Welcome to the ZSA Facts for Action series

This page provides key information to explain what the NHS Talking Therapies services (previously named Improving Access to Psychological Therapy Services) are and will help build your understanding of the role this service has in suicide prevention.

Contents:

  1. What is the NHS Talking Therapies service?
  2. Who does this service support?
  3. ZSA Suicide Prevention Resource Map data - key takeaways
  4. Why is this service important in the context of suicide prevention?
  5. National guidelines for practice
  6. Impact of COVID-19
  7. Recommendations for action
  8. ZSA Suicide Prevention Resource Map - related indicators
  9. References

What is the NHS Talking Therapies service?

NHS Talking Therapies (previously named IAPT)* is an NHS programme in England that offers interventions approved by the National Institute for Health and Care Excellence (NICE) for treating people with depression or anxiety. NHS Talking Therapies were first introduced in 2008 to enable people to access to these interventions and were designed with the inclusion of robust clinical outcomes, with monitoring and reporting embedded within their core operating principles.[1]

Improving Access to Psychological Therapy (IAPT) services are being renamed in 2023 as NHS Talking Therapies, for anxiety and depression. For more information, visit the NHS England website.

Who does this service support?

The annual report on the use of NHS Talking Therapies published by NHS Digital[2] contains analysis of activity, waiting times and outcomes. In 2020-21:

  • There were 1.46 million referrals to NHS Talking Therapies (down 14% from 1.69 million in 2019-20) with 1.02 million referrals starting treatment 
  • 90% of those who commenced treatment started this within six weeks of their referral (up 2.6% from 2019/20)
  • NHS Talking Therapies users will typically have 7.5 sessions of treatment
  • 51.4% of those completing treatment moved to recovery based on the outcome measures used by these services 

A key national measure for NHS Talking Therapies is the percentage of people receiving the first treatment appointment in the first 6 weeks of referral. The NHS Mental Health Dashboard for quatre one 2022/23 [3] references a target of 75% of people that receive their first treatment appointment in the first 6 weeks of referral. At quatre four, the England position was substantially above expected at 89%.

Figure 1 summarises the achievement of this in year target by region. It shows that all regions are achieving the target (75%), with the East of England and London having the highest percentage of people receiving their first NHS Talking Therapies treatment appointment within 6 weeks of being referred. 

percentage of people receiving their first treatment appointment within 6 weeks of referral pic.png

Figure 1 - NHS Talking Therapies access rates by region Q1 2022/23.

The NHS Mental Health Dashboard also includes data on the outcomes achieved by NHS Talking Therapies by looking at the percentage of people who have completed treatment who have recovered. The national target for recovery in 2022/23 is 50% and in quarter one the England position achieves that at 50%. Four regions are currently achieving the recovery target as illustrated in Figure 2 but it is clear that there continue to be opportunities to improve the outcomes achieved for the North West, South West and South East region.

people that attended at least 2 treatment contacts and are moving to recovery pic.png

Figure 2 - NHS Talking Therapies recovery rates by region Q1 2022/23

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Why is this service important in the context of suicide prevention?

As we explore in our Facts for Action: Common Mental Health Disorders, depression and anxiety disorders can have a devastating impact on individuals, their families, and society. The National Institute for Health and Care Excellence (NICE) recommends a range of evidence-based psychological therapies as the first choice interventions for these conditions as they optimise outcomes for these individuals.[4]  

ZSA Suicide Prevention Resource Map data - key takeaways

Our new ZSA Suicide Prevention Resource Map, developed with the NHS Benchmarking Network, provides further intelligence on access to NHS Talking Therapies and the outcomes achieved by shedding additional light on the variation in service provision.

The data below relates to data from 2019-21 and is sourced by the NHS Benchmarking Project unless stated otherwise*. Additionally, indicator labels below will reflect name change from IAPT to NHS Talking Therapies accordingly.

  • The average percentage of people entering IAPT with anxiety or depression as proportion of estimated prevalence (2019) was 18%  This data is an annualised figure and is taken from the Common Mental Health Disorders Public Health Profile.[5] Performance ranges from 7% to 30%
  • The number of referrals received per 100,000 registered population (2020/21) varies between 273 in NHS South Warwickshire CCG and 7,984 in NHS Manchester CCG, with a median average of 3,075
  • The number of referrals received per 100,000 weighted population (2020/21) varies between 273 in NHS South Warwickshire CCG and 5,760 in NHS Oldham CCG, with a median average of 2,546
  • The number of referrals entering treatment per 100,000 registered population (2020/21) varies between 200 in NHS South Warwickshire CCG and 4,010 in NHS Manchester CCG, with a median average of 2,234
  • The number of referrals entering treatment per 100,000 weighted population (2020/21) varies between 216 in NHS South Warwickshire CCG and 3,090 in NHS Castle Point and Rochford CCG, with a median average of 1,775
  • Waiting times from referral to commencement of treatment (2020/21) varies from 4 in NHS Castle Point and Rochford CCG and 62 in NHS South Sefton CCG, with a median average of 15 days
  • The proportion of completed treatment courses that showed reliable improvement (2020/21) varies from 55% in NHS Sheffield CCG and 79% in NHS Warwickshire CCG, with a median average of 68%.

