Investigating Causal Effects of Mental Healthcare Provision on Labour Outcomes: A Case Study of Talking Therapies in England

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Objective for processing

[1 paragraph unchanged] Investigating Causal Effects of Mental Healthcare Provision on Labour Outcomes: A Case Study of Talking Therapies in England England. The following is a summary of the aims of the research project provided by the University of Manchester: The research project aims were to: • Identify the care pathway for individuals with mental health conditions/disorders through the expansion of access to talking therapies in England (IAPT); • Estimate the impact of supply-side factors (namely, provider-level waiting times) on labour market outcomes of patients at the first contact with NHS Talking Therapies services; • estimate the impact of supply-side factors on clinical and labour market outcomes of patients receiving IAPT treatment; • Inform service adaptations surrounding waiting time targets to better meet the needs of the patient population accessing mental healthcare in England (NHS Talking Therapies). • investigate what treatment pathway is optimal for improved labour market outcomes for individuals with common mental disorders: There is an identified need for evidence of the impact of mental healthcare treatments on labour market outcomes of real-world patients with common mental disorders. The impact of mental healthcare services on labour market outcomes of patients was expressed as a priority area of research by NHS England's Director of Operational Interests at a 'Lunch and Learn' seminar hosted by NHS England on 18th June 2024. The meeting was attended by University of Manchester colleagues to share information about the research UoM is conducting and discuss the areas of research which are of particular interest to NHS England. • provide evidence of the impact of different care pathways and varying treatments on labour market outcomes of real-world patients who have need of mental healthcare services; This research study is to aid in improving the service delivery of NHS Talking Therapies for Anxiety and Depression services (formally IAPT), and provide real-world evidence of the effect of mental healthcare treatments on labour market outcomes needed to better understand the relationship of mental health and labour supply in England. By doing so, the NHS may better meet the demands for treatment of the English population, and potentially further reduce the lost productivity caused by mental health conditions. • inform service adaptations to better meet the needs of the patient population accessing mental healthcare in England, namely IAPT services; The project is complete. The University of Manchester require retention of the Data to ensure reconstruction of the study analysis is possible if required. • aid the expansion of mental healthcare services to achieve the objective of reducing lost productivity of workers. No additional data will be requested from NHS England. The following NHS England Data will be accessed: Improving Access to Psychological Therapies (IAPT) v2 This Data Sharing Agreement (DSA) permits processing of the Data for the purpose of secure storage and back up on the NHS England Secure Data Environment (SDE). The data requested from the IAPT dataset captures detailed information on a nationally representative patient population, including patient’s sociodemographic characteristics, treatment pathway through the IAPT programme, and employment information captured at each interaction with the service. The University of Manchester project team will examine the impact of mental healthcare treatment provided by IAPT services on labour market outcomes of patients with common mental disorders at the individual-level. The project team consists of a Data Analyst who is a PhD student, two research fellows, and the Research Centre Lead. This DSA does not permit any further processing that involves analysis or linkage other than for the purpose of verifying findings in line with the original objectives of the study by repeating previous analyses described in this DSA. Following publication of the study findings, it is possible that the findings will be questioned or challenged by third parties through direct contact with The University of Manchester, contact via the publishing journal or an open letter. In such circumstances, The University of Manchester may repeat the previous analyses undertaken to verify that the published results were accurate and may write a response to be issued directly to the challenger or published. The University of Manchester may not undertake different analyses to those undertaken during the original analysis. This DSA does not permit any onward sharing of the Data. This DSA permits the necessary processing of the Data for the purposes of permanently destroying, deleting or erasing the Data once it is no longer required for the purpose for which it was collected. Once destroyed/deleted or erased, The University of Manchester must confirm destruction to NHS England. If any further data processing is required in addition to the above purposes The University of Manchester must submit an Amendment request to NHS England before Data is accessed. Data from the following NHS England Data will be retained: • Improving Access to Psychological Therapies (IAPT) v2 [3 paragraphs unchanged] The study team will not have access to any other data in the Secure Data Environment (SDE) other than the minimised data as outlined in this Data Sharing Agreement. [5 paragraphs unchanged] There is an identified need for evidence of the impact of mental healthcare treatments on labour market outcomes of real-world patients with common mental disorders. The impact of mental healthcare services on labour market outcomes of patients was expressed as a priority area of research by NHS England's Director of Operational Interests at a 'Lunch and Learn' seminar hosted by NHS England on 18th June 2024. The meeting was attended by University of Manchester colleagues to share information about the research UoM is conducting and discuss the areas of research which are of particular interest to NHS England. This research study is to aid in improving the service delivery of NHS Talking Therapies for Anxiety and Depression services (formally IAPT), and provide real-world evidence of the effect of mental healthcare treatments on labour market outcomes needed to better understand the relationship of mental health and labour supply in England. By doing so, the NHS may better meet the demands for treatment of the English population, and potentially further reduce the lost productivity caused by mental health conditions. [2 paragraphs unchanged] The University of Manchester team engaged with subject matter experts when designing the study, however no other organisations are involved as a controller, acting in an advisory capacity, or part of an oversight/steering committee. Data will be accessed by a PhD student who is a substantive employee of University of Manchester. The PhD student has completed mandatory data protection and confidentiality training and is subject to the University of Manchester’s policies on data protection and confidentiality. The individual accessing the data will do so under the supervision of a substantive employee of the University of Manchester. The University of Manchester would be responsible and liable for any work carried out by the individual. The PhD student would only work on the data for the purposes described in this Data Sharing Agreement (DSA).

