Categories
l

IAPT – The Rogue Santa

If Santa lost half his deliveries before reaching the 2nd home on his itinerary, he would be viewed with suspicion. But last year the Improving Access to Psychological Therapies Service (IAPT) lost 46% of clients before their 2nd treatment session. What’s going on?

The Service would prefer to deftly switch attention to treatment completers, defined as those who complete at least two treatment sessions. But no Oncology or Physiotherapy service would define completion of treatment in such a minimalist way. This looks like sleight of hand. Nevertheless for ‘completers’, IAPT offers the defence of effectiveness  across a range of disorders as evidenced by the effect sizes in the Table below:

 

IAPT’s Defence By Disorder

 IAPT’s 2021-2022 Annual Report

Within Subject Effect Size using PHQ9 (for all cases initially at caseness) and only for those who completed two or more treatment sessions.  The ES is pre-treatment mean minus the post-treatment mean/pooled standard deviation 

Depression

1.5

Agoraphobia

0.8

Body Dysmorphic Disorder

1.2

Generalised anxiety disorder

1.0

Hypochondriacal disorders

0.9

Mixed anxiety and depressive disorder

1.2

Obsessive-compulsive disorder

0.9

Other anxiety or stress related disorder

1.2

Panic disorder [episodic paroxysmal anxiety]

0.9

Post-traumatic stress disorder

1.1

Social phobias

0.9

Specific (isolated) phobias

0.8

The mean ES in the above table is 1, this means that at the end of treatment the average client is better than 84% of those at the start. But it is not known how long this change lasts or what proportion of clients would consider themselves back to their old self. No independent person has asked them. The results are based on questionnaire responses made in the presence of the Santa like therapist. Who wants to displease Santa?

Science Has Progressed By Categorisation but IAPT Feigns This

The IAPT Manual states  that its’ staff do not make diagnoses. How then are the IAPT staff supposed to know which label to attach to whom? It can be contended that the diagnostic labels don’t matter, but that is not what NICE says, they recommend specific protocols for particular disorders. IAPT has been dishonest since its’ inception, in claiming NICE compliance. It should publicly admit that its staff excercise unbridled clinical judgement in choosing a ‘diagnostic’ label. As a consequence the treatment it serves up is necessarily idiosyncratic. There is know knowing what this Santa will deliver!

IAPT squeezes its clients into 12 categories, one of which mixed anxiety and depressive disorder is still used despite the advice in the 2019 Manual. No room at the inn for those with an adjustment disorder, personality disorder, bulimia, substance dependence, bipolar or psychosis. The injunction from the Service is to treat the principal disorder, but comorbidity is the rule rather than the exception. The implication is that comorbidity is best ignored. Clients are made to fit the Service and not the other way round.  

The Demise of The Supposed Medical Model and The Rise of Autocracy

There are many who see the ‘medical model’ as totally anathema and who should therefore be rejoicing at the de facto ignoring of diagnosis in IAPT. But they do so under their breath, as the prime movers in the development of the IAPT service, based their reputations on the efficacy of specific protocols for particular disorders e.g panic disorder.

 

The IAPT service is actually an experiment in determining what happens to clients if clinicians have free reign to treat clients as they see fit. The results of this clinician autocracy (or oligarchy if those who hold sway in IAPT/BABCP are considered) is that clients do not improve by any more than would be expected with the passage of time and attention.

The successors to Clinical Commissioning Groups make decisions locally as to how much money to invest in IAPT. But none have been prepared to open the ‘can of worms’ and insist that there is an independent assessor who at a minimum asks clients ‘compared to when you first went to IAPT are you the same, a little better, a little worse, much better, much worse? How long have you been the way you are now?

The Blatant Ignoring of Published Guidelines by IAPT

IAPT’s behaviour is in glaring contrast to that espoused in an Editorial in the most recent issue of the British Journal of Psychiatry who recommended observance of both NICE and Australian/New Zealand Guidelines for the treatment of depression  with ‘robust diagnosis and re-evaluation’ at the start of treatment and at 4-6 weeks, to check that the diagnosis is correct and redirect treatment if no response. They re-iterate that the Guidelines also state that if a person is unresponsive after 4-6 weeks there is ‘a need to address problems that may not seem to be directly pertinent to depression, such as personal, social or environmental factors, and advises that other illnesses (especially personality dysfunction) should also be considered as potential contributors to depression’. No such detailed re-evaluation ever takes place in IAPT, by their own admission they do not diagnose and certainly not personality disorders.

Dr Mike Scott

 

Dr Mike Scott

 

380 replies on “IAPT – The Rogue Santa”

The next time I read a blog, Hopefully it won’t disappoint me as much as this particular one. After all, I know it was my choice to read through, however I truly believed you’d have something interesting to talk about. All I hear is a bunch of crying about something that you could fix if you were not too busy searching for attention.

A fascinating discussion is worth comment. There’s no doubt that that you need to write more on this topic, it might not be a taboo subject but usually people don’t discuss such issues. To the next! Best wishes!

You are so awesome! I don’t believe I’ve read through a single thing like that before. So great to find another person with unique thoughts on this subject. Seriously.. thanks for starting this up. This site is something that’s needed on the internet, someone with a bit of originality.

I blog often and I truly appreciate your information. The article has really peaked my interest. I am going to take a note of your site and keep checking for new details about once per week. I opted in for your Feed as well.

Oh my goodness! Incredible article dude! Thank you so much, However I am experiencing difficulties with your RSS. I don’t understand why I can’t subscribe to it. Is there anyone else getting the same RSS problems? Anybody who knows the answer will you kindly respond? Thanx!!

