BBC Chooses To Ignore Talking Therapies 10% Recovery Rate

this morning BBC Radio 4 focussed on the problems caused by the Improving Access To Psychological Therapies (IAPT) long waiting lists (half more than 28 days)  but reiterated IAPT’s claim of a 50% recovery rate. But IAPT has only ever marked its’ own homework on recovery rates. I spent hours explaining to Radio 4 reporters that the true recovery rate is more likely 10% as detailed in my paper published in the Journal of Health Psychology last year, but they totally ignored this – shortening waiting time for something, that is most likely to be ineffective approaches pointlessness:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

billions of £s have been spent on IAPT over the last decade all without any publicly funded independent assessment of outcome, this would never have been permitted in evaluating a drug. NHS England claimed IAPT has exceeded expectations , but can cite no independent evidence. NHS England have failed the public in terms of accountability. There are so many vested interests in IAPT that the great majority of patients are likely to continue to be short changed. The yardstick has to be the proportion of people who get back to their old selves post-treatment, my study of 90 IAPT clients found that only the tip of the iceberg recover. NHS England need to commit to a publicly funded independent assessment of IAPT using real world outcome measures such as loss of diagnostic status for at least 8 weeks.

There is a troubling alliance of powerholders BBC, IAPT, BABCP and BPS that is ignoring the real needs of those with mental health problems.

 

Dr Mike Scott

  

Only The Powerholders Believe In IAPT

politicians of all political parties and the media believe in IAPT, that should make one immediately suspicious! A decade on there is no evidence of:

  • economic saving – see this link https://www.academia.edu/39289068/Comparative_public_policy_-_the_economic_policy_failure_of_IAPT_in_the_NHS_improving_access_to_psychological_therapies_ either in terms of a) a reduction in work absenteeism b) number of people helped into work or c) reduction in benefit payments
  • psychological recovery – there is no evidence that IAPT clients lose their diagnostic status with treatment, much less that any changes are enduring. When IAPT marks its’ own homework it claims a 50% recovery rate (but without claiming how long this lasts!) but independent assessment suggests only the tip of the iceberg recover

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

Worryingly the iceberg may be melting with the high stress levels amongst IAPT frontline staff. Its much vaunted ‘low threshold’ for access means that therapists are ‘treating’ clients for problems in living e.g a stressed client forced to commute a long distance for financial reasons  complaining of insomnia and tiredness but being treated for depression because of her PHQ9 result! The therapist is stressed by her recovery target, that is unlikely to be met with this client, the client is stressed by the hoops she has had to go through to accommodate appointments in her busy schedule and all to no avail. 

No politician wants to admit the wasting of a £1 billion on IAPT in the last decade. The media and politicians are desperate for a good news story, claiming the success of IAPT and the moral highground of being anti stigma and for mental health gives a warm glow in the winter of our discontent.

But if treatment services began with the hospitality that traditionally marks the Christmas season, then actually they would not go far wrong, it’s not that complicated. 

Dr Mike Scott

IAPT Revolving Door Data Casts Doubt on Recovery Rate

following a Freedom of Information Request from Dr Elisabeth Cotton last year, it appears that 1.5 million people were referred to IAPT between 2 and 10 or more occasions in a 6 year period (2012-2018), with 3.2 million people referred just once. A re-referral indicates that treatment had no enduring effect. Further IAPTs claim is for a 50% recovery rate,  thus at face value 1.6 million would have recovered, but this is only a third (34.5%) of those referred, not a half! Thus even within IAPT’s own terms its’ claims are dubious. 

The staff of my local coffee shop always say ‘see you soon’ as I depart, perhaps this is what IAPT ought to say to clients albeit that in low intensity they won’t actually ‘see’ them, such hospitality. 

