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The IAPT programme has been rolled out across England in the last ten years. Although undoubtedly many people have benefited from having greater access to psychological therapy there are several issues with the practicalities of Improving Access to Psychological Therapies (IAPT) and also with its ideology. The paper aims to discuss these issues.

This is a personal reflection of working within the IAPT system for several years. Significant statements heard or interpretations of what has been said are presented alongside an analysis of the implications.

A number of important concerns are presented. The overarching concept of the “McDonaldization” process is discussed as a way of encapsulating the IAPT experience; with its theoretical reliance on the medical model and the real world impact of tendering for services in the modern NHS. The impact of IAPT on cognitive behavioural psychotherapy is also highlighted.

A lot has been written in the press and online about IAPT. Many of the criticisms seem to derive from people outside of the IAPT system, many of whom have their own personal or professional agenda for attacking IAPT and Cognitive Behavioural Therapy (CBT); often the criticisms are uninformed. This paper is a reflection of working within the IAPT system and not just an uninformed critique of CBT. Several concerns are raised that without remedy may seriously hold back the progress that psychological therapy has made in recent years.

The NHS Improving Access to Psychological Therapies (IAPT) programme provides access to psychotherapy in England through a stepped care approach for adults with depression and anxiety disorders. This evaluation sought to investigate IAPT recovery and reliable change rates of those who scored severe on depression (PHQ-9), anxiety (GAD-7) or impaired functioning (WASA). The paper aims to discuss this issue.

This evaluation employed a within groups design: a single case evaluation follow-up. Routine service data (from services set-up in 2008-2009 to February 2012) from 25,034 patients treated at four IAPT services was analysed.

The analysis revealed that 29 per cent (n=7,059) of patients were assessed as being in the WASA severe range, 41 per cent (n=10,208) in the PHQ severe range, and 57 per cent (n=14,612) in the GAD-7 severe range; with 14 per cent (n=3,548) in the severe range on all three measures combined. There were significant falls on all three measures and a large effect size. The percentage of patients who recovered to a point below the recovery threshold was 30 per cent for depression, 34 per cent for anxiety, 18 per cent for impaired functioning, and for those presenting severe on all measures: recovery rates were 21 per cent for anxiety, 26 per cent for depression, and 15 per cent for impaired functioning. Reliable change for anxiety was found to be greater than IAPT patients overall.

The results show that IAPT enables approximately a third of people scoring severe to recover, lower than IAPT recovery rates overall. Reliable change may be a more effective measure of patient progress.

The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them.

IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned.

There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning.

This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research.

To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally.

Two years ago, we published within this journal a scoping article (Turpin et al, 2006) concerning the urgent need to review and enhance the workforce responsible for delivering psychological therapies to people seeking help for common mental health problems in primary care (London School of Economics, 2006). We estimated that the demand for such interventions, the service models that might deliver increased capacity for psychological treatments, the implications for workforce numbers and the impact that this would have on education and training. Much of the thinking that was adopted within the review was based on current development work around the mental health workforce led by the National Workforce Programme sponsored by the National Institute for Mental Health England (NIMHE) on New Ways of Working (NWW).The current paper reflects on the process and the added value that NWW has contributed to what is a radical new venture, which has been described by the lead evaluator of the pilot Improving Access for Psychological Therapies (IAPT) phase, Professor Glenys Parry, as 'the industrialisation of psychological therapies'. More specifically, it reviews the implementation of a national programme designated as IAPT, which was commissioned on the basis of the NWW work, and the evidence accrued from the IAPT national demonstration sites at Doncaster and Newham, together with the efforts of Lord Layard and the New Savoy Partnership.The first year implementation of IAPT is described, together with the lessons learned from the roll out. As the programme has developed, it has become important to ensure that clients also have a choice of evidence‐based interventions. NWW has provided a means to help practitioners come together from a range of therapeutic orientations and professions to contribute to this more diverse workforce. Finally, it is argued that NWW has been instrumental in helping managers and professions alike think more flexibly about service models and provision, and how to develop a new workforce competent to deliver such an innovative service.

The purpose of this paper is to explore the importance of equal access to Improving Access to Psychological Therapies (IAPT) for people with intellectual disabilities.

The paper identifies barriers to access and shows how a reference group can work to solve the barriers and increase access.

The paper evaluates the authors’ progress to date and how the authors plan to continue to take the work forward.

The paper highlights some of the factors responsible for the authors’ success and gives information that will be helpful to other areas who are interested in facilitating equal access.

The paper demonstrates how the focus of a reference group can drive improvements across services to improve access for people with intellectual disabilities to IAPT services.

