Where are we Going Wrong?
Written on Jan 26, 2026
In 2008 the UK Government (England) introduced a scheme known as IAPT (Improving Access to Psychological Therapies), mainly offering CBT (cognitive behaviour therapy) for common mental health disorders, notably anxiety and depression. The scheme is now known as NHS Talking Therapies. In 2023/24 there were 1.8 million referrals, 671,648 of whom completed a course of therapy. The workforce numbers for 2019/2021 were 13,799 (10,721 patient-facing and 3,059 non-patient-facing). The annual budget in 2021/22 was £776m, with a more recent estimate (2023/24) of '£0.9bn+ spend'.
Recent data show roughly 50% of those completing treatment reached 'clinical recovery', with 67% showing reliable improvement ('meaningful symptom reduction'). Outcomes are assessed using standardized self-report symptom questionnaires. However, many mental health professionals (including me) are sceptical about what changes in scores on scales such as these means in the real-life experience of those assessed. Moreover, there is no comparison group to estimate how scores would have changed without therapy during the period in question. And many people referred to the service do not attend their initial appointment or do not complete their prescribed course of therapy.
Nevertheless, there are two core aims of IAPT that can be more directly measured. The first is facilitating the resumption of, or entry into, paid employment. The second is reducing the number of pharmaceutical prescriptions for common mental health problems. Achieving both these aims was envisaged as leading to an easing of the financial costs of mental illness to the nation, thereby saving money or freeing it up for other NHS purposes.
Indications regarding the first of these aims, though tending to be favourable, present a complex picture, and again a no-treatment comparison group is absent. There is no evidence that the second aim has been achieved.
In fact, as I have indicated in recent posts on this topic, the number of people registered as unable to work owing to mental health problems has grown dramatically in recent years, likewise the number of pharmaceutical prescriptions issued for anxiety and depression. Neither of these unfortunate trends means that IAPT has been a failure, since its aims are curative, not preventative. But they have imposed an ever-increasing burden on the mental health services.
Very loosely, when we are speaking about common mental health disorders, we are most often referring to periods in one's life when one experiences significant problems in the way one feels, thinks and behaves that are disproportionate to any challenges and stresses that one is facing (see note 1). The narrative provided to us by the professionals about our symptoms and mental suffering is that there is something faulty with our genes, our nervous system, our habitual ways of thinking and behaving, and so on, and that, they are best qualified to diagnose what the fault is and apply or recommend the appropriate remedy. Hence, when people are struggling to cope with the demands of everyday life, they (or their carers) should openly acknowledge this and seek a referral to the appropriate mental health specialist.
More people now seem to accept this story. Perhaps we may call it 'a doctrine' and that we have all been 'indoctrinated'. And perhaps this what is meant by 'greater mental health awareness'.
Based on the above understanding, for many years now, governments have been increasing the funding, resources, and workforce provided to our mental health services (see note 2). And yet, there has been no measurable improvement in the mental health of the nation. In fact, things have become decidedly worse, as the figures show.
Most professionals in the mental health services (and indeed the public who use these services) claim that this lack of progress is because the increase in resources and funding has been insufficient. Their message is, 'We are doing the right thing, but we need to be enabled to do more of the same.'
While this answer seems very compelling, perhaps we should step back and take a wider view. Maybe, rather than simply blaming the government, the professionals should be saying to themselves, 'Despite all the extra resources, things are getting worse. So, what are we doing wrong?'
Note
1. If they were proportionate, the answer would be either to eliminate or reduce these stresses or to cope with them more effectively, and this may still be framed as requiring professional assistance.
2. We might add here 'and the avalanche of self-help books for people with common mental health problems, and now the availability of online help'.
I've introduced the idea of 'indoctrination'. How appropriate is this?
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