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The headline stats are blatantly manipulated. Figure 4 of the IAPT stats summary shows that less than 42% of referred patients finish a course of treatment. 27% of referrals ended without the patient being seen by the service and 25% ended after one session of treatment.

In practice, less than 37% of patients are getting prompt and appropriate treatment. The rest are fobbed off with utterly inappropriate therapy, dissuaded from starting or otherwise nudged off the waiting list.

I've heard countless stories from both professionals and service users about blatant manipulation of the IAPT stats. Stories of referrals being "lost in the system" are commonplace. Many services are providing an initial appointment within the 6 week target, but then placing patients on an internal waiting list for further treatment. Many patients with complex needs are simply dropping out, rather than being progressed through the stepped care model.

All this is against a backdrop of massive cuts to "specialist services", i.e. anything that isn't IAPT. The story I'm consistently hearing from practitioners and patient advocacy groups is that the service is failing the most vulnerable patients with the greatest need. Patients with mild depression and anxiety are getting the low-intensity treatment that they need in a prompt manner, but patients with more complex needs are simply being swept under the carpet.

A lot of people simply don't have access to psychotherapy. Many national healthcare systems and health insurers have very limited provision. Many people in the US are uninsured or have very limited access to insurance-funded psychotherapy, despite the MHPAEA and the ACA.

Here in the UK, someone diagnosed with depression or anxiety by their primary care physician is likely to receive no more than six sessions of CBT, often after a wait of many months. Private psychotherapy costs £60-£100 per session, which is totally unaffordable for many people.

We have a chronic shortage of psychiatric inpatient beds and very poor follow-up care. People who are hospitalised after a suicide attempt are often discharged the same day with little more than a prescription for antidepressants and the promise of a home visit by a community nurse.

Sadly, the UK isn't an outlier.

Technical skills have higher economic value but lower social status than skills in the arts. An eccentric painter or musician achieves a level of cachet that an eccentric programmer doesn't. Dysfunction has a certain glamour if you have artistic talent; there's no such thing as a tortured engineer.