£4 billion Spent On IAPT and National Audit Office Says ‘Value For Money’ Is Not Our Concern

and we  have ‘no plans to revisit work’. This was the National Audit Office’s response to a Freedom of Information Request to my colleague Joan Crawford on February 18th 2020 http://FOI-1298.  The NAO’s response continues our ‘purpose was to establish the relevant facts’ with regards to waiting times. The NAO adds it was these concerns expressed by an NHS staff member that first led to the NAO inquiry.  Curiously the NAO  then says  it was planned to describe the responsibilities of different health sector bodies  ‘in assuring and overseeing the accuracy and integrity of the reported data’ but the NAO has never addressed the ‘integrity’ of the data. The NAO has failed to tell anyone that the unit of analysis in IAPT’s own data set, the proportion of people who recover, is suspect. Whilst IAPT claims a 50% recovery rate my own independent analysis submitted to the NAO suggests it is just 10%.  The NAO curtailed its’ investigation in June 2018 because of ‘changing priorities’, leaving its’ findings unpublished and duties undischarged. There is a pressing need for independent audit. 

On the same day as the FOI response, the Government announced that it will spend £2.6 billion over 6 years on flood defences and that every £1 spent will save £8. However the UK Government has failed to ensure that the NAO furnishes it with similar data. Without such data there is no real world accountability.

 

Dr Mike Scott

‘PTSD – Swap War Zone Glasses For Specs Used A Week Before Trauma’

that’s one of the clinical implications of my just published paper ptsd an alternative paradigm. On March 4th I am giving a One Day Workshop titled ‘Getting Back To Me Post Trauma’, elaborating further  on the clinical implications of this work. The day is organised by Chester and North Wales BABCP at Chester Rugby Club.

My work addresses the problem that with cognitive processing therapy, 42% of people drop out of treatment. Most between sessions 2 and 5. In the traditional CPT protocol homework at sessions 3 and 4 involves clients writing detailed accounts of their trauma, which often does not go down well. I also found that in exposure therapy barely half comply with listening to a trauma tape. I argue that the case for trauma focussed interventions is not proven and there is a more user friendly way of going about things.

 

Dr Mike Scott

  

DWP Scores Claimant With Multiple Diagnoses As Zero Impaired And She Loses Benefits

and suffers a depressive reaction. I was preparing a desktop report for Ms X just as a National Audit Office (NAO) Report into the DWPs procedures was announced. It revealed that the DWP were investigating 69 cases of suicide following cessation of Personal Independence Payments (PIPs). The NAO observed that the true extent of suicide in this context is unknown. It is time to put the mental sequelae of DWPs decisions on the agenda.  

Extensive documentation on Ms X reveals recurrent depressive disorder, autism and adult ADHD, together with years of contact with secondary care mental health services. Despite this the DWP assessor indicated that she had 0 problems communicating and interacting with others! Reading his letter of justification he relied entirely on his perception of how she presented at interview.  He gave a total Summary score of 0 which is simply preposterous, whether or not she had sufficient points to meet the PIPs criteria. I have written to the DWP for a review of the case.  I have also suggested that not only should suicides be subjected to an Internal Process Review but all Claimants who are judged to have scored 0. Such a change in PIP score is near miraculous as people are awarded PIPs initially because of enduring functional impairment. But IPR’s are not open to public scrutiny and the NAO pointed out that it is not known whether such reviews have led to any change in practice: There is a need for transparency, I await with interest the DWP’s response to my letter.

Unfortunately the DWP’s assessor has adopted the style of  most mental health professionals, reliance primarily on a single source of data (IAPT on self report measures of doubtful relevance ) or the clinicians take on the client’s story with an open ended interview.  This results in missed diagnosis, mistreatment and misleading statements about the client’s diagnostic status.

Dr Mike Scott

 

 

 

 

 

 

IAPT’s Mistreatment Of Those With Medically Unexplained Symptoms (MUS)

in our paper published today in BMC Psychology, Keith Geraghty and I write of Improving Access to Psychological Therapies (IAPT) malpractice with MUS clients , see link  https://doi.org/10.1186/s40359-020-0380-2

A series of seven core problems and failings are identified, including:

  1. an unproven treatment rationale
  2. a weak and contested evidence-base
  3. biases in treatment promotion
  4. exaggeration of recovery claims
  5. under-reporting of drop-out rates
  6. a significant risk of misdiagnosis
  7. inappropriate treatment.

We concluded that:

There is a pressing need for independent oversight of this service, specifically evaluation of service performance and methods used to collect and report treatment outcomes. This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints. Psychotherapy should not become a default when patients’ physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part. Patients who reject psychotherapy or do not meet selection criteria should be offered appropriate medical and psychological support.

Dr Mike Scott