IAPT and NICE Compliance – panic disorder a case study in infidelity

the infidelity starts with IAPT’s emphasis on psychometric tests to determine treatment. NICE (2020) http://pathways.nice.org.uk/pathways/panic-disorder, observes there are no appropriate screening instruments for panic disorder. The guidelines highlights the importance of a) detailing a timeline for the emergence of various symptoms and b) clinicians being aware of the common comorbidities of depression and substance abuse. But it is doubtful that this can be done within the typically 30 mins IAPT telephone triage assessment by Psychological Wellbeing Practitioners, the least well qualified of all IAPT staff. NICE suggests the monitoring of the frequency and severity of attacks as an outcome measure. But in IAPT notes I have never seen this systematically recorded. 

IAPT is non-compliant with NICE recommended dosages:

  1. Low intensity treatment is likely as the first step in panic disorder treatment. NICE recommends that brief CBT be around 7 hours and integrated with structured self-help materials. But Saunders et al (2021) Journal of Affective Disorders 294 (2021) 85-93 found that the average client in the Improving Access to Psychological Therapies  (IAPT) low intensity therapy has 3 sessions ( a mean of 2.85 sd 2.81). Thus over 84% of those in low intensity CBT receive less than the than the number of NICE recommended treatment  sessions for brief CBT.  But Shafran et al (2021) https://doi.org/10.1016/j.brat.2021.103803 have defined low intensity treatment as consisting of 6 hours or less therapist contact. Thus IAPT’s low intensity therapy is of such low dosage that it would not qualify for NICE’s brief CBT. 
  2. For high intensity treatment NICE recommends 7-14 hours of treatment, involving weekly sessions of 1-2 hours and completed within 4 months. But IAPT clients in high intensity treatment typically receive 5 sessions Saunders et al (2021) Journal of Affective Disorders 294 (2021) 85-93 ( a  mean 4.79 sd 5.51)]. 

IAPT has never systematically monitored compliance to NICE protocols. There is no evidence that IAPT has obeyed NICE’s guidance that ‘CBT should be delivered only by suitably trained and supervised people who can demonstrate that they adhere closely to empirically grounded treatment protocols’.

IAPT pays lip service to adherence to NICE protocols for funding purposes. But this is unacceptable, the NICE guidance is important, for example it warns that benzodiazepines are an inappropriate treatment for panic disorder. The NICE guidance is a means of challenging not only the inappropriateness of pharmacological treatment but also of psychological therapy. 

 

Dr Mike Scott

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