The World Confederation of Cognitive and Behavioural Therapies (WCCBT) has announced that Emeritus Professor David M Clark is to be the first recipient of it’s newly established Global Impact Award for his “seminal contributions to the science, practice and dissemination of CBT”.
Extending his congratulations, Professor Matthew Rushworth (Head of Department) commented that “Professor David Clark’s contributions to cognitive and behavioural therapy have been massive. He is, without doubt, a very deserving recipient of the WCCBT’s inaugural prize. Not only has he carried out some of the foundational research in this field, but he has been at the forefront of translating it into practice in the clinic to improve patient lives”.
Professor David Clark’s contributions to cognitive and behavioural therapy have been massive.
- Professor Matthew Rushworth
David Clark and Oxford colleagues (including Anke Ehlers and Paul Salkovskis) developed a distinctive way of combining clinical observation and experimental studies to successfully develop new and highly effective psychological therapies for three anxiety-related disorders (panic disorder, social anxiety disorder and posttraumatic stress disorder).
Dissatisfied by the poor public availability of evidence-based psychological therapies for mental health problems, David Clark and Richard Layard (London School of Economics) got together in 2005 to lobby Tony Blair’s Labour administration to create a national Improving Access to Psychological Therapies (IAPT) programme. Following successful pilot projects, the programme started to be rolled out throughout England in 2008 (see Clark, 2018 for a historical account).
IAPT (now renamed “NHS Talking Therapies”) focuses on common mental health problems (depression and multiple anxiety-related conditions). It supports self-referral and is a public promise that individuals who are determined to be suffering from clinically significant levels of depression and/or anxiety disorders will be:
- Offered a course of a NICE recommended psychological therapy for their clinical condition
- Delivered by clinicians who are appropriately trained
- With outcomes monitored on a session by session basis
- And the outcomes achieved by each service and with different groups publicly reported (see here), to promote public transparency about the effectiveness of mental health services and to provide data that can be used to further improve the services.
Since its initial development, IAPT has been expanded by each subsequent government administration with David Clark serving as a clinical advisor to help its expansion. Currently, the programme provides a course of psychological therapy to 670,000 people each year and collects outcome data from 98%. The data shows that around 1 in 2 individuals fully recover from their depression/anxiety and around 7 in 10 show worthwhile improvement. These outcomes are close to what is seen in clinical trials. However, in the early days the outcomes were less good. Thankfully, the almost complete dataset made it possible to identify factors associated with better or worse service outcomes and to feedback this knowledge to the services to help drive improvement ( see here for one of many examples).
I am thrilled and honoured to be chosen for this award. An international collaborative network is being created in which we each help each other.
- Professor David Clark
In their initial lobbying for the creation IAPT, Layard & Clark argued that the programme should be able to largely pay for itself due to the savings elsewhere in the NHS that would result from alleviation of depression/anxiety and broader economic benefits as people were able to return to work / work more effectively when less burdened by mental health difficulties. Over the years, multiple studies have provided support for this hypothesis (see for example English studies by Gruber, 2022; El Baou, 2023; Toffolutti, 2021).
The early success of IAPT generated considerable interest in other countries, a point that has been noted by WCCBT. Since 2011, David Clark has assisted policy makers and clinicians in multiple countries/provinces. Currently, Norway (Prompt Mental Health Care) and Ontario (the Structured Psychotherapy Program) have services closely modelled on IAPT. Australia, Belgium, Finland, Lithuania, Iceland, Italy, South Korea, and Spain are all developing versions. This international effort has created a collaborative network in which lessons learned in one country are helping all. For example, Norway recently published a five year follow-up of employment, personal income and health service costs after treatment in their IAPT or in primary care. In addition to having better clinical outcomes, people treated in IAPT were more likely to be employed and have higher personal income. This, along with a similar finding from Spain, is strong evidence that an IAPT type service helps grow the economy, a finding that partly underpinned His Majesty’s Treasury decision to provide an additional £592 million to further expand the English service in the 2023 Autumn Statement.
To date around 9 million people in England have received a course of treatment in IAPT. Recently, the Wellcome Trust awarded Oxford’s Bennett Institute £7million to incorporate the uniquely large and complete NHS TT dataset into the OpenSafely platform. This infrastructure project, led by Sebastian Bacon and Ben Goldacre with David Clark will make it easier for researchers to study the IAPT data and learn lessons about how to further improve the effectiveness of mental health services.
Commenting on the Global Impact Award David Clark said, “I am thrilled and honoured to be chosen for this award. Most importantly, it is recognition for the vision and dedication of the exceptional clinicians (now over 11,000), commissioners, NHS managers and researchers who are responsible for IAPT in England and to the growing number of people in other countries who are tirelessly working to realise the mass public benefit of evidence-based psychological therapies. An international collaborative network is being created in which we each help each other“.
Many congratulations to David!