Strange bedfellows: economics, happiness and mental disorder

Aim - The high economic and social costs associated with the 'common mental disorders', and the need to scale up appropriate care services, are now widely recognized, but responses vary from country to country. In Britain, a current government initiative to promote psychological therapy is driven both by economic pressures and by research on the factors of happiness, or life-satisfaction. This article provides a short critical review of the project. Method - A health policy analysis, with regard to problem definition; objectives; sources of information; criteria for evaluation; impact on existing services, and comparison with alternative strategies. Results - The new programme, Improving Access to Psychological Therapies (IAPT), aims to expand treatment services by training 3,600 'psychological therapists' in cognitive behavioural therapy (CBT), which they will then apply in the wider community. This service, with an initial budget of 173 pound million, will provide treatment for depression and chronic anxiety from local centres across the country. The programme is intended to pay for itself by reducing incapacity costs. Closer examination, however, raises questions concerning the project's theoretical basis, logistics and research methodology, and casts doubt on its advantages over alternative approaches. Conclusions - The IAPT project is ill-designed to achieve its objectives and unsuitable as a model for treatment and care of the common mental disorders in other countries. An alternative strategy, based on closer integration of community mental health and primary health care, should be tested and on previous experience seems likely to prove more cost-effective.