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BABCP Response - NICE Consultation January 2022

‘Attempts to Justify The Cost-Effectiveness of IAPT…Severely Lacking’

this is the conclusion of a recently published study in the Journal of Health Psychology

https://doi.org/10.1177%2F1359105318803751

Scott Steen, the author of the the new cost-benefit analysis, comments ‘The first limitation concerns the high proportion of early disengagement which, according to the latest annual report, around 40 per cent of those entering treatment attend one session only (IAPT, 2018). Within the same annual report, approximately 43 per cent of assessed-only referrals were deemed suitable but declined treatment, while
23 per cent were deemed not suitable, and only 9 per cent were discharged by mutual agreement following advice and support (IAPT, 2018). The second limitation concerns the heavy reliance on brief, self-report measures and lack of long-term outcomes which, when using more in-depth and longitudinal techniques, have found intervention effects to be diminished or even temporary (Ali et al., 2017; Cairns, 2013; Hepgul et al., 2016; Marks, 2018; Scott, 2018)’.

Steen continues ‘research used to justify the economic benefits of the IAPT programme has little relevance for how it delivers and evaluates interventions. For instance, Layard and Clark (2014) cite a study conducted by Fournier et al. (2015) to justify the potential rate at which individuals move from incapacity benefits into employment. However, this specific study focuses only on patients who had recovered from severe depression, were assessed using structured clinical interviews and diagnostic criteria, and were treated by highly trained practitioners, the majority of whom had PhDs. Similarly, research into the long-term effects of interventions appears to have been selectively chosen, omitting the generally limited to mixed findings in this area (Marks, 2018)’.

In summary Steen opines:

‘Taken as a whole, the IAPT programme seems to be delivering treatment at an inefficient cost. Although outcome targets are being reached, this appears to be due to an increased emphasis on low-intensity styled provision which not only drives up costs-per-IAPT outcome but also potentially reduces the appropriateness of treatment allocation and sustainability of these outcomes’.

All CCGs should be asked to consider this study.

 

Dr Mike Scott

8 replies on “‘Attempts to Justify The Cost-Effectiveness of IAPT…Severely Lacking’”

The IAPT LTC/MUS Pathfinder Evaluation Project Phase 1 Final report (2013) of the LTC arm of IAPT showed that management of LTC/MUS patients via IAPT was not cost-effective, but they’ve kept on ploughing ahead with this strategy to cut physical healthcare costs regardless. In a presentation entitled “NHS England IAPT Programme
Physical and Mental Health Treatment Pathways” by Ursula James – National IAPT Programme Manager – on page 10 she discloses that LTC/MUS pilots fell below the recovery standard target, but they keep pressing on with the roll-out of the LTC/MUS arm anyway. All this is reminiscent of the way that Kevin Jarman, IAPT Programme Manager 2008-15 and Work and Health Joint Unit DWP/DH Lead, described them forging ahead with the roll-out of IAPT before the initial evaluation of the IAPT demonstration sites (Newham and Doncaster) had been published – https://www.uea.ac.uk/medicine/departments/psychological-sciences/cognitive-behavioural-therapy-training/-about-iapt-and-the-history-of-the-programme – see from 2 mins 20 on the video onwards. Everything about IAPT seems to have been rushed and sloppy, with a disregard for waiting for concrete evidence to show that it works, and a propensity to ignore the importance of any negative findings.

From what I’ve read in this post and in the comment above, and from the Kevin Jarman video, it strikes me that –

IAPT = one GREAT BIG MENTAL HEALTH DODGY DOSSIER.

Well thanks a bundle Tony Blair, Alan Johnson or whoever. (Not that the Coalition and Tory Governments aren’t to blame too.)

Bring on Chilcot 2 – the sooner that happens, the better for all.

I couldn’t have put it better myself, but I think IAPT was taken up properly by the Labour government under Gordon Brown, with Alan Johnson as Health Secretary, so Tony’s probably off the hook. However, are you aware that Clark and Layard supposedly came up with the idea after meeting at a British Academy tea party in 2003, coincidentally the year in which the Iraq War took place? Layard is reported to have been influenced by the work of Daniel Kahneman, an American behavioural economist, and was by then pursuing his own work on ‘happiness economics’ and how it could influence policy. Clark was a CBT proponent, or monger you could say. At that time, I think he was working at the Institute of Psychiatry at Denmark Hill in London.
An Inquiry into this exceptionally dodgy programme is long overdue. IAPT is a disaster for the NHS, for both mental health and physical health patients.

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