Complex relational needs impede progress in NHS Talking Therapies (IAPT): implications for public mental health

Abstract

Although influential in “Increasing Access to Psychological Therapies” (IAPT), the IAPT initiative is predicated on at least two assumptions (namely, homogeneity of clinical pathology and level of severity) that have been recently challenged. A growing corpus of data, for instance, suggests that IAPT cohorts are not homogenous—in neither their severity nor presentation of psychopathology (1). Instead, IAPT cohorts appear to be confounded by a constellation of severe, and usually unrecognized, mental health issues [e.g., (2–4)]. In this paper, I argue that one such issue is complex relational needs1 and conclude by sketching several ways of addressing this problem.