Moving The Goalposts So That The Cheapest Talking Therapy Option Always Wins

Managerial goals have been scored for the last decade by putting the focus on numbers, waiting lists and the brevity of therapeutic contact. Couple this with capitalising on:

a) the passage of time – people are likely to present at their worst

b) people’s desire to please the provider of any service face to face

c) people’s need to feel they haven’t wasted their time

This ‘capitalisation’ comes to pass by the client completing a psychometric test, such as the PHQ9, in front of the therapist. Enabling the Improving Access to Psychological Treatment (IAPT) provider to claim effectiveness to its NHS funders the local Clinical Commissioning Group. 

My own CCG, Liverpool, is top of the league in gullibility (should have kept to football). Last Autumn, Talk Liverpool claimed an 87% recovery rate. I protested in writing to the Chief Officer of the Liverpool LCG, that this is a preposterous claim, as it would mean that Liverpool Improving Access to Psychological Treatment  (Talk Liverpool) were well exceeding IAPT’s claimed national average rate of 40-50% and the recovery rates in randomised controlled trials. The Chief Officer of the LCG did not even have the courtesy to acknowledge my letter. The Liverpool Echo asked the CCG about the discrepancy in the recovery rates and their representative told them that it was a 40-50% recovery rate. It is difficult to belief that the LCG had not been influenced by the claimed recovery rate in funding Liverpool IAPT to the tune of £10 million this financial year. It is a fine line between extraordinary claims and fraud.

It is cunningly hidden from CCG’s that most clients are offered a ‘cost’ saving low intensity treatment, such as guided self-help, a group or computer assisted cognitive behaviour therapy, only a minority actually get a psychological therapy. CCG’s seem blissfully unaware that none of the randomised controlled trials (rct’s) of the utilised low intensity interventions go anywhere near meeting the requisites of the CONSORT checklist, in particular there is no blind independent evaluation and the researchers are investigating the effectiveness of their own developed materials.

Dr Mike Scott

 

2 thoughts to “Moving The Goalposts So That The Cheapest Talking Therapy Option Always Wins”

  1. 87%! I laughed out loud when I read that.
    I wonder what the percentage would be if repeated the MDS a fortnight later with those 87%.

    1. The Talk Liverpool claim is off the scale for absurdity, but it is also tragic. I see only the tip of the iceberg of IAPT clients making a meaningful recovery. If this was the case with cancer or cardiac patients there would be a national outcry. The media and public figures are delighted with IAPT’s propaganda, ducking any critical appraisal. They don’t even smell a rat when told there has been no publicly funded evaluation, despite £4 billion being spent on IAPT, who are left free to mark their own homework.

      Mike

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