Institutional Bias Against Independent Monitoring of Mental Health Outcomes

There is no parity between the ongoing assessment of physical and mental health problems, there is an institutionalised bias against the latter. Patients increasingly refer themselves to IAPT (a 100% in Blackpool) , the GP simply hands them the telephone number and only sends in a report in unusual circumstances e.g a patient too frightened to ring and book the standard telephone assessment.

 

Whilst the GP’s are increasingly freed from this administrative burden, it removes a baseline against which to independently measure a patients progress through IAPT. The latter continues to mark its’ own homework, claiming a 50% recovery, but Scott’s study (2018) suggests the true figure is just 10% https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0.

 

Dr Mike Scott

Delivering Group CBT – A Special Interest Group

For many years I have been running a ‘Delivering Group CBT’, Workshop following the June 15th Workshop in Manchester, there were 25 signatories for a BABCP Special Interest Group. An application for a SIG has now been made. Anyone interested in joining this merry band would be appreciated, just e-mail me at michaeljscott1@virginmedia.com.

 

The following is a link to the Powerpoint for my recent workshop https://www.dropbox.com/s/6sq5mvrhyvtnz1q/Delivering%20Group%20CBT%20Manchester%20June%2015th%202018.pptx?dl=0. A key feature is that it avoids the dichotomy either individual or group CBT.

 

Dr Mike Scott

IAPT Is a Car Crash – Transforming IAPT

IAPT (Improving Access to Psychological Therapies) is a car crash, funded by the taxpayer to the tune of £1bn, but without any insurance for the public. Staff are stressed out and there is a 10% recovery rate for clients. The National Audit Office (NAO) recently investigated IAPT but have chosen not to make its’ findings  public. I pursued a Freedom of Information Request but the NAO’s response has shed no light on their decision making. These findings are contained in my just published paper ‘Transforming IAPT’ in the Journal of Health Psychology:

 

 

the abstract reads:

The three commentaries on my paper ‘IAPT – The Need for Radical Reform’ are agreed that Improving Access to Psychological Therapies cannot be regarded as the ‘gold standard’ for the delivery of psychological therapy services. Furthermore, they agreed that Improving Access to Psychological Therapies should not continue to mark its ‘own homework’ and should be subjected to rigorous independent evaluation scrutiny. It is a matter for a public enquiry to ascertain why £1 billion has been spent on Improving Access to Psychological Therapies without any such an independent evaluation. What is interesting is that no commentary has been forthcoming from the UK Improving Access to Psychological Therapies service nor have they shared a platform to discuss these issues. It is regrettable that the UK Government’s National Audit Office has chosen, to date, not to publish its own investigation into the integrity of Improving Access to Psychological Therapies data. Openness would be an excellent starting point for the necessary transformation of Improving Access to Psychological Therapies.

 

Dr Mike Scott

Preserve Us From Specialist Units – The Need for Proper Audit

 ‘Complex’ clients tend to gravitate to Specialist Units, but their focus is overwhelmingly on the disorder that they were set up for, recommending anything else outside its’ remit is dealt with elsewhere. The problem is it doesn’t actually work! I recently saw a client with a 10 year history of bulimia, alcohol abuse/dependence. The file was enormous as the Specialist Units had each made their contributions as the client went at greater speed through the revolving door.

 

In fairness there was one letter from the alcohol Unit that suggested that the ‘underlying cause’ for these problems should be sought, now there is a novel idea! But neither of the Specialist Units took this responsibility. IAPT sent  a letter asking the client to telephone to arrange an assessment which was not acted upon and promptly discharged the client. When I saw the client I found that the underlying problem was social anxiety disorder, which pre-dated all the other problems. The records did mention in passing that the client was anxious in social situations, but this had never been a therapeutic focus. The client readily appreciated that there had to be a comprehensive/holistic treatment approach and not the piece-meal approach followed by the agencies. Changing their modus operandi is a monumental task, as there are so many vested interests. But a starting points is to insist on independent audit of recovery rates along the lines that I have pursued re: IAPT.

Dr Mike Scott