Article: Has ‘IAPT’ eaten itself? Jan 2020

[Sly Saint]

The experiment with providing counselling to one in 30 people – Improving Access to Psychological Therapies [IAPT] – appears to have broken the mental health of many NHS therapists themselves.

With the NHS’ new ten-year plan backing expanded access to IAPT, former counsellor Philip K. Marzouk speaks to some of those involved in and impacted by an often-heralded initiative.

The latest figures from the Mental health statistics for England briefing report put the number of referrals through the Improving Access to Psychological Therapies (IAPT) programme at 1.4 million in 2016/2017. That’s three in every 100 people. Services are under immense, increasing pressure to the extent that staff are now running for cover.

Department of Health and Social Care figures from September 2018 showed that 2,000 mental health staff are leaving NHS services per month,

Since 2014, the NSP have been conducting annual surveys with mental health staff to assess national staff wellbeing within NHS services. The figures are remarkable. In their latest survey, NSP found that 43 percent reported feeling depressed in the prior week; 42 percent reported feeling like a failure in the past week; 72 percent think that the service they work in was understaffed and not fit for purpose; and 23 percent were actively considering leaving the NHS. These figures have been broadly consistent since 2014.

Dr. Amra Rao, a clinical psychologist and one of the researchers for staff wellbeing at the NSP, told this journalist that pressures are forcing well-trained leaders out, to be replaced by more junior staff who receive no extra pay for their extra work: “Many leaders have taken redundancies or they have taken early retirement. In psychological services at the moment the leadership is quite fragile.”

This speaks to NHS England’s approach to the crisis: to them, staffing is a revolving door. Their approach is if someone is unwilling to do the job, they’ll find someone who will for less pay.

https://www.mentalhealthtoday.co.uk/blog/the-inside-story-of-how-iapt-ate-itself

 

[NelliePledge]

Feel sorry for the staff but it’s not them who are the truly vulnerable. Very little emphasis on how the IAPT model is failing clients.

 

[James Morris-Lent]

So the mental health staff are displaying maladaptive psychobehavioral patterns. It sounds like they need CBT.

 

[Wonko]

Or.....given that these people are/were considered exemplary examples of their type, models of correct coping and thinking behaviors so perfect that they were deemed capable of 'teaching' correct thinking to those deemed maladapted, it's possible, that the behavior they are now displaying is not maladaptive behavior, but instead is adaptive and correct for the situation they have found themselves in.

Is a behavior only maladaptive if it is against the perceived interests of a few who define it so, instead of being truly maladaptive as in flawed and harmful to the individual.

 

[James Morris-Lent]

Or.....given that these people are/were considered exemplary examples of their type, models of correct coping and thinking behaviors so perfect that they were deemed capable of 'teaching' correct thinking to those deemed maladapted, it's possible, that the behavior they are now displaying is not maladaptive behavior, but instead is adaptive and correct for the situation they have found themselves in.

Is a behavior only maladaptive if it is against the perceived interests of a few who define it so, instead of being truly maladaptive as in flawed and harmful to the individual.

I see. It's all some sort of Jedi mind trick.

 

[Hoopoe]

If the whole thing doesn't work well then it's good that people are leaving.

A project that's built on flawed evidence would not work well in the real world and what may be happening is that CBT is finally meeting reality and the two are not getting along well.

 

[rvallee]

Department of Health and Social Care figures from September 2018 showed that 2,000 mental health staff are leaving NHS services per month,

I'm sorry WHAT? That is devastating. Holy hell is this a dumpster fire.

Hate to do it but: we told you so. We (generally speaking), the guinea pigs on which this paradigm failed, with people lying about it, told you it was stupid. Clinical psychology is a baby of a field, not even close to be ready, the tools are mediocre, the knowledge is limited, the efficacy is non-existent, the feedback mechanism broken on purpose, the hubris, oh hell, the HUBRIS.

A tale that channels both Icarus and Sisyphus. Impressive, truly an epic failure.

Feel sorry for the staff but it’s not them who are the truly vulnerable. Very little emphasis on how the IAPT model is failing clients.

That's always been the failure at the core of BPS: it is strictly for the physicians' benefits, to discard "difficult" patients away. Patient outcomes are irrelevant to this paradigm, it is by physicians, for physicians.

 

[Mithriel]

The cynic in me wonders how many of these "retired" senior staff are now doing lucrative work in the private sector as CBT is rolled out as the answer for everything.

 

[Trish]

I suspect a lot who have left are the most highly qualified and experienced therapist and clinical psychologists who have either moved on to other jobs in the NHS or privately. It seems a huge pity to me that IAPT has gone down the route of low quality therapy for everyone rather than high quality therapy for the few who need it most.

It inevitably means they lose the best most experienced people who actually can help some people in serious distress and with serious mental health problems, and end up with so called group therapy which is no more than classrooms full of assorted people with a wide range of problems being lectured by poorly trained 'therapists' on basic strategies for changing their thinking, or deep breathing or mindfulness or some mix of these, which probably helps almost none of the participants.

 

[Wonko]

But it's much more 'efficient' this way.

The number of people 'treated' per pound paid to staff has been increased.

It would of course be much more efficient if they, for example, used rocks as therapists.

It's likely less people would be 'treated', and that some people might die from injuries caused by the rapid application of projectile therapists when people found out and lost it, but a staff cost of zero - you can't get much better than infinite efficiency.

Given that there appears to be absolutely no verification of successful treatment, or even of treatment, then the numbers can just be made up, or not, as they are now.

Possibly quite small rocks, to cut costs, and reduce the risk of death - it's hard to inadvertently injure someone with a grain of sand no matter how incensed and victimized you feel.