Ensuring IAPT Makes A Real-World Difference - Scott: Dec 2019

http://mhfmjournal.com/pdf/ensuring-IAPT-makes-a-real-world-difference.pdf

see also
£3 Billion Spent On Talking Therapies For No Clear Benefit
http://www.cbtwatch.com/3-billion-spent-on-talking-therapies-for-no-clear-benefit/

 

I find it important to note that this was a target, is merely claimed as such because that was the target and not meeting the target would have been so bad for the continuation of the program that it's seen as preferable to lie.

So in essence IAPT has been "claiming" 50% "recovery" rates since before it even started. Just like PACE, where the numbers were fudged to align better with the initial target. There is no substance behind the claims of 50% recovery, it's merely aspirational and has pretty much been debunked.

That would be devastating to the BPS model.

That would be extremely devastating to the BPS model.

That would be the end of the BPS model.

Though louder for those in the back:

That would be a damning indictment of the entire BPS model and mark it down as a failure. Which it has been.

This is a very relevant observation:

Stuff we have been saying for years but still feels good to see others realizing:

This would be devastating to Sharpe's career:

and literally dismantles his own argument about us being irrational since CBT is used to "help" cancer patients. Doing random nonsense doesn't formally count as helping, and anyway "helping" is literally the main argument for alternative medicine, without evidence it does not matter.

I hope people look at this and compare to the the US initiative called No Child Left Behind, enacted in the early 2000's with the aim of improving education by obsessively focusing on standardized testing and punitive measures for low-performing schools, which in practice lead to many of those schools outright cheating, with the teachers' and administration's oversight, to meet the arbitrary targets. People were essentially placed in situations in which they either lied or lost their jobs. Exactly what has been found in IAPT. Brilliant.

This program is widely seen as a failure and largely for the same reasons: ignorance and wishful thinking. Except IAPT is worse in every respect and was so obviously pie-in-the-sky. And as with every disaster there will be clean-up costs.

 

What worries me about Scott's analysis is that it seems to be the same as that given to me by Simon Wessely - that sausage machine CBT is not as good as proper CBT.

That is not a particularly helpful message for PWME.

The figures that Scott extracts may be helpful but ...

 

Do you know, is there anything very precisely different that separates the sausage machine variety from 'proper' CBT. I expect training would be one feature but how do they view this training or other differences so as to cause 'proper' CBT to be effective?

Or to put it differently perhaps, what is it about the sausage machine that is deficient in SW POV?

 

You would need to ask them but the impression I got was that IAPT was bypassing proper training in the wisdom of true psychotherapy. I guess it is all to do with a delusion of wisdom and importance and the desire to be seen as a high priest who can anoint the diligent and faithful. In simpler terms you and your buddies might be out of a job.

To be fair, it might be reasonable to criticise a service that uses people with three weeks training rather than three years. But not because of learning deep theories in three years, just getting some experience of people's problems.

 

Which is where the old military saying that no battle plan survives contact with the enemy comes into play. That and the fact that his "highly trained" PACE therapists made no better than some rando with a CBT certificate anyway.

The only way IAPT could ever have unfolded was through fast-food type, there literally never was any other possibility (well, other than even worse fast-food). It was pie-in-the-sky and never made economic sense.

Reminds me of Edison's plan for a DC electrical grid. It never made any sense either, was a disaster in small-scale installations and would have been an even bigger disaster in full implementation, massively more expensive than AC and worse on every level. But it was his thing and that's all that mattered to him, he had an ideological battle to win with Westinghouse and Tesla and tiny details like entire towns engulfed in flames because of frequent electrical fires was just a small price to pay for civilization, even if it was massively more expensive and less reliable than the alternative.

Whether Wessely of any of the other IAPT architects did understand or not the most predictable thing about their big idea makes no difference, there never was any other possible outcome.

 

Wessely avoids precision at all costs, so you'll be very lucky to get a clear answer to that. The difference between the sausage machine and proper CBT is [insert self-deprecating bonhomie smokescreen here].

 

This is from the NHS Recovery Rate page:

https://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=6228

 

Uuuuuh....

So it's a metric that isn't scored, therefore not quantifiable, but it has a target of 50%. OK. I guess half is more feeling than number in this context.

It looks like the data is rolled into this report: https://digital.nhs.uk/data-and-inf...hub/mental-health-services-monthly-statistics, but it seems only to be a record of people going into the service, not about outcomes, which aren't even scored. And since we know people in the IAPT services have reported being told to lie and exaggerate outcomes...

So it seems to follow the same approach as with CBT/GET in ME: you completed the treatment, that means you're "recovered" (which we can't measure), now move along.

 

Rely Solely On A Self-Report Measure To Hike Up Funding and Fudge Outcomes
Jan 10 2020

full post here
http://www.cbtwatch.com/rely-solely-on-a-self-report-measure-to-hike-up-funding-and-fudge-outcomes/