£3 Billion Spent On Talking Therapies For No Clear Benefit

when will the Government insist on an independent evaluation of the Improving Access to Psychological Therapies Service? These are the concerns raised in my just published paper ‘Ensuring IAPT Makes A Real-World Difference’ see link http://mhfmjournal.com/Inpress.html

The Key Messages are:

  • Over the last decade over £3billion has been spent on the UK
    Government’s Improving Access to Psychological Treatment
    programme, without any independent assessment of outcome.
    • IAPT claims a 50% recovery rate but other evidence suggests
    that only the tip of the iceberg recover.
    • Expansion of IAPT beyond its remit of depression and anxiety
    disorders should be halted, until it has been demonstrated
    that it adequately performs its’ core task.

Clinical Commissioning Groups are being defrauded by IAPT’s claimed recovery rates

Dr Mike Scott

Mental Health – Propaganda For IAPT and Antidepressants Far Outstrips Evidence of Effectiveness

a just published editorial in Psychological Medicine 1–10. https://doi.org/10.1017/S0033291719003295 indicates that it is  doubtful that antidepressants exert a clinically significant effect compared to being on a waiting list for depressed patients. Strangely the editorial goes on to recommend IAPT as an addition to antidepressants. But there are major problems with this a) the effect of IAPT has never been compared to a waiting list b) IAPT clinicians do not make a diagnosis, so that it is unknown whether IAPT makes a difference for depression c) there has never been an independent evaluation of IAPT. In fairness to the writers of the editorial they do suggest halting the embrace of IAPT until the Service demonstrates that it has a long term effect.  NHS England and Clinical Commissioning Groups should at least heed this latter point. 

here is my 5 minute interview with BBC TV, https://vimeo.com/316124732

and a link to the waiting list  investigation by BBC Radio 4 last week:

https://www.bbc.com/news/health-50658007

the main points of my interview are:

  • only the tip of the iceberg of those attending IAPT fully recover https://journals.sagepub.com/doi/10.1177/1359105318755264 this contrasts with the Organisations claim of a 50% recovery rate
  • IAPT has only ever marked its’ own homework, despite over £3 billion being spent on it in the last decade. There has been no independent assessment of outcome, of the quality that would be expected were the effectiveness of a drug was being evaluated
  • IAPT fails to effectively engage and treat people. The IAPT Annual Report (2018)/2019] see link below, reveals that a third (31.2%) of new referrals drop out before treatment and approximately two thirds (61.1%) do not complete a course of treatment (using IAPT’s liberal definition of treatment as attending 2 or more session) with almost a third (29.54 %)  attending only one treatment session.

    https://www.dropbox.com/s/hwn9ncuuyds8qfa/IAPT%20Annual%20Report%202018-2019.pdf?dl=0

  • the most common gateway into IAPT is via a 20-30 minute telephone assessment with the most junior members of staff who are trained to signpost people via problem descriptors they do not make diagnoses
  • most IAPT clients do not get psychological therapy rather they are given either guided self help, computerised cbt or invited to attend a class/group i.e they receive low intensity interventions which are without the evidence base of the psychological therapies (high intensity)

Dr Mike Scott

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