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IAPT and The Collapse of Its’ Practice-Based Evidence

The Improving Access to Psychological Therapies (IAPT) service has failed to deliver [Wakefield et al (2021) https://doi.org/10.1111/bjc.12268]  and Scott 2021) https://doi.org/10.1111/bjc.12264] practice based evidence. In an attempted rebuttal of my Commentary [ Kellet et al (2021) https://doi.org/10.1111/bjc.12268 ] in the forthcoming British Journal of Clinical Psychology, IAPT fellow-travellers dig an even deeper hole, exposing even more conflicts of interest.

 

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Under UK Government pressure, NHS England is to reconfigure its’ relationship with social care.  It would be timely if the Government also insisted that NHS England put its house in order with regards to the provision of routine mental health services.  As a first step it should insist that NHS England staff cannot be employed by an agency, such as IAPT, that they are responsible for auditing.

Further in 2016 the National Audit Office asked that IAPT be made responsible to an independent body the Care Quality Commission, but the Service has instead been allowed to continue to mark its’ own homework.

Kellett, S., Wakefield, S., Simmonds‐Buckley, M. and Delgadillo, J. (2021), The costs and benefits of practice‐based evidence: Correcting some misunderstandings about the 10‐year meta‐analysis of IAPT studies. British Journal of Clinical Psychology, 60: 42-47. https://doi.org/10.1111/bjc.12268

Scott, M.J. (2021), Ensuring that the Improving Access to Psychological Therapies (IAPT) programme does what it says on the tin. British Journal of Clinical Psychology, 60: 38-41. https://doi.org/10.1111/bjc.12264

Wakefield, S., Kellett, S., Simmonds‐Buckley, M., Stockton, D., Bradbury, A. and Delgadillo, J. (2021), Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. British Journal of Clinical Psychology, 60: 1-37 e12259. https://doi.org/10.1111/bjc.12259

Dr Mike Scott

426 replies on “IAPT and The Collapse of Its’ Practice-Based Evidence”

Thanks Mike. As ever, the Wakefield study makes no mention of attrition. You can have all the pre/post analysis you want and get an effect size, but it glosses over the fact that for so many that start treatment, they get no further than one session. Barry

Exactly so Barry, it just occurred to me that if it were the Grand National and 30% of declared runners were non-starters and 40% of those remaining fell at the 1st fence, there would be an outcry. The Government would force an Independent Inquiry, insisting that none of the racehorse owners were on the Inquiry. But if it is human beings it seems not to matter!
Best wishes
Mike

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Most of the research in to psych therapy is based on invalid and unreliable constructs framed as personal disorders – how can this produce anything like ‘evidence based practice’ or the nonsense of ‘disorder specific models.? Has anyone read the critics of the research literature? William Epstein’s work? etc. We know models/theories account for almost nothing, nor does clinician expertise – its mostly about the resources each person has coming in to therapy making the possibility for any change more likely. This is followed by the relationship and the rest it seems to me are empty rituals that might be responsible for teasing out a modicum of placebo change but thats it – we’ve known for ages if psych therapy is helpful at all this help is largely marginal and transient and applicable to those that need it least of all – the well resourced.

It seems clear that we have myriad cultural disorders causing most of the distress we all see but we have reduced the world to a trigger and the illusion on an internal dysfunction rather than epic attempts to survive these cultural disorders . We don’t need more of the same we need to move beyond the myopic individual focus and begin to develop what David Smail referred to as ‘outsight’ and ‘treat’ the cultural disorders. There is so much self interest and bias baked into the system at this point its the blind leading the blind.

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