Month: September 2023

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NHS Talking Therapies Both Judge and Jury On Recovery

Would you invest in a company simply on the basis of its proclaimed profits? But that is exactly what successive governments have done every year, for the past fifteen years. At a cost of £752 million in the year 2021 for adult Mental Health Services, £922 million on child and adolescent mental health (excluding funding for eating disorders £73 million). Making a grand total of £1.75 billion [Figures from the National Audit Office (NAO ) Report of February 2023] for 2021-2022. The NAO  re-iterates, uncritically, IAPT’s claim of a 50% recovery rate for the Adult mental health service, neglecting to say that there has been no independent verification of this. Further there is not even a claim to the effectiveness of Child and Adolescent Mental Health services!

The NAO  is unphazed by the haemorrhaging of clients from the NHS Talking therapies for Adults. It notes, without comment, that  46% of its clientele drop out before treatment, were treatment is  defined as attending 2 or more treatment sessions. So that the much vaunted 50% recovery rate, applies only to those who complete treatment! 

My own work Scott (2018) on 90 clients going through NHS Talking Therapies predecessor IAPT, was that only the tip of the iceberg recovered.

Dr Mike Scott

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NHS Talking Therapies Builds Sandcastles on The Beach At Low-tide

NHS Talking Therapies for Anxiety and Depression provides snapshots of clients at each therapy session, using two psychometric tests. But these ‘pictures’ provide no indication as to whether the client would regard themselves as having returned to normal (or best ever) functioning for a meaningful period. Despite this NHS Talking therapies claims a 50% recovery rate!  The time-frame used in the tests is the past two weeks, but remission in epidemiological [Bruce et l (2005)] studies and DSM-5-TR [American Psychiatric association (2022)] is defined as having no significant signs or symptoms for 2 months. NHS Talking Therapies has never used the 2 month real-world window, as the minimum period necessary for declaring recovery from an episode of anxiety or depression. Even this period would be insufficient for declaring lasting recovery. The changes depicted by the trajectory of the two psychometric tests, used without a reliable diagnostic context, have no more significance than an NHS Talking Therapies Flag stuck on top of its’ sandcastle, soon to be washed away.

 

The Service has this year made two switches that have not enhanced its’ credibility. The first, is to say its’ focus is now on the provision of ‘talking therapies’ and not ‘psychological therapy’. The latter term has historically been applied to psychological treatments that have been examined in randomised controlled trials (rcts).  But there are no rcts of ‘talking therapies’, they are not evidence-based. The term can be taken to mean whatever the user wants it to mean. Is a person’s conversation with their hairdresser/barber a ‘talking therapy’, was my meeting, an hour ago, with an old school friend in a coffee bar ‘talking therapy’?

The second switch is to append the descriptor for ‘Anxiety and Depression’ to the Services’ role. But the Service takes no steps to ensure that established diagnostic gateway criteria for anxiety and depression are met. NHS Talking Therapies, is it seems dedicated to obscuring what it does, thereby ducking accountability.

Dr Mike Scott

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The National Audit Office Fails To Ensure IAPT Does What It Says On The Tin

On February 9th 2023, the NAO gave its’ seal of approval to NHS Talking Therapies (formerly the Improving access to Psychological Therapies, Service), legitimising the £752 million spent on it in 2021-2022. But the small print reveals that less than 50% of clients completed treatment (attended 2 or more sessions). Further the NAO, took at face value, the Service’s claim of a 50% recovery for completers. These are not the hallmarks of a legitimately funded public body. The NAO is strangely silent on the fact that there has been no publicly funded independent assessment of the effectiveness of NHS Talking Therapies. Nevertheless they recommend the Services method of self-audit, (repeated completion of 2 psychometric tests) for adoption by the rest of the mental health services! 

The NAO took no account of my critique of the Service published in the British Journal of Clinical Psychology (2021):

  • diagnosis is not part of the repertoire of NHS Talking Therapies
  • to most people recovery means no longer suffering from the disorder/s that you presented with
  • psychometric tests measure the severity of a disorder, they are not diagnostic and cannot be the primary metric of recovery.
  • the duration of recovery is critical, and if not established talk of recovery is meaningless
  • the best independent evidence of recovery to date is that in fact the tip of the iceberg recover [Scott (2018) ]. The improvement identified by NHS Talking Therapies is most likely the effects of attention and regression to the mean. The burden of proof is on the Service to demonstrate that its’ clients fare any better than a matched group of clients attending say the Citizen Advice Bureaux. 

If the NAO report were presented in a Civil Court, their findings would be dismissed because their conclusions are outside their area of expertise. NHS Talking Therapies is responsible to politicians and Integrated Care Boards, but to date the latter have failed to hold them accountable, `alongside the NAO. It is sadly reminiscent of Hospital Trusts not holding Senior Managers accountable.

Dr Mike Scott

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Reported Posttraumatic Growth Is Commonplace, But Usually Proves Illusory – Casting Doubt On the Validity Of Relying Solely On Self-report Measures, As NHS Talking Therapies Does

 

NHS Talking Therapies has relied solely on two self-report measures in claiming a 50% recovery rate, in clients who attend more than two treatment sessions. But a study by Boals (2023) of self-report measures of posttraumatic growth (PTG) following a trauma, found that supposed beneficiaries were commonplace, 53%  believing they were exceeding pre-trauma levels of functioning. However, Boals (2023) suggests the genuine growth rate is 0-10%. [This latter figure is strangely similar to the tip of the iceberg Scott (2018) that I found recovered in 90 clients going through IAPT (NHS Talking Therapies predecessor)].  The occurrence of genuine posttraumatic growth is very rare.  Illusory PTG, occurs when an individual convinces themselves they have experienced PTG, mostly via fabricated illusions and motivated biases as a way to cope with the distress associated with the traumatic event. It seems likely this phenomenon would also occur when therapists ask clients how they have fared with the just delivered therapy in NHS Talking Therapies. The PTG self-report measures assess perceived PTG not genuine PTG. This suggests that the much publicised 50% recovery rate in NHS Talking Therapies should be treated with great caution. The recovery rate suggested by the self-report measures may also be largely illusory.

Dr Mike Scott