IAPT – Discrimination and Incredulous Claims

Dr Michael Kelleher, a Consultant Addictions Psychiatrist, interviewed in next months Psychologist has claimed ‘some IAPT services exclude patients that use or have used alcohol until they are many months post abstinent. This is contrary to positive practice guidelines that the National Treatment Agency brought out’ . He continues ‘if people get detoxed they shouldn’t have to wait an arbitrary length of time to be sober before they can have psychological therapy. They should be able to flow into an anxiety or depression programme straight away once a detox is completed’.

IAPT data on 16,723 clients in the North East of England, Boyd, Baker and Reilly (2019), see link below, suggests that the Organisation is superb at spurning those with an alcohol problem,

https://www.dropbox.com/s/q1120m0cbvqb882/IAPT%20Stepped%20care%20model%202019.pdf?dl=0

over a 4 year period the proportion of clients treated with ‘a mental and behavioural disorder due to alcohol use’ never rose above 0.1%, ( 1, 1, 4 and 3 people in successive years). By contrast the proportion with ‘mixed anxiety and depressive disorder’ was 26.8%, 30.5%, 30.1% and 39.6% over the four years.

Dubious Recovery Rate

The North East IAPT service claims a recovery rate of 40-49%, depending on which years are considered. With between a quarter and half of clients categorised as ‘mixed anxiety and depressive disorder’. However the IAPT Manual cautions against the use of the ‘mixed anxiety and depressive disorder’ label thus:

‘The ‘mixed anxiety and depression’ problem descriptor (ICD-10 code) should not be used unless the person’s symptoms of depression or anxiety are both too mild to be considered a full episode of depression or an anxiety disorder. Inappropriate use of the ‘mixed anxiety and depression’ problem descriptor may mean that patients do not receive the correct NICE- recommended treatment. For example, if someone has PTSD and is also depressed they should be considered for trauma-focused CBT as well as management of their depression, but this may not happen if they have been identified as having ‘mixed anxiety and depression’.

Given the common usage of an unreliable ‘mixed anxiety and depression’ label, is it at all credible that the recovery rate should approach IAPT’s claimed national average of 50%? It looks like massaging of data for public consumption.

Choose The Right Clients For Performance

The IAPT Manual published a year ago, see link below:

https://www.dropbox.com/s/pgmbsoqjqmq04qz/IAPT%20Manual%202018.pdf?dl=0

clearly and rightly, states that it would be inappropriate for IAPT staff to provide therapy for clients who arrive at a session intoxicated. But delaying treatment once detoxified, smacks of special selection so the agencies performance figures look good – akin to a school selecting the brightest pupils in the area.

Studies generally show that the prevalence of depression and adjustment disorder are about the same, and psychiatrists diagnose them as often as each other, but curiously over half of IAPT clients in the Boyd et al (2019) study are declared to have depression but the prevalence of adjustment disorder doesn’t rise above 0.6% in any year! Either IAPTs population is incredibly skewed or there is no reliability at all in their diagnostic labels, such that therapists don’t have a clue what they are treating!

Non-Declaration of Conflict of Interest In IAPT Studies

IAPT staff have a penchant for not declaring conflicts of interest in published papers, in the Boyd, Baker and Reilly (2019) paper it is written ‘The authors have declared that no competing interests exist’ , but the lead author presenting at a Conference in Amsterdam in May 2016 is described thus:

Lisa Boyd, IAPT service, Tees Esk and Wear Valley Mental Health Trust, UK Impact of a Progressive Stepped Care Approach in an Improving Access to Psychological Therapies Service: An Observational Study

Dr Mike Scott

CBT for Addictions – As Likely As Winning At Roulette

There has been an outbreak of smashing fruit machines in Liverpool: this week a man was given a 12 month suspended sentence for wrecking a well known Bookmakers machines, he protested that they were not helping him overcome his addiction! This followed hot on the heels of the brilliant fictional TV series ‘Broken’ (filmed in Liverpool) which showed identical behaviour in the wake of the suicide of a gambling addict.

A person I saw recently Mr X ,with a lifelong gambling addiction told me that the longest period he had been without gambling was when he bet a fellow gambler who would last longest, he lasted 2 weeks. Sadly his experience of IAPT was woeful he was introduced to the discredited stop technique to distract himself when he had the urge to gamble.  He said that he had a few sessions with the therapist but the therapist left and he was given a new therapist.  Mr X said that a questionnaire was then administered and because he got below certain thresholds it was deemed that he did not need counselling and the therapy was terminated.  He said that he was alarmed at this because he felt suicidal and he wrote a letter of complaint and was then offered further sessions but declined them because he had lost trust in the enterprise.

Addiction services have been managed by local authorities since 2012 , but with typical cuts of 30% many services struggle. People can fall between services as a tender is often times switched after 3 years.