‘That self-help is not a regular treatment should be clear from the beginning…A self-help intervention cannot replace more usual forms of psychological treatment and this should be made clear from the beginning’ so writes Pim Cuijpers in the most recent issue of Clinical Psychology Science and Practice
but it never is in IAPT.
Cuijpers points out that guided self-help (GSH) for depression has a small effect size around 0.28 and this is substantially less than the O.6 or higher of traditional psychological treatments https://www.dropbox.com/s/3zgy50ub5s5q1yx/Lewinsohn%27s%20Coping%20with%20Dep%20Meta-Analyses.pdf?dl=0.
Further the impact of GSH may be even less when compared to active control conditions as opposed to the common comparisons that have been made with inert waiting lists. In addition a diagnostic interview has been used in only at most half of the GSH studies.
It is unethical not to let clients know that what they will most likely receive initially in IAPT is a substandard treatment. The risks and benefits of any procedure need to be clearly spelt out for informed consent. Service users are entitled to provider track record information. There would appear to be grounds for complaint from former IAPT clients, whether to NHS England or perhaps via a lawyer. The NHS guidance on consent to treatment states ‘the person must be given all the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead’.
Dr Mike Scott