Processing activities

[1 paragraph unchanged] NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and analytics tools. The relevant records from the Improving Access to Psychological Therapies (IAPT) v2 dataset are held in NHS England’s Secure Data Environment. The Data contains no direct identifying data items. The Data is pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient. NHS England will provide access to the relevant records from the Improving Access to Psychological Therapies (IAPT) v2 dataset. The Data will: This DSA permits processing of the Data by NHS England for the purpose of secure storage and back up. • Contain no direct identifying data items. This DSA does not permit any further processing that involves analysis or linkage. Licences for University of Manchester to access the Data in the SDE have been withdrawn. Access to the Data will only be reestablished for the purpose of verifying findings in line with the original objectives of the study by repeating previous analyses described in this DSA. • The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient. This DSA does not permit any onward sharing of the Data with the exception that the Data may be viewed for the purpose of an audit by a regulator such as the Medicines and Healthcare products Regulatory Agency (MHRA). The Data will not be transferred to any other location. The Data will be stored on NHS England’s Secure Data Environment. SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy. In the event that the Data needs to be accessed for the purposes of audit or to enable verification of previous findings; upon approval by NHS England, licenses to access the Data in the SDE will be reestablished for University of Manchester with authorisation from the Chief Investigator where it can be accessed by relevant individuals, only for the purposes of verifying results of previous analyses by rerunning analyses that were previously undertaken. Data would be accessible only for as long as is required to enable verification of the analyses and to write a response as appropriate. Responses will adhere to the rules for small number suppression in the HES Analysis Guide. Access to the SDE is controlled via a multi-factor authentication mechanism and access is restricted to the datasets and periods detailed within this agreement. Access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA. The Data may not be transferred to any other location and may only be accessed by substantive employees of University of Manchester for the purposes described above. Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE. This DSA is required for the following reasons; The Data will be stored on servers at NHS England. (1) The raw datasets (and any associated datasets and syntax files) may need to be accessed for the purpose of audit; Remote processing will be from secure locations within the UK. (2) The purpose of verifying findings in line with the original objectives. The Data will not leave the UK at any time. An audit may be required during the period of this DSA. This would involve a systematic and independent review of trial-related activities and documents, to determine whether data were recorded, analysed and accurately reported. Without all the raw datasets this cannot be done. SDE user access is restricted to an individual within The Centre for Primary Care and Health Services Research at the University of Manchester. The individual is a PhD student and a substantive employee of the University of Manchester. All personnel accessing the Data have been appropriately trained in data protection and confidentiality. The aggregated outputs derived from the Data will be combined with aggregated data from the publicly available IAPT monthly activity data (https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services) to produce provider/area-level IAPT performance metrics of the IAPT providers. This poses no risk of reidentification to patients included in the IAPT dataset. There will be no requirement and no attempt to reidentify individuals when using the Data. A PhD student Data Analyst from The Centre for Primary Care and Health Services Research of the University of Manchester will analyse the Data for the purposes described above. Research fellows (also supervisors of the PhD student) will collaborate with the PhD student to produce the expected outputs described in this Data Sharing Agreement.

