Lessons from the IAPT Programme to Date David M Clark National Clinical Advisor

Where are we up to? IAPT is delivered by 96% of PCTs and covers 56% of the population Currently see approx 460,000 per year Stepped care (42% low intensity only, 17% low & high, 32% high only. Average step-up rate 30%) Average recovery approx 43% BUT the most severe cases improve most. Reliable improvement 64%. Reliable deterioration approx 7% Better outcomes linked to providing NICE compliant therapy, in adequate adequate dose, using stepped care, by a team with a substantial number of experienced therapists plus employment advisers. (see Enhancing Recovery rates report at

Training & Trainees Aligned to treatments in NICE RCTs (not generic CBT) National Curriculae & Competencies Framework Extensive (30-60 days), accredited courses. Aim for trial therapist competence (essential in SMI given smaller effect sizes than depression/ anxiety literature) Modelling of therapy by experienced clinicians Competitive selection of the best trainees (not in-service training). Outcome Monitoring (essential for continued political support) Pre-post data from everyone (<90%) who is treated (liberally defined as ≥ 2 sessions). Well-validated measures, condition specific as well as generic. Public transparency (NHS Information Centre website)

Why getting complete data matters. (Clark, Layard, Smithies, Richards, Suckling & Wright, 2009)

Services require: Core of experienced staff who are competent in relevant therapies Written clinical protocols covering assessment & treatment of each condition IT system for outcome measures and supervision Weekly outcome focused supervision for trainees & other staff Assertive outreach to referrers Self-referral Ambition, desire for innovation, openness to what the data tells you about your service.

Delivering an effective national programme Economic Argument: Crucial. Do NOT ignore. Project Management –Signed-off plans, detailed national documents, governance (DH in partnership with NHS) Stakeholder engagement –Clinical leadership & national advisors –Charities and Professional bodies –Users, the public, the media Policy and political alignment –Reflect and enable big policy agendas Momentum and making it work –Early wins –Clear aims –Deliver to political timetable –Communications

Thank You