In this post I suggest that organizing an event in which the English IAPT (Improving Access to Psychological Therapies) program is presented to citizens, economists and policymakers is a fairly easy thing to do with some potential impact on policymaking.
Assumption 1: Psychological therapies work better than most people assume.
Assumption 2: There is a big treatment gap between what we know that works in research (evidence based treatments) and what people with psychological issues are being offered.
Assumption 3: There are several reasons why closing this gap is not an easy thing to do. One of them is that a lot of clinicians themselves dislike the idea of regulations and guidelines. A second reason is that the clinical field is not using the arguments that work best to persuade policymakers: cost effectiveness. And a third is that the general public is not well informed about how effective psychological treatments (when they are delivered well and based on guidelines) really are (not for all problems, but for example definitely for anxiety disorders).
Assumption 4: There does not seem to be an ideal solution to the case, but the Improving Access to Psychological Therapies project (IAPT) in England looks like a big step forward. It includes elements that are very atypical for mental health care: interventions based on (NICE-)guidelines, extra training of clinicians in how to deliver the evidence based treatments, measuring progress of all patients, publishing those data publically on the website, using cost-effectiveness arguments to justify extra investments, … This is inspiring countries such as Norway, Canada and Israel and states such as California to start their own IAPT centers.
Assumption 5: Professor David M Clark which is one of the founders of IAPT is a charming public speaker who is willing to promote the IAPT model and does so in a way that is persuasive to the general public and policymakers. He also wrote a very accessible book on the IAPT program together with professor Layard.
Action: organize a (free) local event aimed at the general public, economics and policymakers in which Professor David M Clark speaks about IAPT.
What you need:
- a trustworthy name to invite professor Clark to make it seem worth the effort, such as a local professor in clinical psychology. In my experience a lot of CBT professors will love to help out, but they themselves just do not have the time to organize such things. A lot of them do not like lobbying neither.
- some money, but in our case it was not that expensive to organize. The biggest cost for us was a closing reception and a fancy lunch. We paid €1500 in total. We invited professors of several universities to be co-initiators, for which their universities contributed to cover the costs.
- professional organizations of therapists might be partners to help organize the event, but I assume that is culture-dependent. Some will really hate the idea to promote guidelines, cost-effectiveness arguments, …
- good timing might help: we organized it two months before the next federal elections, which made politicians more willing to attend and listen to the message.
Some colleagues and I invited professor Clark and he spoke recently at the University of Leuven (Belgium, link to the website of the event). 400 people attended, and all political parties were represented and were handed over the book on IAPT. We were inspired to organize this event by our Dutch colleagues who organized a similar thing last year. An interview with professor Clark also appeared before the event in a national newspaper.
We combined the lecture of professor Clark (1 hour, you can watch it here) with a panel discussion (1 hour, you can watch it here) including someone who could say something about what guidelines are (local Cochrane institute), what health economics is (a professor in health economics), what clinical psychology in Belgium looks like (a professor in clinical psychology), how politics work (a cabinet member of our minister of health) and how health care is organized (a representative of an umbrella organization of hospitals and outpatient centers). This might not result in the most spectacular discussion, but if you live in a country where there is almost no contact between your professors at the psychology department, the economics department and the people involved in guidelines for medicine, this can be the start of the conversation that is needed to start a project similar to IAPT.
It will still take many years before the IAPT logic will be implemented in Belgium, but I do assume that this event accelerated the process quite a bit.