IAPT Defrauding A Local Clinical Commissioning Group?

on November 20th I wrote to the Chief Officer, (see link below), of  the Liverpool Clinical Commissioning Group, about Talk Liverpool’s claim that it has had an 87% recovery rate in the last 12 months [see Talk Liverpool’s Performance Data]. A Freedom of Information Response that I received on November 19th from the Liverpool CCG revealed that this financial year it expected to increase its’ funding by £2.5 million to £10.6 million. IAPT’s local claims are eye-brow raising as nationally IAPT claim one in two recover [see IAPT Manual (2018)]  – Talk Liverpool have clearly discovered some therapeutic secret that is being kept very secret!   Liverpool CCG has spent £60.6 million on IAPT since 2013-2014 all without any independent assessment. The CCG has simply taken Talk Liverpool’s word and focussed entirely on operational matters such as numbers seen and waiting times. 

https://www.dropbox.com/s/7ch5uka6yq8pukd/CCG%20letter.docx?dl=0

But the issue is not confined to Liverpool, Mental Health Commissioners nationally need to be critical of IAPT. Unfortunately the focus of Mental Health   Commissioners Network Forum is simply on building liason between Commissioners and Providers. The IAPT National Networking Forum  meeting on January 21st  is to be addressed by the Forum’s Deputy Chair. The day is titled ‘Building and developing your service to meet IAPT LTC expansion’ the advertising blurb  for the meeting reads ‘With access rates going up, is your service trying to do things you don’t have the capacity to do? IAPT staff are invited to bring along a Commissioner free of charge. There is a pressing need for Mental Health Commissioners Network Forum to address the question of the reliability of the evidence that IAPT is value f or money.

 

Would be interesting to randomise to IAPT versus alternative active treatment. And to use independent outcomes raters.

Prof Rob Howard has just tweeted, I replied that I absolutely agree.  I added that the cost of local IAPT (Liverpool CCG) has been £60.6 million since 2013-2014, with a 25% increase in funding in the past year all without any independent evaluation. I am blogging on defrauding a local commissioning group in the next few days.

Dr Mike Scott  

4 Out of 10 IAPT Workers Pressured to Alter Results

that is the finding of a survey of 550 current and past IAPT staff , https://survivingwork.org/5241-2/. The credibility of IAPT’s claims are in doubt, a referendum of its’ staff is needed.

NHS England is guilty of breathtaking naivety and laziness when it asserted on Radio 5 Live on Wednesday, November 13th, that 7 out of 10 IAPT clients move to recovery and 5 out of 10 recover. They did so without appeal to any independent audit. My own findings published in the Journal of Health Psychology last year suggested that actually the tip of the iceberg recover https://journals.sagepub.com/doi/10.1177/1359105318755264.

Clinical Commisioning Groups (CCG’s) should no longer see NHS England as a compelling source of persuasion in this matter, rather they need to listen to patients and the workers at the coalface. CCG’s should challenge IAPT to have a referendum of its staff at a local and national level, asking:

‘Do you want IAPT to move towards face to face assessment and treatment, as the norm?’ 

with simple ‘Yes’ or ‘No’ response options. The collective experience of IAPT workers has to be taken seriously. Judging by the stress levels reported by staff in the survey, IAPT cannot seriously maintain that it is  discharging its’ duty of care to its’ staff. 

Dr Mike Scott

When IAPT Clients and Therapists Speak It Is Totally Different To The Powerholders

this morning Vicky, a victim of the Manchester bombing was interviewed on Radio 5 Live she managed to say live how crap she had found the IAPT service. But in the actual recordings she had said how the therapist wanted to persist with trauma focussed CBT/EMDR whilst she wanted to talk about how devastated her child, who accompanied her, was. Not content with this the therapist was constantly looking at the clock and door. On the same programme IAPT clinicians spoke incognito about pressure to fiddle results on the psychometric tests used to assess outcome.  Earlier in the day the public had their say, see link below:

https://mobile.twitter.com/bbc5live/status/1194542289663746048

for those directly involved the response was uniformly negative.

