Unreliable IAPT Gatekeeping – Questions Sent To The Health Secretary, Dr Coffey

1.The Government Improving Access to Psychological Therapies (IAPT) Service is experimenting with public, direct access to a Psychological Wellbeing Practitioner. But PWPs are not trained in diagnostics nor are they qualified therapists. Why then are they being given this gatekeeping role?


2. The IAPT service has cost billions of pounds, since its’ inception in 2008. Why, then has there been no independent audit of the service?


3. With regards to physical health the Government is funding Community Diagnostic Centres, with regards to mental health why is there no facility for reliable
diagnosis in IAPT?


4. With regards to mental health there is no evidence that those availing themselves of IAPT fare any better than those attending the Citizens Advice Bureaux? What then is the added value of funding IAPT?


5. How is the experiment of making PWPs gatekeepers being evaluated and who decided on the criteria?


6. IAPTs claimed recovery rate of 50% has not been independently verified. The independent evidence of an Expert Witness to the Court [Scott (2021) British Journal of Clinical Psychology] suggests that in fact only the tip of the iceberg recover. Is this not grounds for a publicly funded independent audit?


7. How do we know IAPT is value for money?

I await the response with interest

 

Dr Mike Scott

Fraud and IAPT

Should the Improving Access to Psychological Therapies (IAPT) Service be subject to civil legal action for its’ claim of a 50% recovery rate [IAPT Manual (2019)]? If the answer is ‘yes’ how should this take place?

Important considerations in preparing an action are:

  1. The public and referrer’s to IAPT cannot give ‘informed consent’ to the Service’s ministrations if they are misled on effectiveness. There has been no independent substantiation of the services claim. My own work Scott (2018) suggests that only the tip of the iceberg recover.
  2. IAPT by its’s own admission does not diagnose, how then can it meaningfully speak of ‘recovery’?  
  3. The term  ‘recovery’ implies ‘staying-well’ for a period that an ordinary member of the public would regard as reasonable e.g at least 8 weeks, yet IAPT have published no such data on the maintenance of treatment gains.
  4. IAPT’s claims are based entirely on its own chosen metric, a reduction to a below ‘caseness’  scores on at least one psychometric test and its’ interpretation of the results [IAPT Manual (2019)]. They operate with an attributional bias taking credit  for reduced scores, neglecting competing explanations, including:  

a) people present to services at their worst and there is an inevitable improvement with the passage of time – regression to the mean

b) services that give mental health sufferers attention such as the Citizens Advice Bureaux report 70% of service users claiming an improvement in mental health  yet the CABx does not purport to offer an evidence-based psychological treatment. There is no evidence that IAPT client’s fare any better, suggesting that the service confers no added benefit.

c) the tests are conducted under the auspices of the treating clinician, introducing the possibility that the client will give the latter a favourable answer, rather like being asked as you leave a restaurant ‘was everything ok?

d) neither client or clinician wants to feel that they have wasted their time, predisposing both to make a positive response to any enquiry.  

5. There is no evidence that IAPT delivers the evidence-based NICE compliant psychological treatment it claims. The entry requirement for NICE protocols is reliable diagnosis but as IAPT by its’ own admission does not make diagnoses, compliance has to be a marketing gimmick. There have been no fidelity checks on IAPT.

6. Most people initially accessing IAPT do not in fact receive psychological therapy, the staff they encounter are Psychological Wellbeing Practitioners (PWPs)  not therapists, the public do not get what it says on the tin ‘Access to Psychological Therapy’, to a non-lawyer this sounds like fraud!

The Perils of Seeking Psychological Therapy

It is rather like putting your car into the garage and finding your vehicle serviced rather than repaired as you asked. When you arrive to pick it up you discover the garage  doesn’t do ‘diagnostics’, nevertheless you are expected to pay the bill!

The Fraud Is Perpetuated By All The August Bodies Who Should Know Better

At the very least it all sounds very fishy. Yet NHS England, the National Audit Office, Clinical Commissioning Groups, the British Association for Behavioural and Cognitive Psychotherapy (BABCP) and the British Psychological Society all pay homage to IAPT, at a cost of about £5 billion to the public since its inception. These bodies are desperate to avoid cognitive dissonance, they wish to maintain their positive self-image at all costs, with a free flow of staff between the bodies and steadfastly refuse to consider that the decade long experiment with IAPT is a failure. But even more tragically mental health sufferers are left to feed on morsels. 

  1. Dr Mike Scott