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

Hi Sarah - I'm happy to address the questions that you've posted but I'm afraid I have run out of time before I go on annual leave.

While my team doesn't have capacity to regularly monitor and post in S4ME in my absence, they would be happy to respond to questions by email or phone.

I will be back in the office w/c Mon 30 July and hope to return to the forum then.
 
Inara said:
This made me wonder: Does the UK government try to establish what we have in Germany, namely having ME/CFS diagnosed (and re-diagnosed) as F45.0 or F48.0?
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The F45.0 coding is for patients referred for MUS for IAPT national reporting purposes in this instance.

"For those in integrated care with a medically unexplained symptom (MUS), ‘Somatization Disorder’ (ICD-1016 code F45.0) should be selected as the primary problem to identify their specific condition. The relevant MUS-specific outcome measure can then be used for the calculation of recovery (provided paired scores are available)."

https://files.digital.nhs.uk/publication/7/7/iapt-int-rep-dec-2017-exec-sum.pdf
 
Sarah said:
The F45.0 coding is for patients referred for MUS for IAPT national reporting purposes in this instance.

"For those in integrated care with a medically unexplained symptom (MUS), ‘Somatization Disorder’ (ICD-1016 code F45.0) should be selected as the primary problem to identify their specific condition. The relevant MUS-specific outcome measure can then be used for the calculation of recovery (provided paired scores are available)."

https://files.digital.nhs.uk/publication/7/7/iapt-int-rep-dec-2017-exec-sum.pdf
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From that, it looks like (although it's not entirely clear) their 'recovery' measure relevant to CFS is just a Chalder Fatigue score of 18 (the same cut-off PACE used for their post-hoc criteria, which overlapped with their entry criteria. Wonder what their justification for that is.

Chronic Fatigue Syndromes/
Myalgic Encephalopathy (ME)

Chalder Fatigue
Questionnaire

≥ 19
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Diagram from Wilshire & colleague's recovery paper to illustrate how this overlaps with the trial's entry criteria:

rftg_a_1259724_f0002_c.jpeg
 
So, what we're actually seeing is that government gives a damn about the PACE trial that was shown to be unscientific and to have no effect, because politically it is desired to put people into MUS. And in politics it holds "What doesn't fit is made to fit". What we see is, for politics, science is irrevelant. Maybe because for most people science is irrelevant and so there is no one who gets loud.

But still, I think it is crucial to show what realitiy is, and this includes science.

So we also need to start with a new direction.

We need more awareness about the on-goings.
 
I am appalled that the Chalder questionnaire is being used to assess disability in ME/CFS patients. It is utter nonsense.

I wonder whether the placing of 'MUS' in the IAPT program is not so much a top down designed government policy as a result of some very determined people empire building and selling their BPS nonsense to clinical commissioning groups on the basis of saving money. If you look at their propaganda directed at CCG's it's all about reducing GP visits by frequent attenders and thereby saving money. PACE is one of the key bits of 'evidence' underpinning IAPT for MUS, which inevitably means they have to insist ME/CFS belongs in that category. If we manage to kill off PACE, it will become clearer that their edifice is built on sand.
 
Trish said:
I wonder whether the placing of 'MUS' in the IAPT program is not so much a top down designed government policy as a result of some very determined people empire building and selling their BPS nonsense
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I think both come together. It's not new in history, it's common practice.

I wrote in another thread about a German psychiatrist who obviously lacks certain skills (I want to be nice) but is determined to spread the word, and authorities are quite thankful, because now they can save money AND say "scientists say so". WE know people of that kind aren't scientists, and actually I sometimes think authorities, governments etc know so, too. But such people now get their forum.

So we need to make public what these people are - no experts. Sadly, we can't attack governments directly at this point because what we say will be called "conspiracy theory".

This is all so frustrating.
 
Esther12 said:
From that, it looks like (although it's not entirely clear) their 'recovery' measure relevant to CFS is just a Chalder Fatigue score of 18 (the same cut-off PACE used for their post-hoc criteria, which overlapped with their entry criteria.
Click to expand...

It looks that way as far as the CFQ goes. I'm aware of this from the IAPT-LTC Full Implementation Guidance:

Both Chalder Fatigue Questionnaire and PHQ-9 are bolded.

"Notes: Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair measures highlighted in bold. When the measure in bold in the middle column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD-7, if this is different."

Also, from the IAPT Manual:

The measure in the third column is the Chalder Fatigue Questionnaire

"Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair of measures highlighted in bold. When the measure in bold in the third column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD7, if this is different."

Also:

" 6.2.2 IAPT-LTC and MUS outcome measures
To support the implementation of The Five Year Forward View for Mental Health, LTC and/or MUS data from participating IAPT providers will be collected before widespread rollout to all IAPT providers."

Roll-out is being implemented, so I'm not sure what this means for data collection. Although in practical terms it probably doesn't make much difference from an implementation perspective, I think Fibromyalgia is reported as a LTC, although it depends on the the IAPT document you read as to whether Fibromyalgia is described as MUS or a LTC.

