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Stopped Care Replaces Stepped Care in IAPT

over 70% (73.3%) of the Improving Access to Psychological Therapies (IAPT) clients are offered low intensity treatment (such as computer assisted CBT, group psychoeducation or guided self-help) first, and only 4% (4.1%) are then stepped up to high intensity treatment. The first transition appointment is the least well attended [ Davis et al (2020) https://doi.org/10.1136/ebmental-2019-300133]. 

IAPT clients haemorrhage from the system at the outset, 40% of first appointments are missed and 42% of clients attend only one treatment session. But IAPT’s claimed recovery rate of 50% applies only to those who complete two or more treatment sessions. The suspicion is that real world recovery rate is much less. Examination of the trajectory of 90 IAPT  clients using a gold standard diagnostic interview [ Scott (2018) IAPT The Need for Radical Reform, Journal of Health Psychology https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0.] suggests only the tip of the iceberg recover.

A small proportion of IAPT clients (16.4%) are offered high intensity first. The IAPT Manual recommends that this should occur for clients suffering from PTSD, social anxiety disorder or severe depression.  But offers no reliable methodology for deciding who is in what category. The agency claims it does not do ‘formal diagnosis’. 

 

How are clients to be directed to appropriate care?

 

Dr Mike Scott

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