This paper considers the applicability of the Improving Access to Psychological Therapies (IAPT) initiative in meeting the mental health needs of people with learning disabilities.

The author considers the nature of the IAPT service, the potential benefits, the potential barriers and how local services could be better adapted to meet the needs of people with learning disabilities.

Although the IAPT service is well established for the mainstream population, for people with learning disabilities there are deficits and barriers at many levels. Increased attention should be given to removing barriers to access; the provision of “reasonable adjustments” in treatment; and to the monitoring of uptake and outcomes. Even with these issues addressed, the service will not meet the mental health needs of all people with learning disabilities.

Whilst acknowledging the potential value of IAPT, without specific consideration being given, mainstream approaches to mental health will not be applicable to all people with learning disabilities: “reasonable adjustments” need to be made not only at the direct clinical level but also throughout the system, from service commissioning to outcomes.

The Improving Access to Psychological Therapies (IAPT) programme was established to treat people with mild to moderate depression and anxiety and bring them to recovery. Although the Positive Practice Guide for people with intellectual disabilities was published in 2009, no geographical areas are listed as having a special interest in specifically rolling out IAPT to people with intellectual disabilities. Issues related to whether current IAPT services can meet the needs of people with intellectual disabilities are considered, along with adaptations that would be needed to ensure the service is accessible and meets the needs of people with intellectual disabilities.

This study aims to explore whether the cultural competency training in Improving Access to Psychological Therapies (IAPT) services is sufficient to equip Psychological Wellbeing Practitioners (PWP) to support Black, Asian and Minority Ethnic (BAME) service users.

A qualitative design was adopted using semi-structured interviews with six PWP participants. Reflexive thematic analysis using Braun and Clarke’s (2006) six-step process was used in data analysis.

Three themes revealed evaluations of PWP training, factors supporting PWPs’ cultural competency and points of improvement for PWP training. The training briefly and superficially covered cultural competency content; however, it encouraged PWPs to explore potential personal and cultural biases in therapy. PWP training can also be improved by providing more culturally relevant resources and involving BAME service users.

A small sample size (N = 6) was used, impacting the findings’ generalizability.

PWP training does not sufficiently equip PWPs to support BAME service users. PWPs’ reflection of their own ethnic identity and personal experiences, when combined with training, can improve cultural competency. IAPT training should focus on cultural awareness, knowledge and skills to enhance therapeutic experience. Moreover, PWPs should reflect on their identity, personal biases and experiences when working with diverse communities.

This is one of the few qualitative studies evaluating the cultural competencies of PWPs in IAPT.

Primary care psychological interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. People with learning disabilities within IAPT have poorer key clinical outcomes than people who do not identify as having a learning disability. During the global COVID-19 pandemic remote consultations have accounted for nearly 90% of all contacts in IAPT services; this paper aims to report the effects of these on outcomes for people with learning disabilities.

Publicly available national data from the COVID-affected period are compared to the most recent available comparison periods that are not during the COVID pandemic. Data are presented graphically.

People with learning disabilities differ little from those with no disabilities on several key process and outcome variables, although their clinical recovery is very much lower than those without disabilities. People with learning disabilities appear to have been affected by the changes in service delivery in a similar way to those without learning disabilities.

Despite the shift to predominantly remote therapy delivery, outcomes for people with learning disabilities have not been differentially affected compared to those who have no recorded disability. The potential to learn what has worked and not worked in the delivery of remote interventions for people with learning disabilities is highlighted.

Given the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to explore client- and service-related variables that predict successful treatment outcomes and clients’ dropout. Clinician-rated clients’ motivation to change was also explored as a potential predictor for both outcome variables.

A convenience sample of 1,135 (F = 752; Mage = 39.4) was collected from three IAPT services in the North West of England. The study adopts a quasi-experimental, observational design. The analysis involves the description of patients’ socio-demographic and clinical characteristics and the development of three outcome prediction models, using hierarchical logistic regression.

After adjusting for confounders, employment status and motivation to change as rated by clinicians were predictive of both recovery and reliable improvement. The higher number of IAPT re-referrals was negatively associated with recovery and positively with dropouts. Clients who indicated low motivation to change and received low intensity treatment at their last session presented a higher likelihood to dropout.

Given that the evaluation of clients’ motivation to change was solely reliant on clinical judgement, as no validated measure was used, further robust research is recommended to draw sensible conclusions.

This is the first study evaluating clinician-rated motivation to change as a significant predictor of treatment outcomes and dropouts within the IAPT setting. Further research implications are discussed.