A report into the care received by patients with anxiety and
depression across more than 350 NHS-funded psychological therapy
services in England and Wales has revealed good overall standards
of care, but substantial variation in quality.
National Audit of Psychological Therapies (NAPT) – commissioned
by the Healthcare Quality Improvement Partnership (HQIP) and
carried out by the Royal College of Psychiatrists’ Centre for
Quality Improvement – collected data from 357 services and over
10,000 people in therapy for anxiety and depression. The audit
measured ten standards, including patient satisfaction,
effectiveness of therapy, waiting times and number of treatment
Some 80% of patients said they felt well
supported by their therapist and confident in their therapist’s
ability. Importantly, 49% of the patients included in the audit had
recovered by the end of psychological therapy. These
findings indicate that good-quality NHS psychological therapy is
helping many people with anxiety and depression achieve better
However, not all services routinely measure
how well patients were before and after therapy, so it is not yet
possible to draw firm conclusions about how effective all the
services in England and Wales are. 15% of the services that
submitted data for the retrospective audit did not have any
patients with a pre and post score for at least one outcome
The audit report urges all psychological
therapy services to routinely collect information about what
response people make to the treatment they are given.
The audit found that services are generally
good at providing evidence-based psychological treatments recommend
by the National Institute of Health and Clinical Excellence (NICE).
Some 83% of patients with a diagnosis for which there is a NICE
guideline were given the recommended therapy for their condition.
However, not all services record the diagnosis of their patients,
making it difficult to know whether or not the care they are
providing is appropriate for their patients.
Many services, particularly larger ones, are
effective at ensuring that patients are seen quickly once referred.
However, this standard was not met by all services, with one in
seven people in the audit waiting more than three months for their
first appointment. Waiting times are important – patient feedback
indicates that long waits can have a negative impact on a person’s
The report also identified concerns about the
number of sessions being offered to some patients. At a service
level, 56% of patients either received the recommended minimum
number of sessions or recovered. Of those who did not receive the
recommended number of sessions, 41% neither recovered nor made
The audit findings suggest that older people
are less likely to access psychological therapy compared to working
age adults, and this is a finding that needs exploring further. In
terms of ethnicity, no particular groups appear to be over or
underrepresented at the national level.
Overall, the findings reveal that
psychological therapy services are meeting a high number of
standards, but support is needed to help some services improve.
Services that currently fall below the audit standards are being
supported to make positive changes through action planning
resources. A re-audit will then take place to see what improvements
Professor Mike Crawford, Director of the
Centre for Quality Improvement and Lead for the National Audit of
Psychological Therapies said: "The NHS provides more psychological
therapies now than it ever has done. This first national audit of
NHS-funded psychological therapy services confirms the benefit of
much of the treatment provided.
"We know that people with anxiety and
depression highly value being able to access good quality
psychological therapy in a reasonable timescale, and this is
exactly what many patients are experiencing. However, the variation
between services means that there remains plenty of room for
improvement. These findings will help individual NHS services see
where they can improve and provide even better treatment in the
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Note to editors:
The audit is managed by the Royal College of Psychiatrists’ Centre for Quality Improvement, working in close partnership with professional and service user representatives including: Anxiety UK, The British Association for Behavioural and Cognitive Psychotherapies, The British Association for Counselling and Psychotherapy, The British Psychoanalytic Council, British Psychological Society, The Centre for Outcomes Research and Effectiveness (CORE), Depression Alliance, The Mental Health Providers Forum, Mind, The New Savoy Partnership, No Panic, Rethink, The Royal College of General Practitioners, The Royal College of Nursing, The United Kingdom Council for Psychotherapy.