The costs of common mental health problems
Mental health problems account for a quarter of all ill health in the UK, with an estimated cost of £105 billion a year. In the Netherlands, approximately €4,1 billion is spent each year on mental health care. A large proportion of the patients treated in mental health services suffer from common mental health problems such as depression or anxiety disorders. It is estimated that approximately one in four people meet diagnostic criteria for one of these disorders at some point in their life. Fortunately, depression and anxiety disorders can be treated successfully and there are a number of effective treatment options including psychological support and pharmacotherapy. Moreover, research suggests that money spent on psychological treatment for depression and anxiety disorders has a good return on investment. However, recent numbers from the Dutch National Benchmark Institute suggest that about a third of the patients with a depression or an anxiety disorder do not benefit from treatment in mental health care. This translates to 64.000 patients per year who continue to suffer despite having received psychological treatment. The rising costs of mental health care, as well as the substantial group of patients that do not respond well to treatment indicate a strong need for mental health care to become more effective and efficient. In addition to healthcare costs, enduring depression and anxiety symptoms carry enormous personal costs for sufferers and their families.

Outcome feedback technology
Outcome feedback is a computer-based technology that assists therapists in monitoring how their patients are responding to treatment. The system tracks changes in each patient’s depression and anxiety symptoms over time through the use of standardized questionnaires. Next, the patient’s symptom trajectory is compared to an expected trajectory, which is based on the observed course of treatment for hundreds of similar cases. The system alerts the therapist with a “red signal” if a patient’s symptoms are progressing significantly worse than the expected trajectory (symptoms are more severe than those observed in typical cases). The system automatically alerts therapists when a red signal occurs with their patients, which prompts therapists to discuss possible obstacles for improvement with their patients and clinical supervisors.

More efficient treatment
In a recent study, we trained a team of therapists working in a stepped-care psychological service in the United Kingdom to use the outcome feedback technology described above. The service was part of the national IAPT programme in England (Improving Access to Psychological Therapies). What is interesting about this setting is that it already applies highly standardised treatments, and outcomes are regularly monitored and managed by psychological therapists. As such, we did not know whether our relatively simple intervention would have any effect on treatment outcomes or costs. We gathered clinical data for all of the patients treated by this team of therapists, six months before (controls = 349 patients) and six months after the training (feedback cases = 245 patients). We compared average depression and anxiety symptom reductions and duration of treatment between control and feedback cases. Results indicated that feedback cases completed treatment with similar levels of symptom improvement compared to the control cases. However, cases treated using the outcome feedback technology accessed a significantly lower number of treatment sessions, and therefore attained similar clinical outcomes at a reduced cost. This resulted in a total saving of almost £24000 in the costs of care during a study period of six months. Interestingly, these savings exceeded the costs to run the study, which meant that the study in principle financed itself.

Dissemination and impact
This outcome feedback technology is now fully integrated into PCMIS, which is a clinical data management system widely used by hundreds of psychological therapists across England and Australia. This integration of technology ensures the large-scale dissemination and sustainability of this work. Additionally, our research team has recently completed a large-scale randomised controlled trial successfully applying the same technology across multiple psychological services covering London, Cambridge, Cheshire, Humber, West Yorkshire and other regions, the results of which will be published in 2018.