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The day of the bog-standard comprehensive is over (Alistair Campbell, 2001)
This special issue on depression is timed to coincide with a new National Institute for Health and Care Excellence (NICE) guideline (forthcoming). It will be NICE’s 3rd depression guideline, the first in 2004, the second in 2009. Improving Access to Psychological Therapies (IAPT)’s ubiquitous stepped care model, which has gained international recognition for its ‘world-leading results’ (Stevens, 2017), derives from NICE’s depression guidelines (NICE, 2009). So, it is safe to say this latest iteration will shape the context for NHS-funded talking therapy services for the next decade.
What was the impact of NICE’s first two guidelines? Thanks to two independent National Audits (Royal College of Psychiatrists, 2011, 2013), a wealth of outcomes data from IAPT itself (NHS Digital, 2015–16, 2016–17), the recent Psychiatric Morbidity Survey (McManus, Bebbington, Jenkins, & Brugha, 2016), and detailed prescribing data for anti-depressants (HSCIC, 2016), we are in a good position to track NICE’s impact over the last 10 years.
However, the story can only be understood fully against the context of a radical attempt to create a comprehensive ‘universal access’ talking therapies NHS service, free-at-the-point-of-need to all: ‘You are deprived if you cannot enjoy your life. And the most common cause of deprivation is not poverty or unemployment but mental illness’ (Clark, Fleche, Layard, Powdthavee, & Ward, 2018). Professor Lord Richard Layard’s (2005) flawed but brilliantly original analysis for the Prime Minister’s Strategy Unit argued that depression causes the UK’s single greatest disease burden not only due to its prevalence but also its indirect welfare costs. In other words, invalidity due to chronic depression was to blame for rapidly rising welfare spending occurring across the member countries of the Organisation for Economic Co-operation and Development (OECD), but especially so in the UK (Organis