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BABCP Response - NICE Consultation January 2022

IAPT’s Mistreatment Of Those With Medically Unexplained Symptoms (MUS)

in our paper published today in BMC Psychology, Keith Geraghty and I write of Improving Access to Psychological Therapies (IAPT) malpractice with MUS clients , see link  https://doi.org/10.1186/s40359-020-0380-2

A series of seven core problems and failings are identified, including:

  1. an unproven treatment rationale
  2. a weak and contested evidence-base
  3. biases in treatment promotion
  4. exaggeration of recovery claims
  5. under-reporting of drop-out rates
  6. a significant risk of misdiagnosis
  7. inappropriate treatment.

We concluded that:

There is a pressing need for independent oversight of this service, specifically evaluation of service performance and methods used to collect and report treatment outcomes. This service offers uniform psycho-behavioural therapy that may not meet the needs of many patients with medically unexplained health complaints. Psychotherapy should not become a default when patients’ physical symptoms remain unexplained, and patients should be fully informed of the rationale behind psychotherapy, before agreeing to take part. Patients who reject psychotherapy or do not meet selection criteria should be offered appropriate medical and psychological support.

Dr Mike Scott

10 replies on “IAPT’s Mistreatment Of Those With Medically Unexplained Symptoms (MUS)”

Hi Mike,

A big thank you to you and Dr Geraghty for this paper exposing the problems and failings of the MUS arm of IAPT. You make many excellent points. I’m confused on one issue though. It is my understanding that MUS patients/clients are treated differently from the other (the ‘generic’) IAPT clients. Instead of self-referring, I believe MUS clients are generally referred into IAPT directly by clinicians, and their level of entry and treatment is ‘matched’ by the assessors to the apparent severity of their ‘MUS’ rather than them following the ‘stepped care’ approach like others will. Thus it seems that their ‘MUS’ are being regarded as the mental health condition itself, the reason why they are there, (rather than them being treated for co-morbid anxiety or depression), and the outcome of treatment is measured according to how they score before and after treatment on their designated MUS scale – eg the Chalder Fatigue Scale for ME/CFS and the Francis Scale for IBS. (I’ve never seen any results of these outcome measures reported in the public domain, but I may have missed them. I suspect they could be submitted to NICE Guideline reviews though.) Anxiety and depression scores are collected for MUS clients too, and it appears that there is the potential for these anxiety and depression results to be transferred to the ‘generic’ IAPT set if one of the specific MUS outcome measure results is missing for some reason. That’s as I understand it from what I’ve read previously, but I may be wrong or IAPT or may have changed the way that it operates.

Really appreciate your work. It’s maddening that vulnerable patients have to spend so much energy countering extraordinary claims that lack any evidence, it’s good to have significant input from professionals.

My biggest worry is the impact this will have in people’s trust in expertise, especially in medicine. Creating a pseudoscience within medicine will be just about the best argument for pseudoscience zealots everywhere. This weird mind-body ideology and obsession over things like personality traits and thoughts and beliefs is just unhinged superstitious nonsense.

Following on from my last comment:

If IAPT are admitting that they haven’t collected, calculated and reported on any MUS-specific recovery data that has been collected by IAPT providers throughout the LTC/MUS pilot, then that represents a dismal failure of the pilot with respect to that group of clients, and IAPT has important questions to answer on this. While we might expect a pilot service/programme to have to iron out a few unanticipated problems, it would be shocking for it not to have rapidly secured the collection of specific recovery data for a key grouping. What has been happening here? Have NHS commissioners been informed of this apparent failure?

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