IAPT’s Below Intensity CBT – Rhetoric vs Reality

 

The Improving Access to Psychological Therapies (IAPT) Service clients receive on average 6 sessions (amongst those who complete 2 or more sessions), compared to the typical 13  sessions in the 29 evidence based, ‘gold standard’, randomised controlled trials, considered by OST (2008) doi:10.1016/j.brat.2007.12.005. The discrepancy in the dosage of treatment creates a suspicion that, in routine practice, clients receive a sub-therapeutic dose of treatment.

In practice the Service haemorrhages clients, with 60% of all referrals not completing treatment in 2017-2018,  Moller et al (2019) https://doi.org/10.1186/s12888-019-2235-z.  In this period a third (35%) of clients were given an unspecified diagnosis making the delivery of a NICE approved evidence based treatment impossible. The IAPT services claim to a 50% recovery rate, comparable to that in randomised controlled trials, is preposterous in this context.

Service providers, such as IAPT, are necessarily opportunistic and overstate the power of a simple and cheap mode of service delivery, thereby doing wonders for their power and bank balance. But clients are the losers, particularly those from disadvantaged backgrounds, Moller et al (2019) https://doi.org/10.1186/s12888-019-2235-z.

The rhetoric was that the Service would pay for itself because of the positive effects on employment but Moller et al (2019) have found no evidence of this https://doi.org/10.1186/s12888-019-2235-z.Employed: Start of treatment 316,604; end of treatment, 302,746; Unemployed and seeking work: Start of Treatment, 54,580; End of Treatment 49,803; Long term sick or disabled or in receipt of benefits; Start of Treatment, 43,275; End of Treatment, 43,671. Using IAPT’s own data for 2017-2018,  there is a 17% difference in recovery rate depending on whether the client was from the most deprived area , with a 41.0% recovery rate compared to a 58.1% recovery rate for the least deprived area.

 

Dr Mike Scott

 

 

2 thoughts to “IAPT’s Below Intensity CBT – Rhetoric vs Reality”

  1. More than once I’ve been told to discharge when a client has gone into recovery on the questionnaires, regardless of whether the client has met their goals and completely ignoring whether the person themselves actually feels they have made any progress. It all feels a bit mad.

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