The Curious Economics of IAPT To Which the National Audit Office Has Resolutely Turned a Blind Eye


No matter that the likely cost of the Improving Access to Psychological Therapies (IAPT) service last year was £1.2 billion! There are significant pay differentials in IAPT, starting with Band 5 Low Intensity Psychological Wellbeing Practitioners (PWPs)earning £25,655 – £31,534 a year, qualified high intensity(HI) therapists will likely earn £38,890 (progressing annually to £44,503) but there is no evidence of a difference in effectiveness of low and high intensity therapists. There is a claim that the HI therapists work with the more complex cases but the evidence for this is suspect, resting on claims of higher PHQ9 scores amongst the latter’s clients. But in the British Association for Behavioural and Cognitive Psychotherapies (BABCP) submission (and in my own submission) to NICE, in relation to the proposed guidance for depression, we argued that it was inappropriate to choose a single score on this measure to differentiate levels of severity. If IAPT members were in a Union the latter would cry foul at the pay differentials. But would the NAO continue its selective deafness?


The most common scenario is for an IAPT clients to receive the minimalist, low intensity treatment for which there is an absence of evidence of real-world effectiveness. 48% of treatments are low intensity treatments based on CBT principles and 20% are high intensity treatments, a small minority are stepped up from low to high intensity [Clark (2018)]. But the evidence base for the low intensity interventions derived from randomised controlled trials is weak compared to that for the high intensity interventions. But the National Institute for Health and Clinical Care Excellence (NICE) rubber stamps both, with IAPT staff on NICE panels for computerised CBT. There is not only a problem with the science behind IAPT’s approach, but also no evidence that what it delivers on the ground represents fidelity to NICE approved treatment protocols.

In summary there is no evidence that IAPT delivers what it says on the tin, evidence based treatment for depression and the anxiety disorders. IAPT has failed to monitor treatment integrity, why then should such infidelity be so richly rewarded?

Dr Mike Scott