Brightspots David Clark
MBC Education  |   Aug 17, 2023  |   11 minute read

Key Learnings from ‘Revolutionizing Mental Health Treatment: Dr. David Clark on the Power of Measurement-Based Care’

Key Learnings from 'Revolutionizing Mental Health Treatment: Dr. David Clark on the Power of Measurement-Based Care'
  1. Key Learnings
  2. Tips & Tricks for MBC by Dr. David Clark
  3. The Economic Impact of Evidence-Based Mental Health Treatment

1. Key Learnings from ‘Revolutionizing Mental Health Treatment: Dr. David Clark on the Power of Measurement-Based Care’

In our recent session with Dr. David Clark, he shared some important learnings from the NHS Talking Therapies program (formerly known as IAPT) that show the immense clinical value of Measurement-Based Care (MBC) and can help inform its implementation across the globe.


What was particularly interesting was their team’s ability to leverage outcome data to understand what worked best, by comparing results across all of their programs. Dr. Clark shared some of the more impactful findings they observed from the services which garnered the highest outcomes:

  1. Dosage of Treatment – Programs that did well delivered a higher average dose of treatment, with the optimal number of sessions being 10.
  2. Time to Treatment – Clients who started treatment within six weeks of seeking referral had higher outcomes than those with longer wait times, even when the treatment delivered was the same.
  3. Following Clinical Guidelines – Providers who closely followed the guidelines of an evidence-based practice saw higher outcomes than those who made minor alterations.
  4. Appointment Reminders – Organizations with frequent no-shows to appointments quickly improved session attendance after implementing SMS reminders, with improved outcomes following suit.
  5. Customized Assessments – Understanding the challenges patients are experiencing and including additional assessments to measure and track a patient’s unique challenges proved to offer greater insight into symptoms and led to improved clinical outcomes.

This is just the tip of the iceberg of immense learning and innovation that can be done when we engage in MBC. Stay tuned as we share more valuable insights from our first session, and don’t forget to register for our second event with Dr. Clark to learn more from one of the world’s most prominent mental health leaders.

2. Tips & Tricks for MBC by Dr. David Clark

Our last session with Dr. David Clark was packed with incredible insights for implementing MBC. Dr. Clark drew from the key success factors of the NHS Talking Therapies Program to offer some guidance for small to large system-level MBC implementations. The session helped empower attendees with the knowledge to help them strategize and successfully implement MBC across their services.

We pulled clips of some of the most valuable tips and insights shared by Dr. Clark, check them out below:

A Collaborative Approach From Leadership

Dr. Clark shared that the stance leadership takes on Measurement-Based Care and how they introduce it can have a major impact on not only clinician buy-in during implementation, but also how effective it is in practice. Ensuring that data collection is seen as an exercise that exists to provide clinical value, first and foremost, is key to creating a culture of learning and reflection at the organization. The measures and process of Measurement-Based Care should be seen as a way to better understand clients, particularly when their scores are not improving, as the data can help clinicians work together to identify challenges, innovate services, and improve the quality of care they deliver collectively.

Make MBC Easy For Clinicians

Dr. Clark covered a few important factors that are easy for organizations to action which play a significant role in helping facilitate strong adoption and use of MBC:

  1. The role of technology & automation: The work of measurement and data entry should not fall on staff or clinicians, nor should it take away from valuable time in session. Going further, MBC should alleviate any burden of measurement that may already exist and allow the clinician to find clinical value from the data collected. The ability to automatically schedule and deliver assessments to clients (via Email and SMS) to allow them to complete assessments remotely outside of sessions, are both essential to facilitating this process. Additionally, data should transfer directly to the IT system and be automatically visualized, so it can serve as a basis for meaningful discussion with clients in session. Removing any process burden and providing clinical value to clinicians has ensured great adoption for Dr. Clark’s NHS Talking Therapies, and we’ve seen the same across Greenspace implementations.
  2. The importance of clinical training: Dr. Clark stresses the importance of training clinicians and showing them the value of leveraging assessment results throughout therapy. They should be providing training on things like, how to introduce assessments in session, how to get curious about scores with your clients, and how to use results to inform discussions and enhance clinical decision making. Training is also not a static task, but a process that will shift over time dependent on the skills, needs and challenges of your clinical team. If clinicians understand and believe in the value of MBC, it will transfer into implementation success and its effectiveness— strengthening therapeutic alliance and improving outcomes for clients.

