022: 17 · 2021: 45 · 2020: 38 · 2019: 31 · 2018: 30 · 2017: 39 · 2016: 41 · 2015: 43 · 2014: 54 · 2013: 48 · 2012: 41
- FWCI
- 51.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion)
- Figshare (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (069777)
- National Institute for Health and Care Research
- Economic and Social Research Council (RES-107-28-1001)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- Improving Access to Psychological Therapies, depression, anxiety disorders, cognitive behavioral therapy, stepped care, demonstration sites, guided self-help, self-referral, service evaluation, treatment outcomes, ethnic minority patients, employment effects, general practitioner referral
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Depressive Disorder, Female, United Kingdom, Health Services Accessibility, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Surveys and Questionnaires, Cognitive Behavioral Therapy
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