Neither NHS England, Clinical Commissioning Groups or BABCP have taken any steps to ensure that there is independent monitoring of the welfare of IAPT’s clients. Such clients suffer a double whammy, not only do they experience the sense of helplessness often accompanying psychological debility, but they are also powerless to say anything about their experience.
The CONSORT guidelines ( see link below) state that randomised controlled trials should address outcomes that are meaningful to the patient. The same should apply to services delivered in routine practice. Changes in psychometric tests scores are not meaningful to clients, whereas no longer suffering from the disorder they were suffering from at the start of treatment is. But IAPT obfuscates its’ true performance by sleight of hand with psychometric test results. Clients are fodder for providing psychometric test data at each session, no matter that there is no certainty that the test is pertinent to what they are suffering, that repeated administration means that they can remember their last score and will want to convince themselves that they are getting better and that the results are interpreted by their therapist, creating a demand effect.
A major feature of the CONSORT guidelines is that treatment should be evaluated by those independent of service provision. There is no opportunity to protest about incompetence or the arbitrary number of session limit. IAPT violates this and every aspect of the guidelines that might be pertinent to routine practice.
Unfortunately Editors of Journals such as Behavioural and Cognitive Psychotherapy, Behaviour Research and Therapy and the Lancet often ignore the CONSORT guidelines or any translation of them into routine practice. Consequently the evidence base for expansion of IAPT into areas such as psychosis in secondary care, is much less than understood by its’ workers.
Dr Mike Scott
2 replies on “IAPT’s Clients – Vulnerable Adults With No Protection”
There is covert but also overt pressure on people to score lower at the end of treatment. In our service we are coached on how to go through the MDS in the final session and help people score more ‘accurately’ (ie lower) if their scores haven’t gone into recovery. Very few people are likely to stand their ground if their therapist is subtlety (or not so subtlety) suggesting they reduce their ratings on particular items.
This is essentially fraudulent accounting, for which the Organisation and individuals should be held accountable. It is not acceptable that NHS England, Clinical Commissioning Groups and the National Audit Office turn a blind eye to this. IAPT continues to seek to extend its’ remit to those with learning disabilities and the Universities. It does so by preserving Organisational reputation at all costs.