IAPT communications have an agenda, their focus is on persuading their source of revenue, local Clinical Commissioning Groups (CCGs) to expand funding, to cover staffing costs of £0.5billion by 2024. To achieve this goal it uses language that is familiar to the GPs that comprise CCGs, ‘NICE compliant’, ‘recovery’ and claiming a comparability of outcome to those in randomised controlled trials. But CCG’s are themselves under orders from NHS England, who have never critically appraised IAPT’s claims.
The secret to breaking the IAPT Code, is strangely its’ use of the ICD-10 code (the World Health Organisation’s labelling system for all disorders). The recent IAPT Manual (August 2021) https://www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual-v5.pdf recommends that IAPT clinicians give at least one code to each client, to characterise their debility. But nowhere in the Manual does it suggest that IAPT clinicians make a diagnosis. An ICD-10 code is only as reliable as the diagnosis made. The Manual claims that NICE Guidelines are based on ICD-10 codes and that IAPT is therefore NICE compliant. However the treatments recommended by NICE are all diagnosis specific, it follows that if there is no diagnosis there can be no fidelity to a NICE protocol. A key part of IAPT’s code is to gloss over that IAPT’s interventions are based, not on diagnosis but on ‘problem descriptors’. The silent assumptions are that:
a) there would be reliable agreement (reliability) between clinicians about what would constitute a clients main problem and
b) there is a body of evidence that a problem descriptor acts as a key to unlock the door to a specific protocol. Further that the specific protocol has been demonstrated to confer an added value, over and above an active placebo, for the chosen problem descriptor. There is an assumption of clinical utility.
But there is no empirical evidence for either a) the reliability or b) the clinical utility.
IAPT operates its’ own coding device, akin to the Enigma machine used by the Germans in World War 2, and it has as a result ill-served millions. NHS England and CCG’s have totally failed to recognise its’ operation, believing instead IAPT’s public broadcasts e.g a 50% recovery rate, when independent assessment indicates a 10% recovery rate Scott (2018) https://doi.org/10.1177%2F1359105318755264.
Dr Mike Scott
4 replies on “Decrypting the Improving Access to Psychological Therapies (IAPT) Code”
There are so very many confounding variables, which are deliberately ignored, that each time I hear the mantra of “evidence based” treatment, I just want to puke. For example, there has never been any attempts at separating IAPT patients who are also on anti-depressants and those who are not when they count “recovery” rates. It is simply appalling science, or I don’t know what, but science it is not, and definitely not “evidence-based”.
This is an important point Teresa, if the mechanism by which a treatment achieves ‘recovery’ cannot be specified then that treatment cannot be an evidence-based treatment
I and many colleagues used to use the problem descriptor “mixed anxiety and depression ” for the majority of the people we saw. However we were told to stop using it as it negitively effected the services commissioners data as NICE don’t have guidance for “mixed anxiety and depression “.
Yet another manipulation of information.
@MICHAELB, I was told a similar thing too. Plus it does not take a genius to work out that what IAPT is doing is not “science”. It is more akin to snake oil salesman tactics. @Teresa, yep, I have heard the term “evidence based” as if it is some hypnotic term to shut people down who have different opinions than the “norm”. I mean, there are very very few if any places that constantly bombard you with the term “evidence based”. The more they say it, the more I feel it is false as can be. Like, a mechanic will not constantly tell you that you need an oil change because it is evidence based; both parties can see it to be true without needing to be told “evidence based”.
Thank you Mike as always for the things you write in this blog. This one in particular is the amazing silver bullet needed to argue whenever managers get too heated towards me. Working in IAPT feels like the Hunger Games sometimes.