BABCP Response - NICE Consultation January 2022

Problem Descriptors – A Confusing IAPT Signpost Leading to Crashes

‘ I think it is social anxiety disorder, from my problem description my manager thinks its’ generalised anxiety disorder’  should treatment be determined by the power holder or should they just spin a coin with a ?50% chance of the client getting the right treatment. Such is the soap opera acted out in IAPT.

IAPT uses problem descriptors to determine what treatment to give to whom. But problem descriptors are a rule of thumb to determine treatment. In randomised controlled trials treatment was based on a reliable diagnosis, which would typically take an hour or more to determine. IAPT has come up with a problem descriptor shortcut of undetermined reliability and which it seeks to legitimate by asking therapist to provide an ICD-10 code.

The IAPT Manual considers it best practice if a service provides an ICD-10 code for at least 80% of cases. Can it be acceptable for up to 1 in 5 people to have rudderless treatment? When clients are assigned an ICD-10 code it is usually a single code and a Manager may advise that a another code is appropriate rather than the one the clinician selects.  Whilst the IAPT Manual advises that more than one code can be appropriate, it also advises that treatment should be dictated by the principle problem, this likely has the effect of making for single awards of ICD-10 codes.

The IAPT Manual claims that ICD-10 codes are the basis of the NICE recommended treatments, but they are not. Most of the mental health trials considered by NICE are based on the more reliable and stricter DSM criteria. Notwithstanding this ICD-10 provide diagnostic criteria for each disorder, but IAPT also contends that it does not make diagnosis. It is therefore difficult to escape the conclusion that IAPT pays lip service to ICD-10 codes for its’ own credibility.  Despite this the IAPT Manual insists that the treatment protocol should follow the identified problem but the protocols have never been matched to problems but to disorders!

Dr Mike Scott


26 replies on “Problem Descriptors – A Confusing IAPT Signpost Leading to Crashes”

Like most services we do an initial telephone assessment taking around 45 minutes. I was speaking to a senior colleague who told me the purpose of this assessment is for the client essentially to tell their story, and for therapist and client to come up with an agreed description of the problem(s) broken down into ‘typical’ thoughts, emotions, behaviour and physical responses. This strikes me as ripe for misunderstanding and ambiguity, as you say Mike probably often resulting in the wrong treatment for a disorder the person doesn’t have. For example in my experience it is not uncommon for someone who is depressed to describe thoughts and emotions associated with anger, this is a symptom their depression – based on the initial assessment process as it stands currently there is a danger of the person being signposted to something like anger management. The initial assessment procedure urgently needs a revisit and review.

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