Expected output

[1 paragraph unchanged] • A report of findings to IAPT service providers and NHS England and Improvement will be produced and disseminated (expected autumn 2025) • Report, briefing or presentation offered to NHS England to provide feedback on the SDE and use of the IAPT dataset, and its current state. [2 paragraphs unchanged] • Presentation at the Health Services Research UK conference to raise awareness in the research community and gain feedback. Interim findings will be presented at conferences throughout the lifetime of the project in order to gain timely engagement and feedback. • Presentations at the Health Economy Study Group, European Health Economic Association Conference, and International Health Economic Association conference. Applications will be submitted in September 2025 and January 2026. • Presentations at the Health Economy Study Group, European Health Economic Association Conference, and International Health Economic Association conference. [8 paragraphs unchanged]

Expected measurable benefits

[8 paragraphs unchanged] - • The project team will develop a causal model that exploits sources of geographical variation in IAPT treatment effects demand and supply of NHS Talking Therapies to produce causal estimates of IAPT treatment access to NHS Talking Therapies on patients' labour market outcomes. - • This develops the literature by supporting the creation of policy-relevant and actionable findings through a reproducible econometric model (benefit 1 of the list above). - • This will also advance the understanding of regional trends in the demand for IAPT treatments, NHS Talking Therapies services, the provision management of IAPT treatments, NHS Talking Therapies wait lists, and patient labour market outcomes (benefit 2 of the list above). [1 paragraph unchanged] - • The IAPT NHS Talking Therapies service was created to improve access to psychological therapies, providing evidence-based treatments to patients for their identified symptoms of common mental health problems. - • This service delivery model offered treatments based on the identified symptoms at the assessment stage and the patient's treatment goals. - The service has expanded to offer more treatments, different treatment modalities, and additional service options for patients (support for individuals with Long-term conditions, employment advice, and self-help resources). • The Project Team will explore the variation in the impact of waiting to access NHS Talking Therapies services on economic inactivity. Sources of variation include patient demographics such as reported gender, living in areas of low and high deprivation, and age groups (18-34, 35-50, 50-66). - We will explore variation in patient characteristics as an impacting factor in the success of IAPT treatment on labour market outcomes. This can reveal whether patients select psychotherapy treatment based on perceived idiosyncratic (individualised) gains in labour market outcomes. • This can reveal if there are identifiable groups of patients whose economic activity is more responsive to the duration of waiting to access services. For example, many patients will present symptoms of the same condition at the assessment stage of NHS Talking Therapies, but the causes of these symptoms and how they affect the person can differ significantly. There may be no relationship between the decision to participate in the workforce and the presenting mental health problem for some patients, who could then wait to access services with no resulting impact on their economic activity, and vice versa. - For example, many patients will present symptoms of the same condition at the assessment stage of IAPT, but the causes of these symptoms and how they affect the person can differ significantly. • Combining the economic and mental health research fields, the Project can produce causal estimates of the impact of waiting to access NHS Talking Therapies services on economic activity and sub-samples of patients who could benefit most from more efficient management of wait lists using patient demographic data. (benefit 3 of the list above). - These perceived gains from treatment will directly influence the acceptance and adherence to the treatment offered. These findings can also inform the planning of NHS Talking Therapies services across England, such as in areas of higher deprivation and lower labour market prospects, aiding the equitable provision of mental healthcare that accounts for variation in patients’ needs (benefit 4 of the list above). - Combining the economic and mental health research fields, we can produce causal estimates of specific treatment choices on labour market outcomes and sub-samples of patients who benefit most from these choices using patient demographic data. - These findings can be used to identify optimal treatment pathway choices for individuals who declare a goal of their treatment is related to their labour market prospects during their assessment or individuals identified by the assessor who could benefit from employment support (benefit 3 of the list above). - These findings can also inform the planning of IAPT services across England, such as in areas of higher deprivation and lower labour market prospects, aiding the equitable provision of mental healthcare that accounts for variation in patient’s needs (benefit 4 of the list above). [1 paragraph unchanged] • Ensuring patients are provided with adequate information and choice to inform and agree a course of treatment with IAPT practitioners conducting the assessments, and; Ensuring patients are provided with equitable, timely access to NHS Talking Therapies services and; • if there is an identified link between waiting for treatment of a mental health condition and labour supply, practitioners economic activity, NHS Talking Therapies commissioners and service managers will be empowered to make evidence-based recommendations for optimal treatment pathways for waiting time targets to achieve improved labour market outcomes based on the CMD condition patients' socioeconomic and socioeconomic demographic indicators. [2 paragraphs unchanged]

Benefits reported

Yielded Benefits is not a requirement for new applications. Outputs still being derived.