I’m amazed, I have to admit. Rarely do I come across a blog that’s equally educative and entertaining, and let me tell you, you’ve hit the nail on the head. The issue is something not enough men and women are speaking intelligently about. I am very happy that I came across this in my search for something concerning this.

Hello there! This blog post couldn’t be written much better! Looking at this post reminds me of my previous roommate! He constantly kept talking about this. I will send this post to him. Fairly certain he’ll have a good read. Thanks for sharing!

After looking over a number of the blog articles on your blog, I seriously like your technique of writing a blog. I book marked it to my bookmark webpage list and will be checking back in the near future. Please check out my website as well and tell me how you feel.

Your style is very unique compared to other people I’ve read stuff from. Many thanks for posting when you’ve got the opportunity, Guess I will just book mark this page.

I’m impressed, I must say. Seldom do I come across a blog that’s both equally educative and interesting, and let me tell you, you’ve hit the nail on the head. The issue is something that too few men and women are speaking intelligently about. Now i’m very happy that I stumbled across this during my hunt for something regarding this.

The very next time I read a blog, I hope that it doesn’t disappoint me just as much as this particular one. I mean, Yes, it was my choice to read, but I genuinely thought you would probably have something helpful to say. All I hear is a bunch of crying about something that you could fix if you were not too busy looking for attention.

Howdy, I believe your blog might be having internet browser compatibility problems. When I look at your website in Safari, it looks fine but when opening in IE, it’s got some overlapping issues. I simply wanted to provide you with a quick heads up! Other than that, excellent blog.

Next time I read a blog, Hopefully it does not disappoint me just as much as this particular one. After all, Yes, it was my choice to read through, but I genuinely believed you’d have something helpful to say. All I hear is a bunch of moaning about something that you could fix if you were not too busy searching for attention.

After going over a number of the articles on your blog, I honestly like your way of writing a blog. I saved as a favorite it to my bookmark webpage list and will be checking back soon. Please check out my web site as well and tell me what you think.

I need to to thank you for this excellent read!! I definitely enjoyed every little bit of it. I’ve got you book marked to check out new things you post…

Hi, There’s no doubt that your website may be having internet browser compatibility problems. When I take a look at your blog in Safari, it looks fine but when opening in I.E., it has some overlapping issues. I simply wanted to provide you with a quick heads up! Other than that, wonderful website!

The very next time I read a blog, Hopefully it won’t disappoint me as much as this one. I mean, Yes, it was my choice to read, nonetheless I really thought you would have something interesting to say. All I hear is a bunch of crying about something that you can fix if you weren’t too busy looking for attention.

I’m excited to uncover this website. I need to to thank you for ones time just for this fantastic read!! I definitely loved every part of it and I have you saved as a favorite to look at new information on your site.

I’m amazed, I have to admit. Seldom do I come across a blog that’s both educative and amusing, and let me tell you, you’ve hit the nail on the head. The problem is an issue that too few folks are speaking intelligently about. I’m very happy I found this during my hunt for something concerning this.

Right here is the perfect blog for anybody who wishes to understand this topic. You understand so much its almost tough to argue with you (not that I actually will need to…HaHa). You definitely put a fresh spin on a topic that has been discussed for decades. Wonderful stuff, just wonderful.

I’m more than happy to uncover this website. I want to to thank you for your time just for this wonderful read!! I definitely loved every bit of it and i also have you book marked to see new things in your web site.

Hi there! This post couldn’t be written any better! Looking through this post reminds me of my previous roommate! He constantly kept talking about this. I most certainly will forward this information to him. Pretty sure he’s going to have a good read. Thanks for sharing!

Next time I read a blog, I hope that it does not disappoint me just as much as this particular one. I mean, Yes, it was my choice to read, however I truly thought you would have something interesting to talk about. All I hear is a bunch of complaining about something you could possibly fix if you weren’t too busy looking for attention.

Hi there! This blog post couldn’t be written any better! Going through this article reminds me of my previous roommate! He always kept preaching about this. I most certainly will forward this information to him. Fairly certain he’ll have a great read. Thank you for sharing!

Hello there! This article couldn’t be written much better! Looking at this article reminds me of my previous roommate! He constantly kept talking about this. I will forward this post to him. Fairly certain he’ll have a good read. Thank you for sharing!

After I initially commented I seem to have clicked the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I recieve 4 emails with the same comment. Perhaps there is a means you are able to remove me from that service? Thanks a lot.

A fascinating discussion is worth comment. There’s no doubt that that you need to write more about this issue, it might not be a taboo subject but usually people do not speak about these subjects. To the next! Kind regards!

I blog frequently and I really thank you for your information. The article has really peaked my interest. I am going to bookmark your website and keep checking for new details about once per week. I opted in for your RSS feed as well.

Oh my goodness! Incredible article dude! Thank you so much, However I am encountering problems with your RSS. I don’t know why I am unable to subscribe to it. Is there anybody else having identical RSS issues? Anybody who knows the answer can you kindly respond? Thanx!

Hi, I do think this is an excellent blog. I stumbledupon it 😉 I will come back yet again since i have book marked it. Money and freedom is the best way to change, may you be rich and continue to guide other people.

Hi! I’m Charles. If you’re stuck in a financial Groundhog Day, repeating the very same battles, let’s break the cycle. The 1K a Day System is your escape, leading you to new mornings of success and potential. Awaken to something terrific!

Hey! I’m Charles, and if you’re tired of the 9-to-5 grind and think workplace coffee tastes like anguish, I’ve got excellent news for you. Invite to the 1K a Day System, where we swap coffee for capital and desks for monetary self-reliance. Are you ready to sell your tie for a ticket to freedom? Let’s turbocharge your profits and have some enjoyable along the method!

Leave a Reply

Your email address will not be published. Required fields are marked *