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

https://twitter.com/user/status/1000678851830304773


Eta: Sorry, I'd seen the Scott paper but wasn't aware the JHP was dedicating a section to IAPT in its August edition.

 

IAPT Service finder:

https://www.nhs.uk/Service-Search/Psychological therapies (IAPT)/LocationSearch/10008#

 

I think when the JHP volume comes out it will be clear just how rigged these figures are. And the fact that such figures are being banded about will add to the lack of credibility of the service. Shifting IAPT is a big job but I think it contains the seeds of its own destruction.

 

There's a serious problem with the Government mandating a recovery rate of 50 per cent for relevant disorders, mandating incentivised outcomes-based payment systems for providers, and then expecting service claims of "reliable
recovery" rates approaching or exceeding that number to be taken even remotely seriously, all other substantive crisiticisms of IAPT and national reporting aside.

 

Tying in with the HOME study, from the Technical Guidance for Refreshing Plans 2018/19 Annex B: Information on Quality Premium:

"Proportion of people accessing IAPT services aged 65+; to increase to at least 50% of the proportion of adults aged 65+ in the local population or by at least 33%, whichever is greater in Year 1.

"For Year 2, to increase to at least 70% of the proportion of adults aged 65+ in the local population, or where 70% has already been achieved or exceeded by the end of Year 1, to not decrease in Year 2."

https://www.england.nhs.uk/publication/technical-guidance-annex-b-information-on-quality-premium/

 

As you are answering questions on the forum today @Action for M.E., would you be able to confirm whether Action for ME has been a member or attended meetings of the Expert Advisory Group for the joint Work and Health Unit, and if so, whether it has raised any objection with the WHU that ME/CFS patients are being referred to IAPT services under which ME/CFS is categorised as medically unexplained symptoms, and that patients referred as such are categorised for national reporting purposes with ICD-10 F45.0 Somatization disorder?

 

Event: Integrating IAPT Services for Long-Term Conditions and Medically-Unexplained Symptoms

http://www.iapt-nnf.co.uk/Home/ViewEvent/92

 

IAPT-LTC is intended for people with anxiety or depression "in the context" of a LTC, and for people with MUS with no requirement for co-morbid anxiety or depression. The IAPT-LTC Full Implementation Guidance trots out the "two-thirds of people with LTCs have also have a mental health problem" line, citing Naylor C et al., Long-Term Conditions and Mental Health. The Cost of Co-morbidities. London: The King's Fund; 2012.

The applicable NICE Guidelines for anxiety/depression in LTCs in IAPT-LTC are:

• Depression in Adults with a Chronic Physical Health Problem: Recognition and Management (NICE clinical guideline 91)

• Multimorbidity: Clinical Assessment and Management (NICE guideline 56)

 

Though in reality, I'm not sure there's that much concern who is referred for what.

From the IAPT LTC/MUS Pathfinder Evaluation Project Interim Report (2013)

 

To whom should we be directing our concerns about this new and devious plan for subjecting sick people to magical placebos in the name of treatment?

 

IAPT certainly isn't new; generic IAPT was rolled out nationally in 2008, and the IAPT-LTC Pathfinder Project was rolled out in April 2012. IAPT-LTC is currently being rolled out nationally. (Although it is called IAPT-LTC, it actually encompasses both LTC and MUS referrals.)

Others elsewhere on the forum have discussed contacting their MPs to discuss in what ways their MP can support ME in the wake of the recent Westminster Hall debate, so it may be that individuals planning to do this might want to consider addressing the fact that ME/CFS patients are being referred to IAPT under which programme the condition is categorised as MUS, if they feel that is something they want to address. Advocacy efforts can backfire, so I think it is down to the individual to weigh up the approach and recipient of any communication carefully. Just my tuppence worth.

 

Any possibility of a response to this, @Action for M.E.?

 

Apologies for my delay in responding to this.

Yes, we have been part of the Expert Advisory Group (EAG) for the joint Work and Health Unit. Our input was focused on sharing learning from our SEE M.E. project, which involved setting up a pilot service that offered specialist employment support (NOT talking therapies) to people with M.E. who self-referred, with the aim of supporting them to achieve the employment-related goals they set for themselves (eg. achieving their best possible exit from unsustainable employment, achieving more sustainable existing employment, successfully returning to their job after lengthy sickness absence, starting a new job, or starting volunteering or a training course).

The EAG operates with a very clear focus on disability employment from and does not have any remit relating to IAPT or ICD classifications - as far as I know this was not discussed at meetings.

I will highlight the links you have shared here with the Countess of Mar in advance of the next Forward ME meeting on 17 July, the serious issue of IAPT for M.E. being on the agenda. We are keen to see tangible actions agreed at the meeting to address concerns re IAPT being prescribed for M.E., as well as moves to reclassify M.E. as MUS.

 

Thank you, @Action for M.E., for your response.

Action for ME will be aware of the Employment Adviser in IAPT pilots that have sought to embed Employment Advisers in IAPT services, and this in increasing numbers whilst flowing additional employment-related information about patients for IAPT national reporting. So even as you describe the remit, there is clear reason why the categorisation of ME/CFS patients as MUS for referral to IAPT is relevant to disability employment in the context of a WHU EAG's remit, and should have been raised.

With regard to the SEE ME project, I strongly support the misgivings expressed by @Esther12 elsewhere on the forum, and am dismayed that Action for ME is feeding its putative "remarkable results" back to the WHU. I'm not even sure what a "best possible exit from unsustainable employment" means for a pwME. In addition to this thread, it may also be edifying to look at the thread on the Employment Adviser pilots in IAPT to better gauge how feedback such as that on the SEE M.E. project rationalises and supports IAPT Employment Adviser service implementation. Patients of any sort should not be referred by healthcare providers to DWP contracted service providers to receive employment advice. ME patients should not be being referred to IAPT to start with.

https://www.s4me.info/threads/uk-iapt-employment-adviser-pilots-some-information-docs.3512/

This is appreciated. The MUS thread on PR is also a good source of information on IAPT and MUS as they relate to ME/CFS. It's extremely unfortunate that Forward ME's Chair unilaterally dispensed with Suzy Chapman's input, given her knowledge as relates to MUS and ICD classificatory issues is unsurpassable.

https://forums.phoenixrising.me/ind...ary-care-whats-happening-across-the-uk.48710/

Any transparency Action for ME can provide in relation to its involvement with the WHU, particularly in respect of IAPT and ME patient referral to the same would I think be generally much appreciated going forward. Thank you again for responding.