Contrast the above with the comments of Prof Paul Salkovskis, President of BABCP,  a prime mover in the genesis of IAPT, who described it as ‘marvellous’ but that ‘there are inevitably a few bad apples amongst the IAPT staff’.  NHS England waded in, in similar vein  and reiterated IAPT’s claim that 5 out of 10 recover and 7 out of 10 at least move to recovery. See Radio 5 Live podcast, the pertinent section is from 10.43 to 10.55am

https://www.bbc.co.uk/programmes/m000b5wk

I had recorded for the BBC an interview in which I said that it was criminal that over £3 billion had been spent on IAPT without independent audit. It has not been broadcast. I presented data on 90 consecutive clients going through IAPT, some before and others after a personal injury (PI) with a 10% recovery rate overall and no difference as to whether before or after. I had no axe to grind over IAPT, I simply discovered that it was failing people. This study was eventually published last year, together with 3 commentary papers and my rebuttal in a Special Issue of the Journal of Health Psychology https://doi.org/10.1177%2F1359105318781872.

Interestingly an earlier version of the paper was rejected by the Editor of Behavioural and Cognitive Psychotherapy, Prof Paul Salkovskis. To date the BBC seems to have preferred to broadcast his comments, which are without direct and systematic contact with IAPT clients rather than mine.

The powerholders have it, it seems, but I am not going to give up, earlier this week I saw a guy ( a non litigant), call him Dominic who, I discovered after a 1.5 hours assessment had been suffering from depression and generalised anxiety  disorder for 2 years. He had previously had a 15 minute telephone assessment with IAPT , had no more understanding of his condition than before but the assessor opined that he seemed anxious because he had listed a long list of problems.  Dominic was told that he would hear from them to attend a group, I asked him ‘a group for what?’ and he didn’t know.  He then asked me ‘how could I talk about all my problems in a group?’. Dominic said that he had got more out of our chat than in 2 years of seeing his GP and IAPT. Unfortunately most will not escape IAPT’s clutches.

Someone remind me why I am still a member of BABCP.

Dr Mike Scott

 

 

 

Radio 4 and 5 Live Put IAPT Under The Microscope

tomorrow, Wednesday, November 13th the BBC begins broadcasting its’ investigation into IAPT on the radio, with much more recorded. There is a summary below:

It really is time to talk about IAPT

 


 

Sometimes a problem shared is not a problem halved. When you really ask people what they think about something, and really listen to what they say, things can get dark and dirty. And never more the case than if you ask people about the UK’s largest mental health service, Increased Access to Psychological Therapies (IAPT). 

 

Tomorrow turns out to be a day for talking about IAPT. Really talking about it rather than rolling out another Royal or playing the neurolinguistic game of positivity ping pong.

 

There will be a number of discussions tomorrow 13 November on BBC Radio 5 Live about worker and user experiences of IAPT. You can engage with the debate by going to the links below.

The conversation begins on Radio 5 Live in the early hours tomorrow, and will include a discussion on the Emma Barnett Show at 10am. 
Also tomorrow BBC Radio 4’s You and Yours will be looking into IAPT – the show goes out live at 12.18-12.57 including Surviving Work, well me,  talking about our current IAPT survey and thinking about whether its possible to reclaim the mental health turf and establish a genuinely decent model of care. 
 

This is not a one trick pony kind of a discussion. It’s complex and attempts to walk the thin line between protecting decent therapy and making sure we’re not defending the indefensible. From the gaming of data to the heroic efforts of counsellors tucked away in the IAPT system and the many political and financial interests involved. It’s a story of performance data and the impact of performance management on the people delivering IAPT.

It’s about unpacking the data asking why 71% of people working in the service reported burnout, and 67% live with depression or anxiety.

