‘Psychometric Testing In Clinical Settings’ – contains a devastating critique of IAPT

this is the title of a Chapter, by Hamilton Fairfax in a book ‘Psychometric Testing’ edited by Barry Cripps in (2017) and published by John Wiley. Fairfax pulls no punches, on the over interpretation of a psychometric test score:

‘These concerns are increased when organisations place value on such scores, and base commissioning and service decisions on them away from the clinical context. Increasingly, such decisions by NHS and private health care providers are made by individuals who are either not familiar with the specifications of services or not sufficiently trained clinically or methodologically to understand the information they are provided with. Instead they are under pressure to ensure services are economically viable; the attraction of a number that purports to measure improvement is obvious. It is possible to manage mental health services in a way that would not be permissible in banking, the military or food production.

One risks accusations of arrogance or pomposity if one’s critique of a management decision is based on the manager’s lack of awareness or training. A strange and unintended consequence of EBP (evidence based practice) is that it provides a heuristic for the uninformed to speak with authority in a way in which many of us would not speak to a mechanic just because we had read a car manual. Stating that something is ‘evidence-based’, whether or not the person knows much about the area being discussed, is often seen as sufficient. It is dangerous to base policy and the survival of clinical services on this level of insight. In outlining this position I do not want to demonise managers or create an equally unhelpful heuristics. Many are well informed, with good clinical experience, but their roles have increasingly alienated them from the realities of practice. Demand and the pressure to be more effective can diminish flexibility and creative thinking, leading to a reliance on quick information such as numbers and ‘evidence’. I speak from personal experience and am aware that these pressures only increase with more responsibilities’.

Hopefully we can manage a better New Year

Dr Mike Scott

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