British Journal of Clinical Psychology Responds To IAPT’s Conflict of Interest

last week I wrote to Professor Grisham, the Editor of the Journal complaining, inter alia, of IAPT’s failure to declare a conflict of interest over the paper by Wakefield et al (2020) in the current issue, see link https://doi.org/10.1111/bjc.12259.  The Journal has responded  by formally inviting me to write a commentary, which subject to peer review, will appear alongside a response by the said authors. The text of my letter was as follows:

Dear Professor Grisham

Re: Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta-analysis of 10-years of practice-based evidence by Wakefield et al (2020) https://doi.org/10.1111/bjc.12259

In this paper all the authors declare ‘no conflict of interest’. But the corresponding author of the study Stephen Kellett is an IAPT Programme Director.  This represents a clear conflict of interest that I believe you should alert your readers to. The study is open to a charge of allegiance bias.

I am concerned that in their reference to my published study “IAPT – The Need for Radical Reform”, Journal of Health Psychology (2018), 23, 1136-1147 https://doi.org/10.1177%2F1359105318755264 these authors have seriously misrepresented my findings. They chose to focus on a subsample of 29 clients, from the 90 IAPT clients I assessed for whom psychometric test results were available in the GP records. I warned that concluding anything from this subsample was extremely hazardous.  The bigger picture was that I independently assessed the whole sample using a ‘gold standard’ diagnostic interview and found that only the tip of the iceberg lost their diagnostic status as a result of IAPT treatment. Wakefield et al were strangely mute on this point.  They similarly fail to acknowledge that their study involved no independent assessment of IAPT client’s functioning and there was no use of a ‘gold standard’ diagnostic interview.

The author’s of Wakefield et al (2020) compare their findings favourably with those found in randomised controlled trials efficacy studies, suggesting that IAPT’s results approach a 50% recovery rate. But there can be no certainty of matching populations. In the said study there was no reliable determination of diagnostic status, thus there is no way that this heterogenous sample can be compared to homogenous samples of different primary disorders e.g obsessive compulsive disorder, adjustment disorder etc.

It is unfortunate that the British Journal of Clinical Psychology has allowed itself to become a vehicle for the marketing of an organisation which has only ever marked its’ own homework. The published study also calls into question the standard of the peer review employed by the Journal.

Regards

 

Dr Michael J Scott

At least we are getting to open debate, which is more than can be said for BABCP’s in-house IAPT comic, CBT Today.

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