Mental illness (especially depression and chronic anxiety) is the biggest single cause of misery in advanced countries. But only one quarter of those who are ill receive treatment. Our programme has helped highlight this problem, including its economic aspects (see The Depression Report: A New Deal for Depression and Anxiety Disorders), and to bring about a radical new government policy called Improving Access to Psychological Therapies (IAPT). This is now being extended to children, based on recommendations of The Good Childhood Report, co-authored by Richard Layard.
We have been involved in ex ante and ex post evaluation of the programme and continue to be so. In June 2012 our Mental Health Policy Group (a distinguished team of economists, psychologists, doctors and NHS managers convened by Richard Layard) published a second report on How Mental Illness Loses out in the NHS.
Together with the clinical adviser to the IAPT programme, Professor David M. Clark (of Oxford), Richard Layard has written a book for the general public on the significance of mental illness as a source of social and economic ills and on the scope for cost-effective therapy on a very wide scale. Thrive: the power of evidence-based psychological therapies was published by Penguin in July 2014.
We have also promoted the Penn Resilience Programme and evaluated its effects in 22 English schools. This is just one programme of 18 hours so will not change the lives of most youngsters - however, an hour a week for 4 years has a better chance of doing so. Such a curriculum should be based on properly evaluated programmes with known effects. Consequently we have searched the world's programmes and have constructed a 4-year Personal Social Health and Economic (PSHE) education programme that is being trialled in a properly controlled way in UK schools. (See the Healthy Minds Project.)
Do more of those in misery suffer from poverty, unemployment or mental illness?', (with Sarah Flèche) 2017, Kyklos, 70(1): 27-41.
In a contribution to the World Happiness Report 2013, Dan Chisholm, Richard Layard, Vikram Patel and Shekhar Saxena (2013) show that mental health is the biggest single predictor of life-satisfaction. This is so in the UK, Germany and Australia even if mental health is included with a six-year lag. It explains more of the variance of life satisfaction in the population of a country than physical health does, and much more than unemployment and income do.
Mental Illness and Unhappiness, this was published in the World Happiness Report 2013.
In a related paper, Richard Layard (2013) argues that Mental Health is the new frontier for labour economics, in the sense that it is a major factor of production. It is the biggest single influence on life satisfaction, and also affects earnings and educational success. But, most strikingly, it affects employment and physical health. While cost effective treatment exists, only a quarter of those who suffer are in treatment. Yet psychological therapy, such as cognitive behavioural therapy, if more widely available would pay for itself in savings on benefits and lost taxes.
A New Priority for Mental Health
Richard Layard writes an election briefing in 2015. Mental illness (especially depression and chronic anxiety) is the biggest single cause of misery in advanced countries. But only one quarter of those who are ill receive treatment. Mental health is crucial for wellbeing and there are modern evidence-based ways of treating mental health problems which have no net cost to the Exchequer. What are the most important factors affecting wellbeing in our society? And what low-cost ways do we have of improving wellbeing, when “all the money’s gone”?
The need for increased NHS resource
The CEP Mental Health Policy Group led by Richard Layard outlined in 2012 the need for more NHS resources in mental health. Mental illness accounts for 23% of the total burden of disease. Yet, despite the existence of cost-effective treatments, it receives only 13% of NHS health expenditure. It should be expanded. Layard argues that this is a matter of fairness, to remedy a gross inequality, and it is a matter of simple economics - the net cost to the NHS would be very small.
A precursor to this was a report by the CEP's Mental Health Policy Group in 2006, which set out the scale of the problem and describes the key elements of a solution.
Gaining a comprehensive picture of mental health services in England is not straightforward. Historically, this information has been split across sub-sections of the health and social services; and the readily available information often appeared to give inconsistent answers. Rachel Smithies (2010) maps out staffing and expenditure, the number of people in need and the number treated. Her work brings together and interprets the available evidence to provide a single coherent map of mental health need and services, from children to older adults and across both health and social care services, in England.
The Improving Access to Psychological Therapies (IAPT) Programme
The English IAPT is a programme that has been proposed by members of the Wellbeing programme. It aims to make evidence-based psychological therapies for depression and anxiety disorder available to all who need them in the NHS. The main features have been a training programme in NICE-recommended treatments, and a programme for upgrading services, so as to provide suitable placements for trainees with on-the-job training in NICE-recommended treatments. In the first year of the programme, 32 IAPT services were established. David Clark, Alex Gyani, Richard Layard and Roz Shafran (2013) report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery. They find that 40.3 % of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. They conclude that compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.
Enhancing Recovery Rates: Lessons from Year One of the English Improving Access to Psychological Therapies Programme - subsequently published in Behaviour Research and Therapy, 2013.
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. - published in the International Review of Psychiatry
For earlier work on IAPT, see:
Improving Access to Psychological Therapy: Initial Evaluation of Two UK Demonstration Sites - published in Behaviour Research and Therapy, 2009.
Cost-benefit analysis of psychological therapy, (with D. Clark, M. Knapp and G. Mayraz), published in the National Institute Economic Review, 2007.
The effectiveness of psychological therapy - three papers were written for the IAPT Expert Reference Group in 2006-7 and approved by the group in 2007.
Child and Adolescent Mental Health Services
Following recommendations of The Good Childhood Report (co-authored by Richard Layard), IAPT type services have been extended to younger people. This has been implemented as improvements to the Child and Adolescent Mental Health Services (CAMHS) that were already in existence.
For relevant working papers by Richard Layard and co-authors, see:
Personal Social and Health Education (PSHE)/Healthy Minds Project
PSHE education is a non-statutory school subject designed to facilitate the delivery of a number of key competencies relevant to health, safety and wellbeing. As well as contributing to learning in regards to these topics, PSHE aims at outcomes well beyond the classroom relating to physical, mental, sexual and emotional health and safety. Daniel Hale, John Coleman and Richard Layard (2011) review research on evidence-based provision of PSHE education, including a summary of the major impediments and facilitators of evidence-based programming. They provide a model curriculum for the delivery of evidence-based PSHE.
Further information: Healthy Minds Project
The UK Resilience Programme (UKRP) is the UK implementation of the Penn Resiliency Program, developed in the US. It aims to improve children's psychological well-being by building resilience and promoting accurate thinking. Three local authorities launched it in the academic year 2007-08, with workshops delivered to Year 7 pupils in secondary schools. Evaluation of the programme found significant short-term improvement in pupils' depression symptom scores, school attendance rates, and academic attainment in English. Impacts varied by how workshops were organised, and by pupil characteristics. There was no measured impact of workshops on behaviour scores or life satisfaction scores.
The UK Resilience Programme: a school-based universal non-randomized pragmatic controlled trial, Journal of Consulting and Clinical Psychology, Amy Challen, Stephen Machin and Jane Gillham, Vol 82(1), Feb 2014, 75-89.
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