How You Report on Data Matters

NHS Talking Therapies has collected data from 99% of people accessing care, which is an incredibly impressive feat. The approach to how they have chosen to report on data was identified by Dr. Clark as having a major impact on the incentive for clinicians to engage in MBC with their clients. This was reinforced in two ways:

    1. Report on the entire cohort: Rather than reporting on the data of each individual in treatment or of each clinicians case load, they have found it valuable to aggregate and report on data across clinics, regions, treatment cohorts, and the entire population. This has allowed for interesting learnings to be shared across treatment locations, generated useful insights and needs across unique populations served and has eliminated undue pressure for clinicians treating complex cases who may not see their clients improve at the same rate as the average person accessing care.
    2. No Data = No improvement: If clinicians do not collect data on their clients, NHS reports will show there was no improvement at all. This has helped encourage clinicians to engage in MBC because even slight improvements will have a greater impact on the clinic’s aggregate data than no improvement at all. This has also empowered clinical leaders with additional motivation to inspire the adoption of MBC processes among their clinicians.

The Importance of Client Visibility

Dr. Clark expressed the value clients see when they are given the opportunity throughout care to view visuals of their progression. In line with the research, NHS Talking Therapies has seen how powerful it is for clients to see and work to understand trends or patterns in their symptoms, particularly when they feel as though they haven’t made progress or they’re having a bad day or week. Clients can become cognizant of their individual symptoms, can reflect on the potential factors in their life that may lead to changes in their mental health and are able to develop a shared language so that they can better communicate their experiences, needs and goals throughout care. This process allows them to become knowledgeable of their own mental health and work *with* their clinician towards making progress in treatment.

3. The Economic Impact of Evidence-Based Mental Health Treatment

We often discuss the clinical value of Measurement-Based Care (MBC) for people in care, providers, and mental health leaders, sharing over 20 years of research demonstrating a higher overall improvement in clinical symptoms and therapeutic alliance, in addition to reduced drop-outs and no-shows rates.

But how do these benefits translate to total costs of mental and physical healthcare for an individual, as well as across entire health systems? And how can we help providers leverage evidence-based practices for mental health treatment in order to reduce overall healthcare costs? Dr. David Clark, the special guest of our last educational series, helped us answer this question through the outcome data collected through the NHS Talking Therapies program (originally referred to as IAPT) over the last 15 years.

The Benefits of Evidence-Based Psychological Treatments

To start answering these questions, Dr. Clark provided us with a couple statistics about mental health challenges and their relationship to physical health:

  • 40% of people with anxiety & depression also have a long term physical health problem.
  • The cost of managing physical conditions is about 50% higher when patients also have anxiety and depression.


The evidence shows that we can significantly reduce both mental and physical healthcare costs if we dedicate resources to improving treatment options for anxiety and depression, as well as their overall efficacy. There are three evidence-based examples that demonstrate the economic impact of mental health interventions, where mental health improvements have directly translated to overall healthcare cost savings:

1. The Impact of NHS Talking Therapies on Cardiovascular Disease

Dr. Clark shared a study conducted on 636 955 individuals with cardiovascular disease that were also receiving therapy to treat depression, with Measurement-Based Care at its core. The results showed that those who saw an improvement in depression symptoms had a 10-15% lower risk of Cardiovascular Disease.

These findings are particularly impactful when we consider the fact that Cardiovascular Disease is the leading global cause of death. The report outlines that the risk of cardiovascular issues is around 72% higher for individuals with major depressive disorders, compared to those without.

