Facts & Figures

The Treatment Gap

Current situation

  • People who need help with psychological issues only have the Clinical Psychologist (CP) as an option. Described as High Intensity Cognitive Behavior Therapy (HICBT)

  • The high help-seeking threshold of a CP, combined with limited availability and high costs result in a treatment gap: not everyone who needs/wishes help can get it.

  • Symptoms which otherwise could have been treated can increase in severity because of waiting time or lack of help all together

Reducing the gap

  • The Low Intensity Treatment program aims to reduce the treatment gap by using Low Intensity Cognitive Behavior Therapy (LICBT).

  • This concept has been proven to work through the UK Improving Access to Healthcare Programs (IAPT)

Low Intensity Cognivite Behavior Therapy (LICBT)

Key Principles

  1. Efficiency

LICBT is a high volume approach that allows a practitioner to help more clients than can be achieved by high intensity format.

  1. Vehicles

LICBT allows for more ways to facilitate, such as selp-help materials, but also large format groups and computerised CBT programs.

  1. Early access

For clients to make best use of this form of CBT and maximise service effectiveness, individuals need to be able to access services early in the development of their mental health difficulties. As time goes by problems might become trenched and chronic which may reduce the client's ability to respond quickly to a low intensity approach.

Improving Access to Psychological Therapies (IAPT)

Programme of the UK government

  1. Background*

    • Mental ilness represents an enourmous cost to the nation. 40% of all disability resulting from mental illness and 1 in 6 individuals experiencing anxiety or depression.

    • There is a large human cost to those suffering and at that point in time, only 2% National Health Service (NHS) was directed towards treatments for anxiety and depression.

    • The financial cost to the government in terms of loss of work output was estimated at £12-17 billion.

    • In the proposed IAPT scheme, the projected cost of treating this individuals was as little as £0.6 billion**.

*These points come from Layard et al. (2006)**This was based on a forecast of 50% succes rate together with a reduced chance of relapse
  1. Process

    • The new profession of psychological wellbeing practitioners (PWP) will deliver this new treatment.

    • IAPT services should be deliverd through a stepped care model

    • IAPT practioners included at first only practitioners in HICBT or LICBT but later or evidence-based therapies.

    • Teams would be formed and include senior therapists would could provide supervision and other professionals (such as employment advisors) who could help in practical matters.

  1. Results

    • Only 3.8% of clients seen at step 2 to were subsequently stepped up to step 3*

    • 56% of clients who have received treatment had recovered when they were discharged from the service*

    • Higher recovery rates were observed by clients who had experienced difficulties for 6 months or less.*

    • PWPs now deliver the bulk of psycholigical care to adults experiencing common mental health problems in England.

*These points come from Clark et al (2009b)
  1. Limitations

    • In many instances psychological distress is caused and maintained by social and economical reasons that CBT alone cannot address:*

      • Hard manual labour;

      • Unemployed or insecurely employed;**

      • Absence of social support***

    • CBT cannot answer all these problems, but addresses some social and economic needs through inclusion of other advisors to the matrix of services.

      • A vital part of PWP is liaison with other forms of support (such as debt-management, epmployment advisors a.o.)

*These points come from Clark et al (2009a)** Wilkinson & Marmot (2003)*** Brown & Harris (1978)