Understanding outcome variability and improving recovery rates for psychological therapies
In Britain today, one in six adults suffers from depression or a crippling anxiety disorder and it is estimated that at least a third of families includes someone who is mentally ill.
World Health Organisation measures of the scale and severity of illness find mental illness accounts for nearly 40% of all illness in rich countries like ours. By contrast, stroke, cancer, heart disease, lung disease, and diabetes account for under 20%.
In 2008, the government introduced a national programme which was aimed at ensuring all those suffering with anxiety and depression would be able to access evidence-based psychological therapy treatment for their mental health problems. The Improving Access to Psychological Therapies (IAPT) initiative has been rolled out successfully across England and patients can now access effective psychological help.
The Oxford AHSN Anxiety and Depression Clinical Network works with all the IAPT services in Berkshire, Buckinghamshire, Oxfordshire, Bedfordshire, Luton and Milton Keynes which are used by 19,000 patients a year. Our vision is to consistently provide the right, NICE-recommended psychological treatments of the highest quality in a timely fashion so that more patients will achieve recovery and enjoy a better quality of life as a result of treatment.
Our analyses of patient outcome data quantify variations in access rates and outcomes (recovery and reliable improvement rates) by service, by clinical condition (depression, post-traumatic stress disorder, generalised anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, panic disorder, health anxiety and specific phobias), and by patient demographics (e.g. age, ethnicity).
Once outcome variability has been quantified, the network aims to identify predictors of that variability in terms of service models, procedures, types of interventions, therapist training, etc.
The findings are fed back to services so that they can use them to restructure their service provision, as appropriate, to further enhance patient outcomes.
As well as local monthly collection of outcome data from all IAPT services which is discussed at a collaborative half-day workshop every three months, the network has also started a large, 12-month data download of more than 20,000 patients for analysis.
A ten percentage point increase in average recovery rate
The Anxiety and Depression Network has continued to grow and nurture strong partnership relationships across all its project areas. Busy service leads and their data leads continue to meet regularly with the network clinical leads and the network manager to review and enhance patient outcomes and as a result the network achieved a ten percentage point increase in average recovery rates* in 2014/15 from 47-57%.
Since May 2015 the average recovery rate has remained stable and significantly above the national average (45-48%) despite more patients accessing these services and no additional funding.
From January 2014-November 2015 the following gains were made over and above national rates:
- an additional 3,199 patients recovered
- an additional 1,631 were still in recovery two years on
- 384 additional people returned to work
- £755,494 saved for the NHS taking account of extra staff training costs.
* Recovery rate = by the end of treatment the patient has dropped below the clinical/non-clinical threshold for both anxiety and depression.