*All data from NHS Benchmarking Network projects is subject to change dependent upon permissions being receiving from provider organisations to have their data included in the map.  The information reported reflects the data available as at 30/08/2022.

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National guidelines for practice

National Collaborating Centre for Mental Health

The Improving Access to Psychological Therapies Manual [1] describes the NHS Talking Therapies model in detail, along with operational guidance on delivery with a focus on provision of NICE recommended care. This manual will be changed to reflect the name change of IAPT to NHS Talking Therapies. The manual includes information on:

  • The conditions treated by NHS Talking Therapies using a stepped-care approach (i.e. low and high intensity)
  • The importance of delivering evidence-based care
  • The NHS Talking Therapies workforce with a focus on competence, quality and staff retention
  • The importance of data focussing on activity, waiting times and outcomes
  • Improving equity of access and outcomes
  • Working with the wider system
  • Key features of a well commissioned NHS Talking Therapies service linked to the Care Quality Commission domains with the principles that support best practice being:
    • Right number of people seen
    • Right services
    • Right time
    • Right results

NHS Long Term Plan

The NHS Long Term Plan seeks to further improve access to talking therapies for people experiencing anxiety disorders and depression through NHS Talking Therapies, with an aim of these services reaching 1.9 million adults and older adults by 2023/2024. 

NICE Guidance

NICE guidance on conditions managed by the NHS Talking Therapies services are detailed on the Improving Access to Psychological Therapies (IAPT) page on the NICE website*

NHS England are working with NICE to support a new digitally enabled therapy assessment programme for use in NHS Talking Therapies services. This therapy will be provided online or through mobile applications with the support of a therapist. To date, 14 products have been assessed and accepted by the programme and one digital therapy has been evaluated in practice.[6]

* IAPT services have been renamed to NHS Talking Therapies. References to work will not be changed unless the name has been changed from the author.

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Impact of COVID-19

It has been forecast that up to ten million people, the equivalent of nearly 20% of the total population, will need new or addition support for their mental health needs as a result of the COVID-19 pandemic (Centre of Mental Health, 2020).[7]

In response to the pandemic, a number of bodies have undertaken work to predict the potential increase in demand for mental health services.

One example of this is the work undertaken by The Strategy Unit[8] which predicts that there may be 1.8 million new presentations, recurrences or exacerbations of mental ill health across England in the next three years as a direct or indirect result of the pandemic with the next 18 months being particularly challenging for services. 

The Strategy Unit’s work suggests that there could be a 33% increase in overall demand for mental health services (all ages) in the next three years (to 2022/23) and their modelling app[9] estimates that NHS Talking Therapies services in England could receive an additional 856,909 referrals in the next three years equating to a 50.7% cumulative surge in demand:

  • 20.5% in 2020/21
  • 19.1% in 2021/22
  • 11.1% in 2022/23

Local systems can use the app to model the potential surge in demand for their area and impact on specific services and use this to support planning.

The Centre for Mental Health, in collaboration with NHS Trusts and NHS England, has also worked on developing a modelling toolkit for forecasting additional demand for mental health services resulting from the pandemic.[10] This takes the results of various studies and enables the user to input the information they have about their local population into the model to generate an estimate of the amount of additional demand for mental health services in that area.   

Not only has the COVID-19 pandemic has increased the number of people predicted to need mental health support (Centre for Mental Health, 2020)[7] it has also significantly impacted access to services, with 24% of adults, and 28% of young people reporting not being able to access mental health support (Mind, 2020).[11]

Figure 3 looks at the number of referrals received by NHS Talking Therapies services each month from April 2019 and September 2020 and the number of referrals that started treatment over the same period (NHS Digital).[12] This shows that demand for NHS Talking Therapies services reduced from March 2020 onwards in line with when the first COVID-19 pandemic lockdown commenced with a significant drop in referrals observed in April 2020 and May 2020. Data shared with the ZSA transformational informatics lead by Mersey Care NHS Foundation Trust’s Talk Liverpool services indicates that there was a significant reduction in the number of referrals from general practitioners during this period. The average monthly referrals to NHS Talking Therapies services in 2019/2020 was 138,837 and in 2020/2021 (to September 2020) this reduced by 25% to 104,240.

Whilst there was also a reduction in the number of referrals starting treatment during this time, the suppression in these figures was lower than that seen for referrals to the service. If we look at referrals that start treatment as a percentage of those received, this has actually increased during 2020/2021 (74% compared to 70% in 2019/2020). This indicates that the failure to achieve the target access rates as discussed earlier is more likely to be as a result of suppressed demand rather than reduced capacity.

monthly referrals and numbers starting treatment.png

Figure 3 - NHS Talking Therapies: referrals and numbers starting treatment April 2019 to September 2020

In light of social distancing measures put in place to control the spread of the virus, mental health care services have had to adapt by adopting remote means of patient care, including the use of videoconferencing for therapy sessions.  This has been particularly prevalent within NHS Talking Therapies services.  The NHS Digital report into the use of NHS Talking Therapies published in March 2021[13] reported that there were 37,703 Internet Enabled Therapy Sessions in December 2020 making up 9% of all attended appointments in England.

