‘Overall, How Satisfied Were You With Your Talking Therapy?’

on a scale 0-10, with 0 indicating ‘Not at all satisfied’ and 10 meaning ‘Very satisfied’. GP’s asking such a question of Improving Access To Psychological Treatments (IAPT) clients would be in a position to to advise local Clinical Commissioning Groups of the results of their audit. There could then also be comparison of results across CCGs. The same audit question could also be asked of the clientele of private providers and secondary care. Newspapers and the media could ask the same question of IAPT clients. It could also be a project for  intercalating medical students.

Admittedly this brief audit is not as good as an independent publicly funded inquiry into the proportion of IAPT clients that lose their diagnostic status with treatment. But such an inquiry is extremely unlikely because of vested interests, despite the spending of £4billlion of the taxpayers’s money on IAPT. Support for IAPT is eminence based not evidenced based.

Richard Layard, a prime mover in IAPT illustrates this eminence base in the following extract  from his recent book ‘Can We Be Happier? Evidence and Ethics’ (2020) Penguin:

‘The book I wrote on Happiness (2005) clearly struck a chord and was translated into nineteen other languages. But I wanted to apply it in practice, so I asked Ed Miliband if I could write a paper on mental health for Gordon Brown. Instead it became a paper for the No. 10 Policy Unit. It was written with help from my wife and presented at a Cabinet Office seminar in January 2005. The key figure at that seminar was David Clark. One of the world’s leading clinical psychologists, David is also an incredible persuader and organizer, who since then has devoted his life to creating the Improving Access To Psychological Treatment’ 

and in Towards a Mental =Health System That Works London: Routledge (2017)  I wrote

Seligman (2011) also quotes a conversation with Lord Layard (a House of Lords Peer) in which the latter told him that in order for an enterprise to get government backing it was not necessary to prove unequivocally that something worked (in this instance Positive psychology) for it to be adopted, as this watermark was almost never achieved, but that a combination of sufficient evidence and political will was enough. Seligman reports that he was much encouraged by this advice. However, I will argue later that this lowering of the bar of the burden of proof has led to the UK Government’s continuing endorsement of the Improving Access to Psychological Therapies Programme fuelled by the prime movers behind the inception of IAPT, Layard and Clark (2014).

But ethics involves honesty, where is the honesty in not mandating an independent evaluation of a service that you have been instrumental in?

Dr Mike Scott