Trish said:
I wonder whether the placing of 'MUS' in the IAPT program is not so much a top down designed government policy as a result of some very determined people empire building and selling their BPS nonsense to clinical commissioning groups on the basis of saving money.
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From the MUS Positive Practice Guide:

"Membership of the IAPT Medically Unexplained Symptoms Evaluation Task and
Finish Group (2012-13):

Screenshot_20180711-095618.jpg Screenshot_20180711-095624.jpg

Amw66 said:
Does anyone know if the Journal of Health Psychology August issue is a special issue re IAPT or just a feature article?
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I seem to recall it will be a dedicated section.
 
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Trish said:
I wonder whether the placing of 'MUS' in the IAPT program is not so much a top down designed government policy as a result of some very determined people empire building and selling their BPS nonsense to clinical commissioning groups on the basis of saving money.
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I think that is what is known as a confluence of mutually beneficial interests. The psychs want power and prestige, and the pollies and bean counters want plausible deniability.
 
Trish said:
I wonder whether the placing of 'MUS' in the IAPT program is not so much a top down designed government policy as a result of some very determined people empire building and selling their BPS nonsense to clinical commissioning groups on the basis of saving money.
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I think this is the driving force. Which is why therapist-delivered treatments need to be audited and licensed in the way drugs are and those marketing them treated like pharmaceutical companies.
 
Jonathan Edwards said:
I think this is the driving force. Which is why therapist-delivered treatments need to be audited and licensed in the way drugs are and those marketing them treated like pharmaceutical companies.
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yes these treatment packages are "products" just as much as a course of antibiotics and should indeed be subject to monitoring in the same way.
 
NelliePledge said:
yes these treatment packages are "products" just as much as a course of antibiotics and should indeed be subject to monitoring in the same way.
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I have not looked at the status of IAPT " deliverers" other than one link which was a private company set up by psychs, physios/ OTs and business managers. Nice pension scheme for former NHS personnel .
 
Amw66 said:
I have not looked at the status of IAPT " deliverers" other than one link which was a private company set up by psychs, physios/ OTs and business managers. Nice pension scheme for former NHS personnel .
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yes I had it from the largest one which Im surprised to find is actually a non profit because it seemed very corporate to me and didnt have charity ethos https://www.insighthealthcare.org/about-us/ unfortunately a lot of education and health businesses appear to benefit from charitable status they have these contracts and run like busineses and then get donations as well

but to me this was, as Ive said often, a corporate machine churning out CBT sausages
 
Sarah said:
It looks that way as far as the CFQ goes. I'm aware of this from the IAPT-LTC Full Implementation Guidance:

Both Chalder Fatigue Questionnaire and PHQ-9 are bolded.

"Notes: Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair measures highlighted in bold. When the measure in bold in the middle column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD-7, if this is different."

Also, from the IAPT Manual:

The measure in the third column is the Chalder Fatigue Questionnaire

"Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair of measures highlighted in bold. When the measure in bold in the third column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD7, if this is different."

Also:

" 6.2.2 IAPT-LTC and MUS outcome measures
To support the implementation of The Five Year Forward View for Mental Health, LTC and/or MUS data from participating IAPT providers will be collected before widespread rollout to all IAPT providers."

Roll-out is being implemented, so I'm not sure what this means for data collection. Although in practical terms it probably doesn't make much difference from an implementation perspective, I think Fibromyalgia is reported as a LTC, although it depends on the the IAPT document you read as to whether Fibromyalgia is described as MUS or a LTC.



From the MUS Positive Practice Guide:

"Membership of the IAPT Medically Unexplained Symptoms Evaluation Task and
Finish Group (2012-13):

View attachment 3601 View attachment 3602



I seem to recall it will be a dedicated section.
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Kings BPS Mafia strike again
 
NelliePledge said:
yes I had it from the largest one which Im surprised to find is actually a non profit because it seemed very corporate to me and didnt have charity ethos https://www.insighthealthcare.org/about-us/ unfortunately a lot of education and health businesses appear to benefit from charitable status they have these contracts and run like busineses and then get donations as well

but to me this was, as Ive said often, a corporate machine churning out CBT sausages
Click to expand...

Insight Healthcare has a dedicated "Chronic fatigue" page:
Chronic fatigue

Some of the common symptoms of chronic fatigue

Have you been feeling?
  • overly/extremely tired
  • low in mood
  • irritable
  • anxious
Have you had thoughts like?
  • ‘I can’t do this’
  • ‘I don’t understand why I am so tired all the time’
  • ‘I have no energy’
  • ‘I can’t stand the pain’
  • ‘I can’t think properly’
  • ‘I can’t concentrate on this’
Have you noticed?
  • aching muscles and body pains
  • a disruption to your sleep routine
  • a disruption to you eating pattern
  • you are unable to concentrate
  • you are struggling to complete daily routine tasks
Possible causes of chronic fatigue
  • the cause of chronic fatigue is unknown; research has explored biological and psychological factors that could cause chronic fatigue
  • pressure – you may be under pressure at home or work, feel trapped or unable to problem solve certain issues
  • stressful life events – these can be unwelcome or traumatic, such as being bullied at work, getting divorced, or being attacked/abused
How common is chronic fatigue?
  • 2% of the populations have chronic fatigue
  • chronic fatigue is more common in women than in men; it usually develops in the early-20s to mid-40s
Want to read more about chronic fatigue?
Click to expand...
 
we need to do a @Webdog on this and on the Patient.co.uk page it links to it does mention issues have been raised about CBT/GET but in a skimming over kind of way - no mention of PEM, fatiguability as far as I can see

maybe a good project for the autumn
 
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