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. 2024 Jan 30;14(1):e077220.
doi: 10.1136/bmjopen-2023-077220.

Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation

Alice Porter  1 , Matthew Franklin  2 , Frank De Vocht  3   4 , Katrina d'Apice  3 , Esther Curtin  5 , Patricia Albers  3 , Judi Kidger  3
Affiliations

Estimating the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a real-world evaluation

Alice Porter et al. BMJ Open. .

Abstract

Background: Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health.

Objectives: To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links.

Design: A real-world evaluation using IAPT's electronic health records.

Setting: Three National Health Service IAPT services in England.

Participants: Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline.

Intervention: We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control).

Primary outcome measures: Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models.

Results: Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control.

Conclusions: Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models.

Keywords: Adult psychiatry; Electronic Health Records; MENTAL HEALTH.

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Conflict of interest statement

Competing interests: None declared.

References

    1. McManus S, Bebbington P, Jenkins R, et al. Mental health and wellbeing in England: adult psychiatric morbidity survey 2014. Natcen social research and the Department of health sciences University of Leicester,
    1. Daly M, Sutin AR, Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study. Psychol Med 2022;52:2549–58. 10.1017/S0033291720004432 - DOI - PMC - PubMed
    1. World Health Organization . Mental health. 2019. Available: https://www.who.int/health-topics/mental-health#tab=tab_1
    1. NHS England . The NHS Talking Therapies manual. 2023.
    1. NHS Digital . Psychological Therapies, Annual report on the use of IAPT services 2021-22. 2022.

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