Psychological Therapies, Annual report on the use of IAPT services, 2021-22

This report contains experimental statistics for England and is based on the annual period 1 April 2021 to 31 March 2022 which supplements the 2021-22 annual Psychological Therapies publication. It looks at patient outcomes in terms of individual courses of therapy given, and this makes it distinct from the usual assessment of patient outcomes in the Official Statistics, which is based on outcomes for patients’ entire referrals.

The Improving Access to Psychological Therapies programme is centred around particular treatments for depression and anxiety disorders, as recommended by NICE. Since the IAPT programme treats individuals, the focus of NHS Digital’s Official Statistics has been to report activity based around referrals to services. This publication instead reports activity based around individual courses of therapy.

When a patient is referred to an IAPT service, they are first assessed for suitability and to identify suitable treatment(s). For many patients with mild to moderate symptoms of anxiety or depression, a low intensity intervention is first recommended with other, higher intensity therapies offered if necessary. This is known as a stepped care model. Appendix A summarises which therapies are recommended for particular conditions.

Figure 1 shows an example patient journey. In this example a single, continuous spell of care has taken place (known as a referral), but with two distinct therapies given – Guided Self Help first followed by a “step-up” to Cognitive Behavioural Therapy.

It is common for two or more therapies, like those shown in Figure 1, to be given to a patient in a single, continuous spell of care. Since the reporting of outcomes in the Official Statistics reports is based on referrals, it is not possible in such circumstances to evaluate the effectiveness of each individual therapy given to the patient. That is, to what extent did each therapy contribute to the patient’s overall outcome?

Findings presented in this report and data published in the accompanying tables are based on distinct courses of therapy, not distinct referrals. For further details about the definition of a distinct course of therapy, see Appendix B.

Figure 2 below shows the total number of courses of each therapy given to patients in 2021-22, as well as the extent to which each therapy was offered as the first, second or subsequent course of therapy in the referral.  

Cognitive Behavioural Therapy was given most frequently in 2021-22, accounting for 44.6% of all courses of therapy in the year. This has increased from 38.5% in 2020-21. Cognitive Behavioural Therapy and Guided Self Help (Book) together account for 72.3% of all courses of therapy in the year. This has also increased from 65.5% in 2020-21.

Guided Self Help (Book), Collaborative Care and Non-guided Self Help (Book) had the highest rates of being given as a first course of therapy (94.8%, 93.1% and 92.5%, respectively). Conversely, more than half of courses of Eye Movement Desensitisation Reprocessing and Structured Physical Activity were given as the second or subsequent course of therapy (albeit in the latter case there were only 47 courses of therapy in total). 

Table 2 of the accompanying data tables can be downloaded from the overview page for additional information.

For further details about NICE-recommended IAPT therapies, see the IAPT manual, published here NHS England » The Improving Access to Psychological Therapies Manual

Some courses of therapy are given to the patient as a discrete course; that is, there are no other therapies given to the patient at the same time. Conversely, some courses of therapy are given to the patient alongside another type of therapy.

Figure 3 shows the proportion of courses of therapy that are given as a discrete course (i.e. with no other therapies given at the same time) and that are given concurrently with another type of therapy.

Overall, a course of therapy was delivered as a discrete course 93.2% of the time. This has increased from 88.2% in 2020-21. 

There was a variation between how each specific type of therapy was delivered. The therapies Counselling for Depression, Cognitive Behavioural Therapy and Guided Self Help (Book) were most often delivered as a discrete course with over 93% of the courses given without overlapping with another therapy type. Structured Physical Activity, Non-Guided Self-Help Computer and Eye Movement Desensitisation Reprocessing were the therapies most often delivered alongside another therapy, with over a third of each of these therapies delivered concurrently.

Table 3 of the accompanying data tables can be downloaded from the overview page for further details.

The number of appointments expected to be given in a course of each therapy differs according to the type of therapy.

Figure 4 shows that the mean treatment appointments for high intensity therapies was generally higher than for low intensity therapies. In particular, Couples Therapy for Depression, Interpersonal Psychotherapy and Brief Psychodynamic Psychotherapy had the highest mean treatment appointments (all above 9), however some therapies that are recorded as high intensity, such as Applied Relaxation and Collaborative Care have comparatively lower means, with means of 4.4 and 3.7, respectively. 

Table 5 of the accompanying data tables can be downloaded for further details. 

See Appendix A for information on which therapies are classed as high or low intensity. For further details about NICE-recommended IAPT therapies, see the IAPT manual, published here The Improving Access to Psychological Therapies Manual.

In routine monthly psychological therapies reporting, patient outcomes are measured in terms of three measures: reliable improvement, recovery, and reliable recovery. In this analysis, the construction of these measures has been approximated using the patient questionnaire scores recorded at the start and end of the course of therapy and the problem recorded at the start of the course. This approximation is referred to here as 'therapy-based' recovery or improvement, and is not comparable with other measures of recovery, reliable improvement or reliable recovery presented elsewhere in the IAPT Official Statistics reports. For a full explanation of how patient outcomes have been calculated in this analysis and how they differ from standard outcomes measures, see Appendix C.

Figure 5 (below) shows the number of courses of each therapy type for referrals that have completed a course of treatment in 2021-2022, as well as accompanying recovery and reliable improvement rates. 

Figure 5 shows that, of therapies with more than 5,000 courses in 2021-22, the highest rates of therapy-based recovery and improvement are amongst Interpersonal Psychotherapy (48.2% and 62.9%), Counselling for Depression (48.0% and 59.0%) and Cognitive Behavioural Therapy (44.5% and 60.2%). Therapy-based outcomes rates for some therapies should be read with caution where they were less frequently used than other therapies in 2021-22.

The data tables can be downloaded from the overview page for further details.