but as anyone knows who has copied a fellow pupil’s homework, this can end in tears! The Service believes, it disseminates ‘best practice’ by networking clinicians together. But there is no evidence that this is the case.Those most vocal or most eminent are likely to hold sway. Ensuring the dominance of eminence not evidence-based treatment. This runs the risk of creating a totalitarian culture in which it is not possible to express a dissenting opinion. The power-holders then control what is published in journals/publications. But like the Russian regime of the 1980’s they would vigorously protest that they are engaged in Glasnost (0penness).
The use of artificial intelligence in mental health is an exemplar, ‘par excellence’ of copying. The authors of IESO claim that its interactive text messaging service for clients, is based on the careful selection and analysis of client-therapist exchanges and that they have determined what works. If indeed this were the case it would make the provision of mental heath services much cheaper for the NHS (as well as making a nice profit for IESO). But no such reliable database with real-world outcomes e.g being free of a disorder as assessed by an independent observer for at least 8 weeks, has been determined.There are no published papers to substantiate a real-world effect. Without fidelity checks there can be no assurance of the translation of an evidence-based treatment to routine practice.
I recently read James Davies’s book Sedated: How Capitalism Has Created the Mental Health Crisis, (2021) Atlantic Books, without necessarily buying into his thesis that Capitalism is the arch-enemy, it is certainly the case that financial factors ( NHS Talking Therapies cost the taxpayer £ 2 billion a year), coupled with the opportunity to exercise unbridled power has produced a dysfunctional mental health system. But the problems are not confined to primary care, I recently saw a client who has had 4 years of secondary care treatment in relation to child abuse, the records revealed no objective audit. This echoes the National Audit Offices failure to provide any credible independent assessment of mental health services. There is an inherent believe that the mental health services must be all too the good because the clinicians are well-intentioned. But if they had stopped long enough to listen to my client he would have told them ‘I need a new approach, I have plateaued’. In reality there is no Glasnost. Let’s no be copy-cats.
Dr Mike Scott
4 replies on “NHS Talking Therapies Proceeds by Copying”
I work for talking therapies. I’ve just received a document with my patients feedback in for last year yfor how treatment was for them. While I agree none of this is perfect by any means, but the feedback in that document was nothing like the picture that you constantly paint here on your website. Of course it’s not going to work for everyone, nothing does. But it can and does change some lives for the better. I find what you write very interesting but it seems to come with much repeated vitriol that does not reflect the reality of the actual experience of many many people receiving the therapy.
I have no vitriol regarding NHS talking therapies. Over the past few years, I have simply presented the data on the effectiveness of the service, which shows a tip of the iceberg recovery rate. Prior to 2015, I had no objection to Iapt, but in my early books, I simply thought that it wasn’t the right way to go, but it was nevertheless, a credible experiment. But when I collected data on 95 clients of the services, treated either before or after personal injury, the results were dismal. I collected the data in the context of an expert witness to the Court for which diagnostic reliability and objectivity are paramount. I have simply gone were the data has lead. I don’t doubt that clinicians are well intentioned and clients often perceive them as helpful but they are rarely returned to their best functioning. Clinicans understandably want to feel that they are doing a good job, and I applaud their trying alas the data suggest there are fundamental problems. A forthcoming paper ‘Thanks, But No Thanks’ underlines this using further data.
I think simply going where the data has led you is equally a ‘proceeding by copying’ approach. The data that is pumped out we know is flawed. Patients don’t use the MDS accurately, they often complete it at the last minute before a session and then report the scores not being reflective. And often report feeling much better than when they started treatment. The data itself and the data collection is surely flawed and not fully reflective of all service users experiences as the previous poster mentioned. Does your ‘thanks but not thanks’ paper follow any other data?
The only data that counts, is that which reflects real-world consequences. The randomised controlled trials of CBT focussed on recovery from a disorder as assessed by an independent observer using a standardised diagnostic interview. As such it was reliable data. I used the same methodology, ‘gold-standard’, for the Courts in my assessment of the effectiveness of IAPT tretment. By contrast NHS Talking Therapies has played with numbers, by alleging that changes in scores on a psychometric test are a reliable guide to recovery. Change in test scores with time, would not stand up in Court, as there are numerous alternative explanations including placebo effect, regression to the mean and a desire to please. One has to follow the data but first ensure that it is reliable data. In my ‘Thanks, But No Thanks’ paper I look at the neglected area of those who attend only one assessment/treatment session.