Is usual care worth a monkey? Or more precisely the £2bn per year spent on NHSTalking Therapies for Adult and Children’s mental health?
Cuijpers et al (2024) anticipated that the response rate of treatment as usual would have improved as a result of the dozens of RCT’s conducted over past decades. Regrettably there has been no percolation. Remission rates and pre- post effect sizes did not significantly improve over time. In primary care the remission rate for care as usual was 27%. The pre-post standardised mean difference in care as usual in primary care was 1.11. But this is no different to that found in NHS Talking Therapies, suggesting that the latter confers no added value. Interestingly the remission rate using independent assessors in care as usual in the Cuijper et al (2024) analysis was found to be just 14%, Almost 80% of patients in routine care do not respond to treatment.
This tip of the iceberg response is identical that found by myself Scott (2018) assessing litigants with a standardised diagnostic interview with regards to their psychological treatment either before or after personal injury. (In specialised mental health care the response rate was 20%). In the rcts the response rate to psychological treatment was 41%.
Dr Mike Scott