In addition to decreasing the occurrence of Cardiovascular Disease, a reduction in depressive symptoms was also associated with anywhere from 11-19% lower risks for coronary heart disease, stroke, and all-cause mortalities. Individuals in the 45 to 60 year-old range with improved depression had a 22% decreased likelihood of death during follow-up compared to those who had not improved, while those 60 and over had a 15% reduction. Additionally, the impact on the costs of care due to evidence-based psychological treatment is long lasting. Dr. Clark shared that those who recover have a reduced occurrence of any kind of future adverse cardiovascular events and relapse of their anxiety or depression.

The study reinforces the need for effective and accessible psychological treatments in order to drive improved outcomes for both mental and physical health challenges. There is a clear link between mental health outcomes and physical health, demonstrating the economic benefits of evidence-based psychological treatments, both for individuals and health systems.

2. The Impact of Psychological Treatment on Individuals in the Workplace

In Thrive: The Power of Evidence-Based Psychological Therapies, Dr. David Clark and economist Richard Layard present their arguments which catalyzed the creation of the NHS Talking Therapies program. The program had Measurement-Based Care as its foundation, to meaningfully improve outcomes, understand efficacy of services, and inform continuous service innovation. A significant part of their case rested on the impact of evidence-based care on individuals in the workplace, where the treatment of anxiety and depression would help to reduce unemployment, absenteeism, and presenteeism (when employees are at work, but unable to be their most productive).

In wealthy nations, mental illness makes up half of all illness in working-age people (45 and under). Not only is it the most prevalent illness in this age group, but almost half of all reported disability leave can be attributed to mental illness— in the US, it accounted for about 1/3 of those on disability, making a clear connection between unemployment and mental health.

Dr. Clark and Richard Layard argue that if this population was able to work, it would increase total employment by more than 4%, which has massive economic implications for both those individuals, taxpayers broadly, and the overall national output.

Not only are people living with mental illness or mental health challenges less likely to hold employment, those who are employed are often unable to be their most productive or are often out sick, known as presenteeism and absenteeism. Presenteeism refers to the lack of productivity attributed to those suffering from mental health challenges. When surveying people in the workplace, it was found that mental health related presenteeism accounts for similar levels of reduced output in comparison to absenteeism.

In the UK, it was estimated that the combined impact of presenteeism, absenteeism, and unemployment is a reduced national income (GDP) of about 7%. With this in mind, the economic benefits associated with enhancing the mental health of the workforce are extensive, both for the overall health of the population, healthcare costs and economic productivity.

3. The Economic Impact of Evidence-Based Mental Health Treatment

A recent economic evaluation conducted on data from 27,540 patients receiving mental health treatment through the NHS Talking Therapies program found that the main drivers of healthcare costs can be tied to wait times and the overall effectiveness of treatment.

Note: The authors of this study use quality-adjusted life years (QALYs) to measure the overall health and quality of life a person can expect to experience due to psychological interventions. QALYs take into account life expectancy and quality of life during that time. The researchers have determined that one quality-adjusted life year to be worth £20,000, meaning that if the psychological intervention used costs less than £20,000, it can be considered cost-effective.

Wait times

The delay from initial time of access to actual treatment resulted in increased healthcare costs due to patients accessing other healthcare services and costs associated with health-related quality of life. This was particularly true when dealing with more severe mental health challenges. You can see in the visualizations below the direct correlation between extensive wait times and both QALY and background costs, where waiting time plus treatment time that extended over 6 months results in cost increases of up to £1,000 for severe depression and up to around £750 for severe anxiety, per patient.

44220 2023 106 Fig3 HTML

Treatment Effectiveness

Treatment effectiveness was also a key driver of the overall cost of mental healthcare services. Mental health symptom improvements were shown to have a positive impact on both background costs and QALY costs. The upper row of graphs below shows that when treatment services for depression were 20% less effective than average NHS Talking Therapies services, they were around £200 to £250 more costly per patient, depending on the severity of depression. As a comparison, treatment services for depression which were 20% more effective than average NHS Talking Therapies services were around £150 to £200+ less costly, depending on severity. When treating anxiety, the services which were 20% less effective were almost £300 more costly per patient for mild and moderate anxiety, while services 20% more effective had similar cost-effectiveness to those seen in depression treatment.

