Improving access to psychological therapy: Initial evaluation of two UK demonstration sites

Copyright © 2009 Elsevier. NOTICE: This is the author’s version of a work accepted for publication by Elsevier. Changes resulting from the publishing process, including peer review, editing, corrections, structural formatting and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Behaviour Research and Therapy, 2009, Vol. 47, Issue 11, pp. 910 – 920 DOI: http://dx.doi.org/10.1016/j.brat.2009.07.010Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed ‘demonstration sites’) during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55–56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed

Does Migration Make You Happy?:A Longitudinal Study of Internal Migration and Subjective Well-Being

The authors acknowledge financial support from the Economic and Social Research Council (ESRC) (RES-625-28-0001). This project is part of the ESRC Centre for Population Change (CPC). Financial support from the Marie Curie programme under the European Union's Seventh Framework Programme (FP/2007-2013) / Career Integration Grant n. PCIG10-GA-2011-303728 (CIG Grant NBHCHOICE, Neighbourhood choice, neighbourhood sorting, and neighbourhood effects).The majority of quantitative studies on the consequences of internal migration focus almost exclusively on the labour-market outcomes and the material well-being of migrants. We investigate whether individuals who migrate within the UK become happier after the move than they were before, and whether the effect is permanent or transient. Using life-satisfaction responses from twelve waves of the British Household Panel Survey and employing a fixed-effects model, we derive a temporal pattern of migrants’ subjective well-being around the time of the migration event. Our findings make an original contribution by revealing that, on average, migration is preceded by a period when individuals experience a significant decline in happiness for a variety of reasons, including changes in personal living arrangements. Migration itself causes a boost in happiness, and brings people back to their initial levels. The research contributes, therefore, to advancing an understanding of migration in relation to set-point theory. Perhaps surprisingly, long-distance migrants are at least as happy as short-distance migrants despite the higher social and psychological costs involved. The findings of this paper add to the pressure to retheorize migration within a conceptual framework that accounts for social well-being from a life-course perspective.PostprintPeer reviewe

In defence of global egalitarianism

This essay argues that David Miller's criticisms of global egalitarianism do not undermine the view where it is stated in one of its stronger, luck egalitarian forms. The claim that global egalitarianism cannot specify a metric of justice which is broad enough to exclude spurious claims for redistribution, but precise enough to appropriately value different kinds of advantage, implicitly assumes that cultural understandings are the only legitimate way of identifying what counts as advantage. But that is an assumption always or almost always rejected by global egalitarianism. The claim that global egalitarianism demands either too little redistribution, leaving the unborn and dissenters burdened with their societies' imprudent choices, or too much redistribution, creating perverse incentives by punishing prudent decisions, only presents a problem for global luck egalitarianism on the assumption that nations can legitimately inherit assets from earlier generations – again, an assumption very much at odds with global egalitarian assumptions

The external benefits of higher education

The private market benefits of education are widely studied at the micro level, although the magnitude of their macroeconomic impact is disputed. However, there are additional benefits of education, which are less well understood. In this paper the macroeconomic effects of external benefits of higher education are estimated using the “micro-to-macro” simulation approach. Two types of externalities are explored: technology spillovers and productivity spillovers in the labour market. These links are illustrated and the results suggest they could be very large. However, this is qualified by the dearth of microeconomic evidence, for which we hope to encourage further work

Regional policy spillovers : the national impact of demand-side policy in an interregional model of the UK economy

UK regional policy has been advocated as a means of reducing regional disparities and stimulating national growth. However, there is limited understanding of the interregional and national effects of such a policy. This paper uses an interregional computable general equilibrium model to identify the national impact of a policy-induced regional demand shock under alternative labour market closures. Our simulation results suggest that regional policy operating solely on the demand side has significant national impacts. Furthermore, the effects on the nontarget region are particularly sensitive to the treatment of the regional labour market

The regional economic impact of more graduates in the labour market: a “micro-to-macro” analysis for Scotland

This paper explores the system-wide impact of graduates on the regional economy. Graduates enjoy a significant wage premium, often interpreted as reflecting their greater productivity relative to non-graduates. If this is so there is a clear and direct supply-side impact of HEI activities on regional economies. We use an HEI-disaggregated computable general equilibrium model of Scotland to estimate the impact of the growing proportion of graduates in the Scottish labour force that is implied by the current participation rate and demographic change, taking the graduate wage premium in Scotland as an indicator of productivity enhancement. While the detailed results vary with alternative assumptions about the extent to which wage premia reflect productivity, they do suggest that the long-term supply-side impacts of HEIs provide a significant boost to regional GDP. Furthermore, the results suggest that the supply-side impacts of HEIs are likely to be more important than the expenditure impacts that are the focus of most HEI impact studies

Transport strategy in Scotland since devolution

This article critically reviews how the Scottish Executive's approach to transport has developed since devolution. Although there is much to commend, a number of concerns can be identified, including the possibility that a number of strategic infrastructure schemes appear to have been approved on political rather than on technical grounds. It is difficult to know whether the current set of transport infrastructure investment plans represents good value for public money

The New Deal: jeopardised by the geography of unemployment?

The New Deal is the Labour government's flagship programme to "end the tragic waste of youth and long-term unemployment" by getting people off welfare benefits and into work. This paper argues that the principal weakness of the New Deal is that it seeks to influence the character of labour supply (i.e. the motivation and skills of the unemployed) while neglecting the state of labour demand, which varies greatly between places. The uneven geography of unemployment in the UK is likely to have a crucial bearing on the programme's impact and effectiveness, but this has been largely ignored in its development. The paper outlines some of the practical consequences of this imbalance and suggests how it could be rectified for the programme to be more effective

Legal determinants of external finance revisited : the inverse relationship between investor protection and societal well-being

This paper investigates relationships between corporate governance traditions and quality of life as measured by a number of widely reported indicators. It provides an empirical analysis of indicators of societal health in developed economies using a classification based on legal traditions. Arguably the most widely cited work in the corporate governance literature has been the collection of papers by La Porta et al. which has shown, inter alia, statistically significant relationships between legal traditions and various proxies for investor protection. We show statistically significant relationships between legal traditions and various proxies for societal health. Our comparative evidence suggests that the interests of investors may not be congruent with the interests of wider society, and that the criteria for judging the effectiveness of approaches to corporate governance should not be restricted to financial metrics