 

Here’s the information you need to get involved:

 

BBC Radio 5 Live  https://www.bbc.co.uk/5live

The Emma Barnett Show https://www.bbc.co.uk/programmes/m000b5wk

SMS: 85058

Telephone: 08085909693

Useful Twitter contacts: @EmmaBarnett @cave_rob @BBC5Live @survivingwk

 

BBC Radio 4 Live https://www.bbc.co.uk/radio4 

You & Yours https://www.bbc.co.uk/programmes/b006qps9

Useful Twitter contacts: @BBCRadio4 #youandyours @cave_rob @survivingwk 

 

Tomorrow the Labour Party announces its health strategy. Let them know what you think about IAPT and send your thoughts to:

@labour_MH

@jonAshworth

@johnmcdonnellMP

@disabilityLab

@jeremycorbyn

 

And here are some reliably vocal folks who you might find interesting to follow on the day:

@UK_Counsellors

@PCSRuk

@MarkOneinFour

@Glennademeter

@aclientfirst

@clareslaney

@alliance4CP

@MHResist

@NSUNnews

@Mental_Elf

@DrTonyOSullivan

@pcu_union

@Paulananke

@IanBFAWU

@Skourkos1

@davidamunday

@keepnhspublic

@NHSCampaign

Dr Mike Scott

IAPT’s Training Fails But CBT Can Make a Real World Difference

three papers just published in the journal Cognitive Therapy and Research, tell contrasting stories: two are by leading lights in IAPT assessing the competence of trainees, in neither study did they demonstrate any real world outcome. By contrast in a study by Perrin et al (2019) of individual CBT for children (aged 10 to 18) suffering from generalised anxiety disorder 80% no longer had GAD by the end of 10 sessions of treatment compared to 0% in the waiting list.   These impressive results were maintained at 3 month follow up.

IAPT could learn from the Perrin et al (2019) study in that client’s diagnostic status was assessed using  a standardised diagnostic interview  and again at the end of treatment using blind assessors, further therapists followed an evidence based protocol for the identified disorder. Whilst it is costly to make such rigorous assessments and IAPT might fear having to explain to Clinical Commissioning Groups the necessary change in modus operandi, IAPT might then at last make a socially significant difference.

IAPT has been provisionally scheduled to be the focus of presentations on BBC TV and Radio on Wednesday, November 13th. 

Perrin et al (2019) Cognitive Therapy and Research (2019) 43:1051–1064
https://doi.org/10.1007/s10608-019-10020-3

Liness et al (2019) Cognitive Therapy and Research (2019) 43:959–970
https://doi.org/10.1007/s10608-019-10024-z

Liness et al (2019) Cognitive Therapy and Research (2019) 43:631–641
https://doi.org/10.1007/s10608-018-9987-5

Dr Mike Scott

National Audit Office Failed To Audit Improving Access To Psychological Therapies Service

 

because it was ‘too busy’. In response to a freedom of information request, from Liverpool, Consultant Psychologist, Dr Mike Scott, the NAO said on November 1st 2019 that amongst its’ reasons for curtailment of its’ investigation were Brexit, the collapse of Carillion and spending increases on generic medicines.  Further the cost of its’ incomplete investigation in 2017-2018 was £74,000. But Dr Scott comments that the reasons that prompted the investigation still remain. He adds that the IAPT service has cost the taxpayer over £3 billion in the last decade with no independent audit of outcome. Clinical Commissioning Groups have simply taken at face value IAPT’s marking of its’ own homework – whither accountability? The NAO response is a yet further illustration that despite official assurances mental health is at the bottom of the agenda. Is it beyond the political parties to go beyond the rhetoric on mental health at the forthcoming general election and commit to an independent inquiry as to how IAPT client’s actually fare? 

In his submission to the NAO Dr Scott pointed out that IAPT had never been subjected to independent audit using the ‘gold standard’ methodology that has been used to assess the effectiveness of a drug. His own published research see link https://journals.sagepub.com/doi/10.1177/1359105318755264 has suggested that only the tip of the iceberg of IAPT client’s recover much less than the 50% claimed by the Organisation. The Journal of Health Psychology also published 3  commentary papers and a rebuttal paper by Dr Scott.  He suggests  that Clinical Commissioning Groups should in the short term refuse to fund the low intensity interventions (guided self- help, computerised cognitive behaviour therapy and educational classes)  that the majority of IAPT clients receive and for which the evidence base is particularly weak, in favour of funding the face to face psychological therapies and for the long term insist that they will be guided by an appropriate independent audit.

Dr Mike Scott