44220 2023 106 Fig4 HTML

Where Measurement-Based Care comes in

The first and last example addressed above were drawn directly from NHS Talking Therapies outcome data, which represents the largest data set drawn from the use of Measurement-Based Care (MBC) in treatment. Since the launch of NHS Talking Therapies in 2008, their team has leveraged the outcome data generated by MBC to continually inform service innovation and improvements. These changes have resulted in a drastic improvement of service effectiveness, raising average recovery rates from 38% to 52% by 2018 (see graph below).

Screenshot 2023 09 08 at 2.15.47 PM

The key to this improvement was simple. They used the data to identify groups within the population that were not responding to treatment, uncovered similarities amongst them, and collaborated on service improvements and program innovations that could address their unique needs. As one example, after identifying that many patients not improving under IAPT were unemployed, they offered support from employment advisors (EA) alongside psychological therapy. The difference was notable, with 47% average recovery for those who received EA alongside psychotherapy vs. only 27% for those who did not.

Dr. David Clark, co-creator of NHS Talking Therapies, shared in our recent educational webinar that, “if we hadn’t been collecting outcome data on everyone in our services, we’d still be in that position [low recovery rates] and blissfully ignorant”.

Not only does MBC help to enhance clinical decision making and strategic innovation, but evidence shows it improves outcomes, increases therapeutic alliance, and reduces drop-outs and no-shows, when compared to treatment as usual. The economic value, as well as mental/physical health benefits, and cost reductions are greatest when we implement an evidence-based and outcome-informed treatment practice that is proven to deliver superior clinical results.

The NHS Talking Therapies data makes it clear how imperative it is for healthcare systems and service organizations to focus on improving access to evidence-based psychological treatment options. This requires Measurement-Based Care to be at the foundation of the treatment process— as we know it will lead to improvement in care at an individual level, while providing powerful outcome-data to inform continuous service enhancement at the system-level. Not only will this drive better mental and physical health outcomes that lead to lower related healthcare costs, but organizations and health systems will be better equipped to understand the impact of services and how they can continually iterate and improve overtime.

Final thoughts

The insights shared by Dr. Clark make a direct case for the funding and advancement of evidence-based psychological treatments, and for the continued proliferation of Measurement-Based Care as a fundamental component of evidence-based practices. This direction is also supported by accreditors like the Joint Commission and the Mental Health Commission of Canada, both of which advocate for Measurement-Based Care as a foundational component of evidenced-based care. Years of research demonstrates the clinical benefits of Measurement-Based Care; we know it’s the right step for health systems and service organizations to take in order to best support the people they serve. What the outcome-data above shows is that incorporating MBC throughout any service is also the best thing we can do to improve overall health outcomes across populations and see a significant reduction of related healthcare costs.

To learn more from Dr. David Clark and hear his answers to some of the most pressing MBC questions, register for our next session with one of the leading minds in mental health service innovation and leading global expert on Measurement-Based Care (MBC).

Register now and submit your questions for Dr. Clark.


  1. Catarino, A., Harper, S., Malcolm, R., Stainthorpe, A., Warren, G., Margoum, M., Hooper, J., Blackwell, A. D., & Welchman, A. E. (2023). Economic evaluation of 27,540 patients with mood and anxiety disorders and the importance of waiting time and clinical effectiveness in mental healthcare. Nature Mental Health1(9), 667–678.
  2. Céline El Baou, Desai, R., Cooper, C., Marchant, N. L., Pilling, S., Richards, M., Saunders, R., Joshua E.J. Buckman, Aguirre, E., John, A., & Stott, J. (2023). Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England44(18), 1650–1662.
  3. Layard, R., & Clark, D. M. (2014). Thrive: The Power of Evidence-Based Psychological Therapies. In Google Books. Penguin UK.