Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience

The Improving Access to Psychological Therapies (IAPT) program is a large-scale initiative targeting to upscale the availability of NICE recommended psychological treatment for depression and anxiety disorders with England’s Health Service. The IAPT program is set on the premise of a wide range of clinical and policy development, with the most prominent being the 2004 systematic review of NICE recommendations. In the NICE systematic review, evidence for the effectiveness of a variety of interventions relating to the management of depression and anxiety disorders were put into perspective. As a result of the reviews, a series of guidelines were adopted with some of them extending strong support towards the use of certain psychological therapies, with CBT being the most recommended treatment for depression.

Other recommended therapies include therapies (interpersonal psychotherapy, behavioral couples therapy, counseling, brief dynamic therapy) are also recommended (with varying indications) for depression, but not for anxiety disorders. The recommendations are based on evidence that some individuals respond well to low-intensity intervention. Thus, NICE also advocates for a stepped-care approach to the delivery of psychological therapies in mild to moderate depression and some anxiety disorders. In moderate to severe depression and in some other anxiety disorders (such as post-traumatic stress disorder) low-intensity interventions are not recommended and instead it is suggested that patients should at once be offered ‘high-intensity’ face-to-face psychological therapy.

In order to determine the outcome of the recommendations, the National Health Service (NHS) in England identified Doncaster and Newham as demonstration sites for pilot studies. Since 2006, each demonstration site received substantial funds to recruit and deploy an expanded workforce of CBT-focused psychological therapists. The sites were to be used in assessing the depression related clinical problems reported, the number of patients seen, the completeness of data reported, as well as the self-referral versus the GP referral. Based on the high level of data completeness on the PHQ-9 and GAD-7, it becomes possible to accurately assess any clinical improvements that the patients achieved while being treated in the demonstration sites.

Following the success of the Newham and Doncaster Demonstration sites and the submission of a detailed business case, which included reviews of controlled evaluations of CBT in depression and anxiety disorders, the UK Government announced that it intended to greatly increase the availability of evidence-based psychological therapies for depression and anxiety disorders throughout England through a phased roll- out that would last several years. Over the years, the support has been provided in terms of training and the adoption of an IAPT service model that has seen the establishment of IAPT services in 95% of PCTS. However, there still exist a wide variation in the number of therapists employed in the services and, as a consequence; they vary substantially in the number of patients that they are able to see.  Also, 3,660 new high-intensity therapists and PWPs have been appointed and put on training, with the IAPT services seeing around 310,000 patients per annum, with the aim of seeing around 900,00 per annum by 2015 when the roll-out of the program should be complete.

You have just read a summary of the research paper: Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23(4), 318-327.