Tag: BPS

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BABCP Response - NICE Consultation January 2022

BBC Chooses To Ignore Talking Therapies 10% Recovery Rate

this morning BBC Radio 4 focussed on the problems caused by the Improving Access To Psychological Therapies (IAPT) long waiting lists (half more than 28 days)  but reiterated IAPT’s claim of a 50% recovery rate. But IAPT has only ever marked its’ own homework on recovery rates. I spent hours explaining to Radio 4 reporters that the true recovery rate is more likely 10% as detailed in my paper published in the Journal of Health Psychology last year, but they totally ignored this – shortening waiting time for something, that is most likely to be ineffective approaches pointlessness:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

billions of £s have been spent on IAPT over the last decade all without any publicly funded independent assessment of outcome, this would never have been permitted in evaluating a drug. NHS England claimed IAPT has exceeded expectations , but can cite no independent evidence. NHS England have failed the public in terms of accountability. There are so many vested interests in IAPT that the great majority of patients are likely to continue to be short changed. The yardstick has to be the proportion of people who get back to their old selves post-treatment, my study of 90 IAPT clients found that only the tip of the iceberg recover. NHS England need to commit to a publicly funded independent assessment of IAPT using real world outcome measures such as loss of diagnostic status for at least 8 weeks.

There is a troubling alliance of powerholders BBC, IAPT, BABCP and BPS that is ignoring the real needs of those with mental health problems.

 

Dr Mike Scott

  

Categories
BABCP Response - NICE Consultation January 2022

IAPT’s Eventual Implosion

there are no limits to IAPT’s ambitions, making failure inevitable. IAPT’s target in practice is, “whatever the client complains of” and treatment is operationalised as “whatever its’ therapists do”, Both focii are so loose that it cannot fulfill it’s promise, like a totalitarian revolution that runs out of steam.

The IAPT Manual published a year ago leaves both targets and treatment ‘fuzzy’, whilst proclaiming a commitment to NICE Guidelines. A target of ‘client complaints’ makes no distinction between ‘ disorder’ and everyday unhappiness/stresses. Yet the treatments advocated by NICE are quite specific to disorders.

At most IAPT staff ask about some symptoms of a disorder, but without coverage of all the symptoms of a disorder. But they are not taught to ask whether a symptom is present at a clinically significant level, i.e whether it is making a real world difference to a client’s life. Only clinically significant symptoms count in DSM. As a result IAPT client’s are typically treated for disorders they don ‘t have, without any fidelity check on compliance with a protocol.

There is tremendous vested interest, financially, emotionally and intellectually in IAPT continuing as it is, marking its’ own homework with applause from BABCP and the BPS.

Dr Mike Scott

Categories
BABCP Response - NICE Consultation January 2022

CBT Researchers Have Abandoned Independent Blind Assesment – Beware of Findings

I have been looking in vain for the last time CBT researchers assessed outcome on the basis of independent blind assessment, which was a cornerstone of the initial randomised controlled trials of CBT.  Current CBT research is more about academic clinicians marketing their wares. Journals such as Behaviour Research and Therapy and Behavioural and Cognitive Psychotherapy and organisations such as BABCP and BPS are happily complicit in this. The message is give a subject a self-report measure to complete, it is less costly than expensive highly trained independent interviewers blinded to treatment, forget about the demand characteristics of a self-report measure ( a wish to please those who have provided a service) and don’t worry if the measure does not accurately reflect the construct under question. My psychiatric colleagues might be forgiven for saying that at least the trials of antidepressants have usually been double blinded, if since the millennium CBT studies have rarely managed to be single blinded, is it time the CBT-centric era ended? But purveyors of other psychotherapies have even more rarely bought into the importance of independent blind assessment.

The overall impact of inattention to independent blind assessment is that the case for pushing CBT is actually not as powerful as the prime movers in the field would have us believe, this may actually be a relief to struggling practitioners. For example Zhu et al (2014) [Shangai Arch Psychiatry, 26, 319-331 examined 12 randomised controlled trials of CBT for generalised anxiety disorder in which there was supposedly independent blind assessment  but in 6 of the 12 studies the main outcome measure was based on the results of a self-reported scale completed by the client (i.e outcome was not actually assessed by the blinded assessor) and concluded that the quality of the evidence supporting the conclusion that CBT was effective for GAD was poor. A meta-analysis of outcome studies  conducted by Cuijpers (2016) World Psychiatry, 15, 245-258 found that using criteria of the Cochrane risk of bias tool only 17% (24 of 144) rct’s of CBT for anxiety and depressive disorders were of high quality. Cuijper et al concluded that CBT ‘is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still
uncertain and should be considered with caution’. Only half the studies had blind assessors and it is not clear whether they were the determinants of outcome or a client completed self-report measure, the study needs further analysis. My impression is that the weakest of studies are those examining guided self-help, computer assisted CBT, (the step 2 interventions in IAPT) yet these interventions are most commonly offered.

Dr Mike Scott

Categories
IAPT

National Audit Office IAPT Investigation, Whistleblowers

Below is the National Audit Office’s request for evidence re: IAPT, I note they have a whistleblower’s policy. It may be possible to ask for anonymity. I would hope that BABCP and BPS would make a submission to the National Audit Office, but to my knowledge this is not on the agenda of either, why not?

Investigation: Improving Access to

Psychological Therapies performance data

Scheduled Autumn 2017
Sector
NAO Team Director: Jenny George

Audit Manager: David Raraty
Media contact Angharad Thomas
Direct line: 020 7798 7208 Mobile: 07985 274421 Email: pressoffice@nao.gsi.gov.uk

The ‘Improving Access to Psychological Therapies’ (IAPT) programme increases access to

National Institute for Health and Care Excellence approved treatment for depression and

anxiety disorders. In October 2014, the Department of Health and NHS England

jointly published Achieving Better Access to Mental Health Services by 2020. This set new

standards for the time people should wait for mental health treatment and the care they should

be able to access. In the case of IAPT services, the standards are that 75% of people referred

should be treated within six weeks, and 95% within 18 weeks of referral, and that 50% of

those who complete treatment will recover. NHS Digital publishes monthly statistics

that report performance against these standards. This investigation will establish the facts

around how the national statistics are prepared.

If you would like to provide evidence for our study please email the study team on

enquiries@nao.gsi.gov.uk, putting the study title in the subject line. The team will consider the

evidence you provide; however, please note that due to the volume of information we receive we

may not respond to you directly. If you need to raise a concern please use our contact form.

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