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NHS Talking Therapies-Sham Monitoring

The most recent edition of the IAPT Manual, February 2023   states that over 98% of clients completed two psychometric tests at the beginning and end of treatment. This sounds like pretty impressive monitoring of outcome. But less than half of clients (46%) complete treatment, defined as attending two or more treatment sessions. There is a deafening silence from NHS Talking Therapies about the dropouts. Most plausibly half of clients are voting with their feet before treatment begins.

Therapist use the test results to demonstrate to managers that they have achieved the necessary 50% recovery rate with clients. Failure to achieve this target can result in sanctions.  It is therefore not surprising to find, as Faija et al (2022) did, that there is considerable variation in the way in which clinicians ask the questions on the tests and in the proffered response options. These authors found that the ritual completion of two tests (PHQ-9 and GAD-7)  at the beginning of each session was regarded by clinicians an encumbrance and that it had no bearing on the treatment session. For managers and NHS Talking Therapies the data is nevertheless pressed into service as  propaganda.  This extensive database is meaningless.

 

The questionnaires measure the severity of depression and generalised anxiety disorder. But NHS talking therapies clinicians do not make diagnoses. So that the tests are de facto administered in a vacuum. The data are no more meaningful than same tests completed by attenders attenders at a shopping centre or at a GP surgery. By themselves they betoken nothing at all. It can be expected with repeated completion of the tests, in whatever context, scores will come down as people remember previous scores. Announcing as NHS Talking Therapies does that the improved scores indicate recovery from a disorder, is nonsense. Matters become even more bizarre when the Service implies that its’ ministrations have played a pivotal role in the recovery. 

Monitoring is an expected part any professional activity, whether it be in an operating theatre or on a plane. It is understood that those charged with monitoring will be able to give feedback to the active players if anything is amiss. Whilst there is an authority gradient between the latter and former, this is not allowed to hold sway. But it is very different in NHS talking therapies the clinician has no means of open dialogue with managers or the Organisation. It is despotic rule. The client is a pawn in a game with combatants of different agendas. 

Dr Mike Scott

69 replies on “NHS Talking Therapies-Sham Monitoring”

I’m currently in hospital and in patient staff have been brilliant, I’ve not really seen the psychologist much but the respiridone is working really well for me and if I want to talk to staff they make the time. The problem I find is when we are not in patients the support just drops off and I have 0 trust in crisis team or cahms but have got on with the hospital staff who have treated me like a human and frankly have made my stay here feeel safe welcoming and even had my laughing muscles working something I haven’t had for years . Id like to say a public thankyou to all the staff from domestics , physio, gym staff , nurses, drs and support staff . You have all been brilliant. I know I talk to much( the result of sitting in my flat since my friend died march 2021 and having no one who cared. My neighbours helped with my cat too. So thankyou all and thanks to dr Scott who is trying so hard to address the wrongs of greed in mh medicine 

Good that Hospital is working out. I think the problem is more to do with Care in the Community, a noble idea and worth striving for, but there is so much ticking boxes and really listening is scarce, with a lot of vested interests.
Take good care of you
Mike

Exactly the privatised care in the community is not good at all. I just did a lovely pay it forward day bought a Chinese lady and a very old lady some shoes socks n slippers and the staff some sweets and fruits. Honestly it was the best fun I have had in a while.  I know exactly what you are saying  and I respect your fight .The community care is failing because if people don’t have family there is no witnesses to their behaviours towards us. Being kind and polite goes both ways. Id let you see my notes and you would understand what is happening to female middle aged diagnosed autistics and how we got treated in the gp and community.  But I have seen a vast change in care and transporting since I kicked off 4 years ago. They might not like me at the top of CNTW  but I believe I make or made a differences  as transport mode,  laundry stuff and bringing ill mh patients to the wards when we crack up has vastly improve. Id like to see research and support for adult diagnosed men and woman adhd and autistics. The gov knows we were mistreated and I’m sure many psychologists do. It’s a question of the patients trying to forgive and. The way I was and have been treated in St George’s has enabled me to get past that block. However I’m still worried of what happens when I get out. I owe my neighbours downstairs who looked after my cat.  Keep fighting the good fight respect to you and your team
Maria Nelson 

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