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Recommendations for action

Action for NHS Commissioners and Providers (NHS Talking Therapies):

  • Continue to look for opportunities to improve access to psychological therapy services, particularly where access rates are significantly below the national access rate standard and in line with the NHS Long Term Plan ambitions.
  • Continue to work on driving improvements in recovery rates and reliable improvement for those completing treatment by NHS Talking Therapies services.
  • Explore the opportunities for digital technologies to enhance both access to and outcomes of NHS Talking Therapies services.

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ZSA Suicide Prevention Resource Map - related indicators*

* Indicator labels below will reflect name change from IAPT to NHS Talking Therapies accordingly.

Direct indicators 

Access

Referrals received

Referrals entering treatment

Waiting times

Outcomes

Indirect indicators 

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References

[1] The National Collaborating Centre for Mental Health (2018, updated 2020). The Improving Access to Psychological Therapies Manual. Available at: https://www.england.nhs.uk/wp-content/uploads/2020/05/iapt-manual-v4.pdf 

[2] NHS Digital (2022). Psychological Therapies, Annual report on the use of IAPT services 2020-21. Available at: https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/improving-access-to-psychological-therapies-data-set/improving-access-to-psychological-therapies-data-set-reports 

[3] NHS England and Improvement (2022). NHS Mental Health Dashboard Quarter 1 2022/23. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/01/nhsmh-dashboard-q1-2022-23.xlsm 

[4] NICE. Digital therapies assessed and accepted by the Improving Access to Psychological Therapies Programme (IAPT). Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/improving-access-to-psychological-therapies--iapt-/submitting-a-product-to-iapt#published-IABs

[5] Public Health England: Common Mental Health Disorders Public Health Profile. Definition: Access to IAPT services: people entering IAPT (in month) as % of those estimated to have anxiety/depression. Available at: https://fingertips.phe.org.uk/search/entering%20IAPT#page/6/gid/1/pat/44/par/E40000003/ati/154/are/E38000004/iid/90592/age/168/sex/4/cid/4/tbm/1/page-options/car-do-0 

[6] NICE. Digital therapies assessed and accepted by the Improving Access to Psychological Therapies Programme (IAPT). Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/improving-access-to-psychological-therapies--iapt-/submitting-a-product-to-iapt#published-IABs 

[7] Centre for Mental Health (2020).  Covid-19 and the nation’s mental health: October 2020. Available at: https://www.centreformentalhealth.org.uk/publications/covid-19-and-nations-mental-health-october-2020 

[8] The Strategy Unit (2020). Estimating the impacts of COVID-19 on mental health services in England. Available at: http://www.strategyunitwm.nhs.uk/sites/default/files/2020-11/Modelling%20covid-19%20%20MH%20services%20in%20England_20201109_v2.pdf 

[9] The Strategy Unit (2020). Mental Health Surge Modelling app. Available at: https://strategyunit.shinyapps.io/MH_Surge_Modelling/ 

[10] Centre for Mental Health (2020). Forecast Modelling Toolkit. Available at: https://www.centreformentalhealth.org.uk/forecast-modelling-toolkit 

[11] Mind (2020). The mental health emergency: How has the coronavirus pandemic impacted our mental health? Available at: https://www.mind.org.uk/media-a/5929/the-mental-health-emergency_a4_final.pdf

[12] NHS Digital. Psychological Therapies, Report on the use of IAPT services. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services 

[13] NHS Digital (2021). Psychological Therapies: reports on the use of IAPT services, England - December 2020 Final including a report on the IAPT Employment Advisers pilot and Quarter 3 2020-21 data. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/december-2020-final-including-a-report-on-the-iapt-employment-advisers-pilot-and-quarter-3-2020-21-data 

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Content reviewed and updated 13/09/22

Bernie’s story: Improving Access to Psychological Therapies

This NHS England and Improvement animation discusses how IAPT services can help older people affected by anxiety and depression, including those with a long term condition. 

Introduction to IAPT

This video by Leeds IAPT services explains from a patient’s perspective what these services can offer and how people can access services.

Improving Access to Psychological Therapies: Using evidence to change policy

This video produced by the University of Oxford discusses the work of Professor David Clark and his team with successive governments, using evidence to demonstrate how the NHS can better tackle depression and social anxiety.

Suicide Prevention Resource Map

Explore our interactive map to gain a more in-depth picture of suicide rates in your community and the different health, social and service provision factors related to people dying by suicide.
Glossary of terms

Case study examples of best and innovative practice

Islington iCope

iCope, an IAPT service in Islington, London, is dedicated to the provision of high-quality cognitive behavioural therapy (CBT). Due to patient referral rates increasing annually and in the hope to improve patient recovery rates, iCope developed an approach called recovery consultations. This was to ensure that they could meet the national target of having 50% of patients recovered, both across the service but on an individual clinician basis.