Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform, 2018, Scott

http://journals.sagepub.com/doi/full/10.1177/1359105318755264#articleShareContainer (Free full text - mentions PACE)

 

A little hard to follow, but definitely interesting and useful in challenging the claimed efficacy of IAPT and similar treatment modalities. Basically IAPT is failing to prove that they are helping patients, especially in a meaningful manner (versus some dodgy uses of questionnaires), and the limited data reviewed by the author suggests that even those numbers have been badly inflated.

 

Given that MUS including ME/CFS are now being drawn under the IAPT umbrella, this study showing little effect even for mental health disorders calls the whole service into question.

 

wow

And he suggests they arent even doing a good job getting the diagnosis right as a prerequisite for selecting the right method

 

Just one yuuuuuuge expensive fustercluck.

 

It's a government policy decision made so they can claim more people with mental illness are being treated than ever before. While at the same time closing down inpatient facilities for those with really severe mental illnesses which are much more expensive.

Result - prisoners and rough sleepers with serious mental illness who need good inpatient mental health care, and lots of under-trained 'therapists' messing with the heads of mildly to moderately anxious and depressed folk and people with physical 'MUS' illnesses who shouldn't be fobbed off with CBT.

 

While loving any critical reference to PACE, and sceptical of the overall value of IAPT, I'm not sure about this paper.

How was the sample selected?

It sounds like it's different from what is reported for IAPT elsewhere:

This was mentioned, but I didn't see any details on exactly how the sample was selected:

I thought that the arguments presented which criticised the way IAPT worked out assessed outcomes were stronger than the alternative data presented here. Without more information on how the participants were selected t's difficult to interpret the results.

This was a bit interesting:

I didn't read the testimony in the appendix.

 

Professor Ken Laidlaw (UEA) discussing the aims of the IAPT programme with Kevin Jarman, IAPT Programme Manager 2008-15 and Work and Health Joint Unit DWP/DH Lead:

Kevin Jarman: '...we moved very quickly into roll out. In fact, to be honest, the evaluation of IAPT at those Newham and Doncaster services wasn't actually published until 2010, by which time we were at least two years into the roll-out of the programme, which er, if you look at I suppose improvement science, that's not probably the best way of doing it. But we were fortunate that the original erm the original er way the programme was set up and the sort of original results were so positive that people thought and policy makers thought that it was worth going forward into the next roll out phase.'

https://www.uea.ac.uk/medicine/depa.../-about-iapt-and-the-history-of-the-programme

 

Who needs evidence?

 

Paywalled at http://journals.sagepub.com/doi/abs/10.1177/1359105318781873

 

A nice abstract. I will presumably be able to get at this through college but it takes me a while to get through the system. This is presumably what David Marks flagged up as imminent a week or so ago.

I thought the figure must be getting somewhere near a billion. With my 96 year old mother waiting in A/E again this evening I am unimpressed.

 

Full paper,
http://sci-hub.tw/http://journals.sagepub.com/doi/10.1177/1359105318781873

 

I'm sorry to hear that, I hope she gets seen soon, and is OK.

 

A quote from this new paper

Ouch.

 

A nice paper. I see Indigo has got theURL for everyone to see.
Basically it shows that IAPT is hopeless for the conditions that CBT is supposed to be standard for. It does not even mention MUS or ME or the problems of PACE.

But it is worse than that. Although the author is clearly being usefully critical I get the impression he still believes that randomised controlled trials (note the absence of double blind) for these therapies can give reliable results. He argues with others who seem even less critical than him but they are still arguing over evidence that is basically no use. And he talks of tailoring treatment to the patient, which sounds sensible but clearly cannot be evidence based.

The bottom line for me is that this really is the worst case scenario. The whole business is voodoo in comparison to normal medical science. I now see why referees of my own paper wanted me to cut out comments that might make it look as if rather a lot of clinical psychology trials might be useless. As the author of this paper concludes, the Emperor really has nothing at all.

That said, inasmuch as you can get useful evidence in this context, the author here seems to have done a very good job. He has produced figures that clearly do make some sense. Simon Wessely was right. If you do trials that suggest that there is a curative recipe, a whole lot of incompetent people will be brought in to provide a service that is of no use to anyone.

It's bit like when we got people in to look at how bad the dry rot was in the downstairs bedroom window frame. They told us that the upstairs bedroom floor had no joists left and asked when we last went into that room.

 

"‘Around half are likely to be completely cured’ was the proud boast of Alan Johnson, Secretary of State for Health, on 10 October 2007 at the inception of Improving Access to Psychological Therapies (IAPT). It is tempting both in research and public policy to redefine the original hypothesis when the findings do not support the prediction."

Fifty per cent recovery rate was more than a prediction by Alan Johnson. It was a mandated standard.

The Mandate
A mandate from the Government to NHS England: April 2014 to March 2015
Presented to Parliament pursuant to Section 13A(1) of the National Health Service Act 2006

https://mentalhealthpartnerships.com/resource/nhs-mandate-2014-to-2015/

p. 15: "3.7 This will also involve extending and ensuring more open access to the Improving Access to Psychological Therapies (IAPT) programme, in particular for children and young people, and for those out of work. NHS England has agreed to play its full part in delivering the commitments that at least 15% of adults with relevant disorders will have timely access to services, with a recovery rate of 50%. They will also begin planning for country wide service transformation of children and young people’s IAPT. NHS England will work with stakeholders to ensure implementation is at all times in line with the best available evidence."

p. 5: "7. NHS England is legally required to pursue the objectives in this document.3 However it will only succeed through releasing the energy, ideas and enthusiasm of frontline staff and organisations. The importance of this principle is reflected in the legal duties on the Secretary of State and NHS England as to promoting the autonomy of local clinical commissioners and others."

This standard was reiterated in the 2015/16 and 2016/17 NHS Mandates.


NHS Service Standards

https://www.england.nhs.uk/mental-health/adults/iapt/service-standards/

"Access standard
Access: IAPT services should be providing timely access to treatment for at least 15% of those who could benefit (people with anxiety disorders and depression.

"Recovery standard
Recovery: At least 50% of people who complete treatment should recover."

 

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