IAPT acts with impunity, as there is no feedback to IAPT as to how clients have fared in the medium to long term. Clients are discharged as soon as their PHQ-9 dips below 10, whatever the diagnosis. IAPT continues in blissful ignorance, likely mistaking a short term placebo effect for true recovery. The problem is systemic, the abscence of a feedback sanction, making IAPT incapable of learning from mistakes.
‘For any system to function efficiently, it needs to know the outcomes of specific actions in a consistent, reliable, and expeditious way’. Pat Croskerry (2000) The Feedback Sanction see link below:
GPs could put to patients initially referred to IAPT the question ‘Since IAPT are you back to your usual self? For how long have you been back to your usual self? An 8 week period of back to usual self would be indicative of recovery, shorter than this it is likely to be the natural variation in symptoms observed by Bruce et al (2005)] see link below:
For those with a negative response the following clarifying question could be asked:
“Compared to how you felt prior to IAPT treatment, how would you rate the symptoms for which you sought treatment during the past week?
1= substantially worse,
2 = moderately worse,
3 = slightly worse,
4 = no change,
5 = slightly improved,
6 = moderately improved,
7 = substantially improved)”.
The GP’s response endorsement of a response would be based on the totality of their understanding of the patient’s functioning not just the client’s verbal report. Perhaps classifying patients whose symptoms were rated as “substantially improved” or “moderately improved” as treatment responders. This would be independent assessment of IAPT’s performance and one that could be fed back to the service. A GP conducting such an audit on IAPT clients could present it as part of their professional appraisal. But a GP could similarly audit secondary mental health care.
GP’s are the nearest to advocates for their patients, unless they perform this function with mental health services, patients will be like 17th Century defendants in the legal system without representation, pawns in an overwhelming system. It is time to move on from this to representation in a 21st century health service.
Dr Mike Scott