Blog

July 2016

• Is it Feasible to Have a Nationally Funded Psychotherapy Service?

  Community and Mental Health Team, Health and Social Care Information Centre (2015). Psychological therapies; Annual report on the use of IAPT services: England 2014/15.

  There have been calls from mental health professional organizations and by the media to provide publicly funded psychotherapy in Canada. Rates of common mental disorders in Canada are high, such that about 20% of the population will personally experience a mental illness in their lifetime. In 1998, the estimated direct and indirect economic cost of mental illness in Canada was $7.9 billion (all figures are in Canadian dollars). Current estimates of costs to fund a public psychotherapy service in Canada may be about $1 billion to $2.8 billion – which far outweighs the cost. Most outpatient psychotherapy in Canada is provided by professionals in private practice who charge somewhere between $100 and $200 per session, costing Canadians nearly $1 billion per year. Some people are fortunate to have workplace insurance that covers some but not all of the costs, but most people in Canada do not have insurance and so they pay out of pocket or they go untreated. Research shows us that approximately 13 to 18 sessions are needed for 50% of clients to get better with psychotherapy. Which means that even with an insurance plan, many Canadians who need psychotherapy will find it to be a financial burden. Since 2008, the National Health Service in England implemented the Improving Access to Psychotherapies (IAPT) services to provide publicly funded psychotherapy to the population. The psychological treatments provided through IAPT are evidence-based (e.g., CBT, interpersonal psychotherapy, brief dynamic psychotherapy for depression). For mild to moderate problems, individuals get low intensity interventions first (i.e., self help, internet based interventions), followed by more intensive psychotherapy if needed. Treatment outcomes are measured from pre- to post-treatment with valid standardized measures of depression and anxiety. At post-treatment, patients are categorized as reliably deteriorated, not changed, improved, and recovered. The goal of the IAPT is to achieve 50% recovery rates among patients. In their online 2014-15 annual report, the IAPT service reported that it treated over 400,000 patients in that year. 44.8% of patients were rated as reliably recovered – that is over 180,000 mentally ill patients improved and no longer had a mental illness. Reliable improvement was seen in 60.8% of patients – this included recovered patients plus those who still had a disorder but were feeling significantly better than when they started. Recovery was highest for people 65 years and older (57.8%). Rates of recovery were similar for depression (44.6%) and anxiety (47.8%) disorders, and between men and women. Waiting times for treatment was less than 28 days for 66.0% of patients.

  Practice Implications

  The experience in England with the IAPT is instructive for Canada. The IAPT service provides evidence-based psychological therapies within a publicly funded national health service. The IAPT approached its target of 50% of patients recovering from mental illness, and over 60% of patients were reliably improved. Waiting times were low for most patients. Given the experience in England’s National Health Service, the implementation of a national strategy for psychotherapy appears to be feasible and effective. Will political leaders in Canada be able to see the financial and human value of publicly funded psychotherapy?