Are NHS mental health therapies working for everyone?

Today we’ve published a briefing on mental health statistics in England, including information on how common mental health problems are, and how NHS mental health services are performing. Here I discuss one key finding: mental health treatments appear to be working much better for some groups of people, while minority groups are experiencing worse outcomes. This raises questions as to whether NHS psychological therapies in England are working for everyone.

Getting help for mental health problems

A 2014 survey found that one in six adults in England had experienced a common mental health problem, such as depression or anxiety in the past week. In 2017, one in eleven people had been diagnosed with depression by their GP, and 12% of GP patients said in a survey that they were experiencing anxiety or depression.

NHS England’s ‘Improving Access to Psychological Therapy’ programme (IAPT) aims to make it easier for people with common mental health problems like depression and anxiety to get help that will improve their conditions. This often takes the form of ‘talking therapies’ like cognitive behavioural therapy or guided self-help. People can be referred to IAPT by their GP, or they can self-refer. In 2016/17, 1.4 million people were referred to IAPT, 965,000 people entered treatment, and 567,000 people finished a course of treatment.

The majority of people referred to IAPT are women (64%). In every CCG in England, more women were referred to IAPT than men in 2016/17.

Waiting times and recovery rates

NHS England has a number of goals for its IAPT services. Firstly, people should not wait too long for treatment – 75% of those referred should be treated within six weeks. This target is being met nationally, but there are big differences in waiting times across England. Our briefing sets out these differences.

Another goal is that IAPT treatment should be effective: specifically, half of those finishing a course of treatment should “enter recovery”, meaning they no longer meet the criteria for a clinical case of the problem they were suffering from. Improvement and recovery are measured using tests like PHQ-9 and GAD-7, which estimate how serious a person’s condition is. Note that these waiting targets don’t apply to services for other mental health conditions.

In 2016/17, 49.3% moved to recovery and 65.1% showed a ‘reliable improvement’ (i.e. a significant improvement), in their condition. Rates of recovery and improvement vary across England – but they also vary between different demographic groups of people accessing services.

Lower recovery rates in deprived areas

Referrals to IAPT are higher in deprived areas of England. People living in the most deprived neighbourhoods were twice as likely to be referred to IAPT as those living in the least deprived areas in 2016/17. However, of those finishing treatment, people in the most deprived areas were least likely to show reliable improvement (60%) or to move to recovery (39%), while those living in the least deprived areas were the most likely to improve (68%) or recover (58%). It’s possible that those living in deprived areas tend to have more serious mental health problems, which would mean that recovery is harder to achieve. But the reliable improvement measure isn’t affected by this, and so the data indicates that those living in deprived areas are less likely to experience positive outcomes from IAPT.

Those lioving in deprived areas are less likely to improve or recover after IAPT psychological therapy

 

Lower recovery rates for ethnic minorities

People identifying as White (including White British, White Irish and Other White) were more likely to move to recovery and to see an improvement in their conditions than those of other ethnicities. 50% of people identifying as White moved to recovery, compared with 44% of those identifying as Asian or Asian British. Meanwhile, 66% of those identifying as White reliably improved, compared with 61% of those identifying as Asian or Asian British.

People identifying as White are more likely to improve or recover after IAPT psychological therapy than other ethnicities,

 

Lower recovery rates for people with disabilities

Around 11% of people referred to IAPT in 2016/17 reported a disability of some kind. Those reporting a disability were less likely to reliably improve (60%) or move to recovery after IAPT therapy (39%), than those without a disability (66% and 52% respectively). People with a hearing disability had recovery and improvement rates similar to people with no disability. The lowest rates were for people with personal, self-care and continence disabilities – 55% of these reliably improved and 32% moved to recovery.

People with disabilities are less likely to show improvement or recovery after psychological therapy.

 

Lower recovery rates for LGBT people       

Information on sexual identity was collected for around 62% of those referred to IAPT in 2016/17. Around 3% of those identified as gay, lesbian or bisexual.

Those identifying as heterosexual were more likely to move to recovery after IAPT than any other group. Those identifying as bisexual were the least likely to show improvement, although there was little difference on this measure between people identifying as heterosexual and people identifying as gay or lesbian. No data is available on people identifying as transsexual.

People identifying as LGBT are less likely to show improvement or recovery after IAPT psychological therapy.

What do these inequalities show?

The findings above raise further questions. For instance, they aren’t adjusted for age breakdowns of demographic groups – for example, recovery rates among people aged under 35 are slightly lower than those in older age groups, so demographic groups that are disproportionately made up of younger people may be expected to have lower recovery rates, even independent of other factors.

Recovery and improvement rates differ across England (as described in our briefing paper), so some variation between different demographic groups may also reflect differences in the effectiveness of particular local services. Similarly, recovery rates vary for different mental health conditions, so if different demographic groups tend to have different types of conditions, this may be reflected in recovery rates.

 

Sources

Where not otherwise specified, data is taken from NHS Digital’s publication Psychological Therapies: Annual report on the use of IAPT services England, further analyses on 2016-17.