‘we can only deal with one problem, because that fits into the 6 sessions of therapy that we start with’, but the Improving Access to Psychological Treatments (IAPT) service makes no public declaration of this. Clients want a holistic approach in which all their problems are catered for. It is magical thinking to believe that a) a mental health problem can be resolved in 6 sessions b) the benefits gained from addressing the chosen mental health problem will, by a process of osmosis, resolve the other mental health problems. This represents delusional Organisational thinking, unfortunately I think it would take a lot more than 6 sessions to treat!
Recently I saw Ms X and she related to me her two sojourns through IAPT. I also had access to the IAPT correspondence, for confidentiality reasons, some of the details have been changed:
Five years a ago, Ms X found out that she had been adopted, she felt that she had never fitted in with her adoptive family, though they were kind. She felt that she had always been a ‘worrier’, her adoptive mum had chronic health problems and shortly after learning of her adoption she became concerned over any blemish on her skin. Ms X saw her GP and she advised self-referral to IAPT. She had a telephone assessment with a Psychological Wellbeing Practitioner and was advised that her PHQ-9 score was normal and her GAD-7 score at ‘caseness’. But no diagnosis was given. A letter from IAPT indicated that she ‘agreed to attend a worry management course’ but she said only a group programme was on offer. Ms X dropped out after attending one group session. Her GP had recorded that the treatment had not helped. I assessed her using a standardised diagnostic interview and it was clear that she had been suffering from illness anxiety disorder and general anxiety disorder (GAD) at the time of seeking help form IAPT and her diagnostic status was unchanged by IAPT’s ministrations.
Two years later she was at work, when her hair got caught in machinery at work causing a scalp injury. However the injury was under the hairline and not visible, but she could feel an indentation on her scalp. She developed a phobia about being around machinery leading to poor attendance at work and possible disciplinary action. The accident re-ignited her illness anxiety disorder that had been in remission for about 6 months. I noted that she continued to meet diagnostic criteria for GAD. Her GP advised self-referral to IAPT and she had a telephone assessment with a Trainee Psychological Wellbeing Practitioner, both PHQ-9 and GAD-7 scores were at ‘caseness’. No diagnosis was given. Ms X was told that they could only treat one of her problems and she chose her health anxiety concerns. She was placed on a 6 week waiting list for the Silver Cloud computerised CBT. During, the course of her cCBT she had 4 interactions with IAPT staff responsible for the smooth functioning of the Silver Cloud programme. They said that she was ‘depressed and anxious’ but gave no diagnosis. During treatment her specific phobia was not addressed at all. The diagnostic interview that I conducted revealed comorbid illness anxiety disorder and GAD but she was not depressed. She understood that there was to be a review of her progress at the end of cCBT to see what if any further help might be appropriate. This never happened. The Silver Cloud programme had no impact on her diagnostic status. IAPT’s treatment was ‘in the Clouds’.
This case raises important questions:
- Why was a minimalist intervention repeated when the first such intervention had not worked?
- Why are the least well-trained clinicians given the power to direct treatment?
- Why are the least well-trained clinicians given the power to re-direct treatment?
- Why is IAPT allowed to behave in a way that would not be tolerated in physical care vis a vis a focus on just one problem and continued management by the most junior clinician when treatment fails?
- Where is the publicly funded independent audit of IAPT?
Unfortunately, this is not an isolated case, my own review of 90 cases suggests just a 10% recovery rate Scott (2018) https://doi.org/10.1177%2F1359105318755264) . There has been a dereliction of duty by NHS England, Clinical Commissioning Groups and the National Audit Office. The British Psychological Society has rubber stamped whatever IAPT has proposed. The British Association for Behavioural and Cognitive Psychotherapy have become an IAPT mouthpiece, its’ journal CBT Today intolerant of dissent.
Dr Mike Scott
3 replies on “IAPT’s Hidden Agenda”
I live in Newcastle and had suffered stress and anxiety for most of my life due to a psychologically and physically abusive childhood and a none existent teenhood. I trained in and passed as most improved recruiter lost to be second by 1point to be best recruit, I had physical skills the other didn’t have. My parents refused to do rites of passage, school photos refused 16/18and21st birthday not acted on, my recruits course wasn’t acted on.I refused a public giving of my service medal. I felt unloved and was kicked out after a camping weekend aged 16. I got sent fir cbt .it made me worse and frustrated me .being told what I can and can’t talk about made me ill. I’m sure I was labrat as I repeatedly said no cbt. But still had it. I met one councillor and she said to my face she wasn’t going to do what she was told as I was a human being.she had turned up late and i had saw her in the car park when she said this. I had 2 s sons she was good but I didn’t go back because I got work in a Butlins. I saw a professor in psychology and he said I was too intelligent and that CBT would make me worse. I know I was depressed. My notes from 2012 was full of low mood and-anxiety states but no depression put. I’m studying Mh since I had psychosis. And people are still pushing cbt and the t makes me full of rage now, it’s a trigger. A jobs coach tried to push it on me but took me off her books when I stated that she had no right to public ally abuse me as negative and say I had a bad attitude for not taking precarious work .DWP job coaches are forcing it on job seekers. I quoted human rights and they took me off their books. There’s years of this but I don’t have space to tell my story
Why are the least well trained clinicians given the power to direct or redirect treatment?. That’s a very good question I asked myself for a long time without being able to come up with a meaningful answer. Let’s try
IAPT model is based on an economical model which fits in well with neo-liberal capitalist societies. The service is based around the needs of the service not around the needs of the patients. And this rampant model will infiltrate deeper more through all structures and services of the NHS following the new NHS Bill.
The first interventions at step 2 are the cheapest ones: digital solutions, guided self-help provided by PWP the least trained in the service .They are the ones who provide the first screening, high volume and low intensity interventions . If that does not work or the patient requests (is able to request) more support they will be escalated to step 3 with more trained therapists but who are much less in number. Bringing attention onto some PWPs errors of clinical judgement is not well received in my experience. The general understanding is that PWPs are young individuals who are learning and therefore allowed to make mistakes. The opposite will apply to the well trained therapists workforce as a matter of course.
IAPT services are very flawed system but nothing so far has replaced it.
It’s just one aspect of the general inappropriateness of the whole NHS medical structure. Patients need multitalented teams of medical consultants, social services and educational and career advisors, in addition to counselling on problem solving. But we have to diagnose ourselves first, in order to be sent to exactly the right consutant for our problem, although it is only accidents that are likely to require just one or a few specialities, to get a person back to health and normal levels of activity. I’ve been out of action for around 35 years, and it is entirely because I go round and round in circles, because no consultant is allowedto tresspass ontoa part of thebody that is not in their speciality: so people with illnesses that cross artifician NHS created boundaries, can never meet anyone in a position to make a diagnosis. Instead, the trend is to blame the patient and send them for brainwashing by CBT, even though that is just plain insulting to the inteligence of the majority of people who have not been brainwashed into believing in CBT miracle cures themself!
What the woman in the case report actually needed, was to talk to citizens advice, and to the health and safety at work excecutive, in order to sue her employer for damages, and to get the unsafe premises shut down until the machinery was made properly safe. Once she has some compensation money in the bank, and is receiving the social help she needs, she will probably feel a whole lot better!