Is Psychological Therapy for Young People Value for Money?


 In 2023, 1 in 5, 8 to 25 year olds had a probable mental disorder, with 700,000 young people given psychological help, according to NHS England. Heralding these findings, this morning (November 21st 2023), on BBC TV, the athlete, Jessica Ennis-Hill, led a call for all to listen more to children and for greater investment in the mental health services. The case for the first is beyond dispute but the case for the latter is ‘not proven’. It is an attractive notion that if we invest more in the young it will prevent adult mental health problems. The idea does give a sense of control, and the sense of powerlessness we get when we see the dire state of distressed youth, can be assuaged perhaps a little by it. But as presently constituted the evidence that we can deliver on this ‘promise’ is lacking. But it does not behove the Service providers, or their likely employer, NHS England to proclaim this publicly. To do so may dispirit well-meaning staff.

 The Children and Young Persons Improving Access to Psychological Therapies (CYP-IAPT) has never been audited despite costing almost a £1billion a year. Ludlow et al (2020) have warned of the importance of not repeating the same mistakes as in the Adult IAPT Service, with low recovery rates. The natural recovery rate for young people with depression and/or anxiety is 54% within a year, Roach et al (2023). This can be reliably used as a benchmark for effectiveness of interventions. Does anyone seriously believe that existing psychological services for young people would clear this threshold? If not, why is there not a major rethink? A case can be made that ‘watching and waiting’ may often be the best policy, perhaps circumventing the pathologising of youth. It is more likely than not that the practise of identifying disorder on the basis of self-report measures, though extremely convenient for researchers , leads to the over-identification of ‘cases’, particularly as the time frame for DSM disorders e.g 6 months for GAD is ignored. But the more prevalent you can claim a disorder the greater ease of attracting funding, Service providers will quietly rejoice in NHS England’s ‘findings’.


Dr Mike Scott