IAPT’s Sojourn Into The Quagmire

Putting patients with medically unexplained symptoms, such as CFS (chronic fatigue sundrome) and IBS (irritable bowel syndrone) on a mental health pathway, is a fraught endeavour, can there be any certainty that physical investigations of their difficulty will continue? Who will provide that certainty, surely not IAPT( Improving Access to Psychological Therapies) workers? Perhaps GP’s or gastroenterologists – doubtful?

 IAPT’s focus is on psychological interventions, most patients with long term physical conditions will find it incongruous to be offered a mental health intervention, unless there is a clear additional problem such as panic disorder. There is a danger that those with LTC’s will feel the normal emotional distress associated with their long standing problem is being psycho-pathologised.  

Whilst some with LTC’s may wish to avail themselves of psychological help, many will do so at the behest of a GP or gastronetrologist, believing that they would not be suggesting it, if it were not evidence based. Yet there is in fact a weak evidence base for CBT for these conditions compared to that which obtains for the anxiety disorders and depression.

Psychological interventions in the LTC area serve to distract from improving the poor quality services in areas in which CBT could make a real world difference. Rather they have a novelty value and attract funding/empire building.

Dr Mike Scott

44 replies on “IAPT’s Sojourn Into The Quagmire”

When the purpose of IAPT for MUS and LTC patients is to reduce physical healthcare costs including secondary care appointments and investigations (in order to pay for the IAPT programme), I think we can be quite confident that when patients are put onto the mental health pathway their physical healthcare will be curtailed, or at very least pressure will be brought to bear for it to be reduced. For MUS patients, a delay to referrals and investigations could be dangerous. Of course, some patients with LTCs may benefit from psychological therapy and it could also help them to manage their conditions more effectively, so reducing subsequent healthcare costs, but others may not appreciate this intrusion or added strain in their lives. The IAPT LTC/MUS Pathfinder Evaluation Project Phase 1 showed that subsequent healthcare costs for these patients did not reduce by giving them this therapy, and yet the IAPT roll-out is now targeted predominantly at LTC and MUS patients to presumably try to recoup the costs of the whole IAPT programme. IAPT’s own evaluation project suggested that patients were still utilizing physical healthcare at around the same level after therapy. ( see [PDF]
IAPT Providers Network 7 February 2018 – Yorkshire and the Humber … page 86 of 111 , and [PDF]
VLE – Frequently Asked Questions – UEA page 45 of 61 )

From information available online, it appears that on Wednesday 7 February 2018, Ursula James, IAPT’s Programme Manager, delivered a presentation entitled “National IAPT Programme Update, Key Themes for 2018/19 and Q&A” to the Yorkshire & Humber IAPT Providers Network. From the accompanying slides also available online, I’d hazard a guess that the ‘Q&A’ bit referred to “Recent Q & A’s from Claire Murdoch’s webinars”, Claire Murdoch being NHS England’s National Mental Health Director. These Questions and Answers seem to relate to the work of NHS commissioners, suggesting that Murdoch’s webinars were aimed at NHS commissioners, or at least perhaps that commissioners were among the attendees. It’s worth reading Q5 and the accompanying answer provided in Ursula James’s presentation – [PDF]
IAPT Providers Network 7 February 2018 – Yorkshire and the Humber … (page 86 of 111).

My interpretation of this particular Q&A was that it was being suggested that commissioners should consider ‘some disinvestment’ in physical healthcare services (at their own risk) on the basis of ‘early findings’ and ‘anticipated savings’ in relation to reductions in physical healthcare usage from IAPT delivered to LTC patients. If so, this would seem a wholly irresponsible/reckless thing to suggest when the IAPT evaluation project reported that patients were still utilizing physical healthcare at around the same level after therapy. But isn’t disinvesting in physical healthcare services on the basis of ‘anticipated savings’ derived from ‘early findings’ a reckless approach to take anyway? Is this what happens when a business model is applied to a crucial public service? Act first, concrete evidence later? I’d be interested to know what other people think.

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