A new era of mental health science: thinking beyond access - how a new multidisciplinary approach will improve the effectiveness of treatments

Depression and anxiety are two of the world’s leading health problems. With one in four people estimated to experience a mental health condition in their lifetime, it is unlikely that any family is left untouched by them. And for far too many, being unable to access effective treatments can mean many years of suffering.

At ieso, we envision a world in which high-quality mental healthcare is accessible when and where it is needed, so that millions more people have the option of recovery. To realise this ambition, we’ll need a new mental health science.

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Why is improving mental healthcare so challenging?

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Mental health treatments, such as psychological therapies (also known as talking therapies), can be highly effective at reducing symptoms of depression and anxiety, but they only work for some people, some of the time.

If more people are to benefit from them, we need to address three key challenges:

• Access: Demand for psychological therapies far exceeds the number of trained therapists required to deliver them.
• Monitoring: In most countries, it is uncommon to measure a person’s depression and anxiety at the start and end of a course of psychological therapy, or to monitor which elements of therapy they have been given. Without this information, it is impossible to understand which elements of therapy are working.
• Quality: Depression and anxiety are heterogenous conditions. Different people experience different symptoms, and these symptoms are driven by a complex interplay of biological, psychological and social factors. Because we do not fully understand which elements of psychological therapy are effective at targeting which symptoms, we are unable to personalise mental healthcare by matching people to specific treatments that are most likely to work for them.

IAPT: A world-leading mental health service

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Since its introduction in 2008, the Improving Access to Psychological Therapies (IAPT) programme has transformed mental healthcare in England. By training a therapist workforce with the skills to deliver NICE-recommended treatments, IAPT has scaled access to psychological therapies to 600,000 adults per year and reduced waiting times. Crucially, the emphasis IAPT places on evidence-based treatments and session-by-session monitoring of patients’ depression and anxiety has ensured a minimum quality standard for the care delivered. In so doing, IAPT has increased average recovery rates to 50%.  

Nevertheless, challenges remain: demand for psychological therapy still exceeds supply and there is limited scope to improve recovery rates beyond chance-level without the scientific knowledge required to tailor treatments so that they target an individual’s specific symptoms and needs.

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What’s different about ieso?

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Building on IAPT’s trailblazing progress to date, ieso combines clinical, scientific and technological expertise to enable the next generation of mental healthcare.  

As an online provider of psychological therapy, ieso pioneered at-scale delivery of effective digital mental healthcare. We have delivered over 500,000 hours of text-based treatment to more than 90,000 people, at times and places that suit patients and therapists. Indeed, 60% of our treatment has been accessed outside core working hours.

In our last post, we discussed how new digital solutions hold the potential to increase access to treatment at a previously unimaginable scale. But how are we improving monitoring and quality of the mental healthcare we deliver?

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How we are improving treatment effectiveness

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Like IAPT, ieso delivers evidence-based psychological therapies and monitors patients’ depression and anxiety outcomes over time. What makes our treatment service different is that, with patient consent, we capture every exchange between therapist and patient. As such, we have a globally unique dataset of outcomes-indexed transcripts that means we can learn, for the first time, which elements of psychological therapy are working for whom at scale.

To unlock the insights held in our treatment dataset, ieso has developed an AI-based tool that uses advanced computational methods to automatically annotate every session of therapy delivered. This is in stark contrast to the <1% of therapy that it is possible to systematically assess with labour-intensive manual ratings within IAPT. By monitoring session-by-session patient outcomes, analysing how they relate to the precise elements of psychological therapy delivered and feeding back to therapists which elements are effective, we have been able to improve care quality and continuously increase recovery rates beyond 50%.

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The next generation of mental health science

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Our ambition to improve access to high-quality mental healthcare does not stop there. Next, we are turning our efforts to personalising psychological therapy by learning how best to target an individual’s symptoms with the most effective elements of treatment.

We have already shown that different symptoms of depression are associated with different depression sub-types. By understanding how different people with different symptoms respond to specific elements of therapy, we will be able to treat faster by accurately predicting which therapies are most likely to work for a particular individual first time.

Moreover, insights from our real-world treatment data about what is working for whom will stimulate new discovery research into the biological, psychological, and social mechanisms that contribute to mental health conditions and drive treatment response. This research will require a multi-disciplinary scientific approach, informed by expertise-by-experience, to ensure we identify research questions that are most likely to lead to patient benefit. With the knowledge the research generates, it will be possible to treat smarter by:

• refining existing treatments so that they are more precise in targeting the mechanisms that cause depression and anxiety
• inspiring new treatments
• understanding how to combine different treatments (e.g., psychological therapy, drug treatments and/or social interventions) to improve and maintain recovery.

A new era of mental health science is here, and it is set to transform our ability to refine, personalise and scale treatment delivery so that millions more people can access effective mental healthcare when and where they need it.