Categories
l

How Do NHS Talking Therapies Clients’ Fare Downriver?

The Improving Access to Psychological Therapies River began flowing 15 years ago, rebranded NHS Talking Therapies last year. Yet we still don’t know how clients fare, downstream long-term. Quite why we don’t know is an interesting question. One doesn’t have to be a conspiracy theorist to suggest that there may be an unholy alliance of Service Providers and politicians/media at work. The former fearing independent public audit, the latter wanting to be seen championing the side of the ‘good’.

Clients invariably enter the river destabilised. Some may quickly regain their balance and be part of the 40% of people who do not go on to engage in treatment (defined by the service as engaging in 2 or more treatment sessions). But what proportion of those who have had treatment go on to return to how they were before entering the river? Or to put it another way, what proportion reach the promised land? What proportion  continue to thrash about at sea? Despite the much vaunted and extensive NHS Talking Therapies database it is impossible to answer these simple questions. There is clearly something amiss here. The answer cannot be to spend £2billion a year on child and adult services in NHS Talking Therapies. Just throwing money at a problem cannot be an answer to anything. 

The best guess from an independent review [Scott (2018)] is that only the tip of iceberg recover. The burden of proof is on those who would claim otherwise, simply reiterating NHS Talking Therapies mantra of a 50% recovery rate is not evidence.  

The NHS has proposed that interventions are evaluated using the mnemonic PICOTS. P requires a specification of the population being addressed and presupposes a reliable diagnosis. But NHS Talking Therapies therapists are not trained to make diagnoses. The Service therefore fails at the first hurdle. I stands for intervention and requires the specification of the intervention used so that it could be replicated and evaluated by other clinicians. But there have been no fidelity checks to establish whether a particular protocol has been followed. Rather there is a cacophony of voices claiming to deliver ‘CBT’. The service falls at the 2nd hurdle. C pits the service against a control condition, but there has been no such evaluation of NHS Talking Therapies. There is no reason to believe that its clients fare any better than if they had attended the Citizen’s Advice Bureaux. O refers to outcome, but there has never been a blind independent assessment of NHS Talking Therapies Clients instead there has been entire reliance on self-report measures which are subject to both demand characteristics (wanting to please the therapist and not think you have wasted your time) and regression to the mean (people invariably come at their worst and there is some improvement with time whatever. Finally there is T, which is about the duration of gains (time),  never has there been a real world assessment of recovery e.g lasting at least 8 weeks. NHS Talking Therapies fails all the NHS hurdles.

Dr mike Scott 

716 replies on “How Do NHS Talking Therapies Clients’ Fare Downriver?”

Any news on CQC looking at inspection and rating ?
“Improving access to psychological therapies (IAPT)
“Therefore, CQC is not able to
regulate psychological therapies in IAPT services and we hold no data relevant to the inquiry.
However, we are currently working with the Department for Health and Social Care, trade
associations and other key stakeholders to identify and understand how we may inspect and
rate psychological therapies going forward. Progress on this matter has been delayed due to the
Covid-19 pandemic”

https://committees.parliament.uk/writtenevidence/39835/pdf/

Hi Michael
Very interesting, the short answer is that I don’t know. So have just e-mailed CQC to find out the current position. Will let you know if I hear anything.
Take care
Mike

This comes from 2020 Forgive my ignorance it might not be of value or apropos this link https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/patient-level-information-and-costing-systems#updates — 2020 Specification for Patient-level information and costing systems (PLICS) IAPT data set
file:///C:/Users/Owner/AppData/Local/Temp/MicrosoftEdgeDownloads/9ec60e5e-619f-4254-896e-836f1f12404c/212304402020specification.pdf

It seems like there was a suggestion pre-pandemic to do costing in a different way, but no indication that this materialised and nothing to suggest regulation in a way a member of public would understand.
Take care Liz
mike

Is “costing” a development of the Payment by results system, that was linked to clustering and care pathways. Evaluating the “care pathway” could be beneficial, costing seems to simply rely on IAPTs own KPI data being provided.
I’m not aware of care clustering being officially scrapped.

I also thought there may have been some benefits in people being able to identify their care cluster and then asking/demanding appropriate treatment eg. for cluster 3

“Moderate problems involving depressed mood, anxiety or other disorder (not including psychosis).”
– Care is usually provided by Primary Care or IAPT Services
– The problem is likely to be short term when treated
– The care package will contain high intensity psychological interventions, including individual therapy, possible medication and lifestyle and physical health advice.
– Clinical review will be carried out at a maximum of 6 months from commencement of treatment
– Treatment may be provided for up to 6 months”

So rather than being dependent on services making the decision and simply refusing or passing on to PWPs, people could hold the service to account.

https://www.mpft.nhs.uk/service-users-carers/care-clusters/find-your-care-cluster

Care Clustering appears to be used in IAPT, training course 2021

Mental Health Clustering Tool (MHCT)
Welcome to your Mental Heath Clustering Tool (MHCT) IAPT course

https://www.rcpsych.ac.uk/events/conferences/2021/mental-health-clustering-tool-(iapt)

I’d be fascinated to see how this is being used by PWPs who have the majority of first contacts, along side “problem descriptors”. Personally I don’t think it’s used.
Another flaw in the IAPT/TT system?

Hello there! Do you know if they make any plugins to assist with SEO? I’m trying to get my blog to rank for some targeted keywords but I’m not seeing very good gains. If you know of any please share. Appreciate it!

I’d also like to mention that most of those that find themselves without health insurance usually are students, self-employed and people who are out of work. More than half in the uninsured are really under the age of Thirty-five. They do not really feel they are looking for health insurance since they are young and also healthy. Their own income is frequently spent on houses, food, and also entertainment. Many individuals that do work either whole or not professional are not given insurance by way of their jobs so they go without because of the rising tariff of health insurance in america. Thanks for the suggestions you discuss through this blog.

I抳e read several good stuff here. Certainly worth bookmarking for revisiting. I surprise how much effort you put to make such a great informative website.

I used to be suggested this blog by way of my cousin. I am no longer sure whether or not this publish is written by means of him as nobody else understand such detailed about my trouble. You are wonderful! Thanks!

Can I simply say what a aid to search out someone who really knows what theyre speaking about on the internet. You undoubtedly know how one can deliver a problem to gentle and make it important. Extra people have to learn this and perceive this aspect of the story. I cant imagine youre no more well-liked since you definitely have the gift.

What i do not understood is in fact how you are not really a lot more well-favored than you might be now. You are very intelligent. You recognize therefore considerably on the subject of this subject, produced me in my view consider it from a lot of numerous angles. Its like men and women don’t seem to be interested except it is something to accomplish with Woman gaga! Your own stuffs nice. At all times maintain it up!

I have noticed that car insurance corporations know the motors which are prone to accidents along with risks. In addition, they know what types of cars are susceptible to higher risk and also the higher risk they may have the higher your premium price. Understanding the uncomplicated basics involving car insurance will help you choose the right style of insurance policy that can take care of your preferences in case you happen to be involved in any accident. Appreciate your sharing the ideas with your blog.

medicine in mexico pharmacies [url=http://cmqpharma.com/#]purple pharmacy mexico price list[/url] medication from mexico pharmacy