More Less
More Less

Mental health at scale

Opinion image

The impacts of a nationwide mental health service in England

Common mental health problems, including depression and anxiety, significantly impact individuals and economies. In the UK, mental ill health constitutes the primary source of disability, while the economic costs of mental health problems are estimated to be up to 4% of GDP.

Despite significant advancements in evidence-based psychological therapies, mental health continues to receive less focus and fewer resources compared to physical health within national healthcare frameworks. Mental health professionals emphasize that such therapies can profoundly alter patients' lives. Moreover, patients often express a strong preference for these therapies over the use of antidepressants.
In our recent IZA Discussion Paper, we assess the effects of England's national mental health initiative, the Improving Access to Psychological Therapies (IAPT) program, recently rebranded as NHS Talking Therapies for Anxiety and Depression. IAPT stands out as the world’s largest national mental health service dedicated to providing evidence-based psychological therapies for prevalent mental health problems. Since its inception in 2008, the program has served over seven million patients, which equates to more than 13% of the English population, primarily employing cognitive behavioral therapies (CBT).
Our analysis estimates the treatment impacts by comparing the experiences of patients receiving therapy with those on the waitlist, ensuring the waiting period matches the treatment span. This approach relies on the program's high demand and resultant variable waiting times across different services and periods, along with its first-come, first-served policy. This methodology provides the first causal estimates of the program’s effectiveness based on non-experimental, nationwide data. We use a novel dataset, representing the broader English demographic. It includes all patients who started their treatments between 2016 and 2018, over a million people in total.

Our results indicate that patients who received treatment exhibited a significantly higher likelihood of reliable improvement of mental health, with a recovery rate approximately 43 percentage points (pp) higher compared to those awaiting treatment. Additionally, treated patients showed a reduction in depressive symptoms and in anxiety symptoms. The treatment also positively impacted work and social life in the short term. Treated patients reported significant decreases in impairments at work and in social activities. Among participants who were initially unemployed or on long-term sick leave, those who underwent treatment were significantly more likely to be employed at the conclusion of the treatment period (+3pp) and less likely to receive statutory sick pay (-3pp).

A preliminary cost-benefit analysis indicates that every pound spent on treatment within the IAPT program yields mental health benefits valued at a minimum of £5.50.

These findings show that dedicated mental health services are effective in delivering evidence-based psychological therapies on a large scale and in a cost-efficient manner. The IAPT program could thus serve as a model for administering mental health treatments to the broader population, potentially enhancing the lives of millions.

© Ekaterina Oparina, Christian Krekel, and Sorawoot Srisuma

Ekaterina Oparina is Research Economist at the Centre for Economic Performance of the London School of Economics (LSE)
Christian Krekel is Assistant Professor in Behavioural Science in the Department of Psychological and Behavioural Science, London School of Economics (LSE), and IZA Research Affiliate
Sorawoot Srisuma is Reader in Econometrics as University of Surry (NUS, U of Surrey)

Please note:
We recognize that IZA World of Labor articles may prompt discussion and possibly controversy. Opinion pieces, such as the one above, capture ideas and debates concisely, and anchor them with real-world examples. Opinions stated here do not necessarily reflect those of the IZA.

Related IZA World of Labor content:
Economics of mental health by Richard Layard
Health effects of job insecurity by Francis Green
How to reduce workplace absenteeism by Wolter Hassink

Photo by Nik Shuliahin on Unsplash