National Institute for Health Protection to Control IAPT?

in a blog written just before the demise of Public Health England I noted  the’Breathtaking Naivety of Public Health England On Mental Health’, https://wp.me/p8O4Fm-2HI. My hope is that its’ replacement the National Institute of Health Protection (NIHP)  will question why £4billion of the taxpayers money has been spent on the Improving Access to Psychological Therapies (IAPT) Programme, without any publicly funded independent evaluation of the service. My own independent finding was that only 10% of  those going through the IAPT service recover and that the public are very dissatisfied https://connection.sagepub.com/blog/psychology/2018/02/07/on-sage-insight-improving-access-to-psychological-therapies-iapt-the-need-for-radical-reform/ ,. By contrast IAPT claims a 50%  recovery rate, but my just published paper in the British Journal of Clinical Psychology, https://onlinelibrary.wiley.com/doi/10.1111/bjc.12264#.XzwEMhZvXuk.email  casts serious doubts on the Services claim.

I have written to Baroness Harding of Winscombe, Dido Harding, the head of NIHP  to clarify whether the NIHP is indeed going to be the monitor of IAPT’s performance and if not who is? I have also stressed that no agency, including IAPT, should be allowed to mark its’ own homework.   It is imperative that a the metric for gauging the effectiveness of a service is one that the general public would recognise as meaningful, such as being independently assessed as no longer suffering from the disorder that they first presented with, as opposed to a surrogate measure, such as a change of score on a psychometric test completed in the presence of the therapist.

As MPs resume sitting in Parliament it is critical to ask who will now be in charge of ensuring IAPT does what it says on the tin and how will this QUANGO be made accountable?

Dr Mike Scott

British Journal of Clinical Psychology Commentary and Rebuttal Of IAPT Paper

the Journal yesterday published my critique, ‘Ensuring IAPT Does What It Says On The Tin’ https://onlinelibrary.wiley.com/doi/10.1111/bjc.12264#.XzwEMhZvXuk.email of the recent IAPT ( Improving Access to Psychological Therapies) paper, by Wakefield et al (2020).

£4bn has been spent on IAPT without publicly funded independent audit. This is a scandal when the best-evidence is that only 10% of those using the service recover. There is no evidence that the Service makes a real world difference to clients’ lives, returning them to their old selves/no longer suffering from the disorder that they first presented with for a significant period. The claimed 50% recovery rate by the service is absurd.  Not only has the now defunct Public Health England  mishandled the pandemic, but it has had a matching performance on mental health. It is too early to judge whether the newly formed Health Protection Board will grasp the nettle of mental health. But I doubt that it will until there is open professional discussion that the present IAPT service is not fit for purpose. It will likely need the involvement of politicians to ensure radical reform of IAPT and that mental health is not again kicked into the long grass.

Dr Mike Scott

 
 
 
 

‘Ensuring IAPT Does What It Says On The Tin’

this is my critique of the IAPT paper published in the current issue of the British Journal of Clinical Psychology, and the Editor has just accepted it for publication. Wakefield et al (2020) will be invited to respond.

Not quite sure when it will see the light of day, but hopefully it is at least the beginnings of open discussion. 

An area I’ve not touched on, in my paper is the effect of IAPT on its staff. Some are taking legal action against IAPT for bullying and have highlighted massive staff turnover. But it is very difficult for them to go into detail with litigation pending.  Others are suffering in silence to become financially secure enough to leave. Staff are in an invidious position, at best they might hope for an out of Court settlement. But unsurprisingly there is no great Organisational demand for whistleblowers. Gagging clauses it appears are still about and I heard of one being used recently by an employer against a victim of  the Manchester Arena bombing.

We need a national independent inquiry not only about the speed with which lockdown was imposed, but also about what has been happening in IAPT. But today I was talking with a survivor of the 1989 Hillsborough Football disaster, that I’ve kept in touch with since shortly afterwards, and we reflected on how long it has taken to get anywhere. He was too exhausted to follow through on the Statement he gave that was doctored by the police.

Bullying tends to centre on what the Organisations contend are ‘one or two bad apples’, which at a push they might make some compensation  for, to avoid adverse publicity, and without admitting liability. But I think there is a bigger phenomenon of Organisational Abuse that operates in an insidious way akin to racism, that needs to be called out. 

Dr Mike Scott

 

British Journal of Clinical Psychology Responds To IAPT’s Conflict of Interest

last week I wrote to Professor Grisham, the Editor of the Journal complaining, inter alia, of IAPT’s failure to declare a conflict of interest over the paper by Wakefield et al (2020) in the current issue, see link https://doi.org/10.1111/bjc.12259.  The Journal has responded  by formally inviting me to write a commentary, which subject to peer review, will appear alongside a response by the said authors. The text of my letter was as follows:

Dear Professor Grisham

Re: Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta-analysis of 10-years of practice-based evidence by Wakefield et al (2020) https://doi.org/10.1111/bjc.12259

In this paper all the authors declare ‘no conflict of interest’. But the corresponding author of the study Stephen Kellett is an IAPT Programme Director.  This represents a clear conflict of interest that I believe you should alert your readers to. The study is open to a charge of allegiance bias.

I am concerned that in their reference to my published study “IAPT – The Need for Radical Reform”, Journal of Health Psychology (2018), 23, 1136-1147 https://doi.org/10.1177%2F1359105318755264 these authors have seriously misrepresented my findings. They chose to focus on a subsample of 29 clients, from the 90 IAPT clients I assessed for whom psychometric test results were available in the GP records. I warned that concluding anything from this subsample was extremely hazardous.  The bigger picture was that I independently assessed the whole sample using a ‘gold standard’ diagnostic interview and found that only the tip of the iceberg lost their diagnostic status as a result of IAPT treatment. Wakefield et al were strangely mute on this point.  They similarly fail to acknowledge that their study involved no independent assessment of IAPT client’s functioning and there was no use of a ‘gold standard’ diagnostic interview.

The author’s of Wakefield et al (2020) compare their findings favourably with those found in randomised controlled trials efficacy studies, suggesting that IAPT’s results approach a 50% recovery rate. But there can be no certainty of matching populations. In the said study there was no reliable determination of diagnostic status, thus there is no way that this heterogenous sample can be compared to homogenous samples of different primary disorders e.g obsessive compulsive disorder, adjustment disorder etc.

It is unfortunate that the British Journal of Clinical Psychology has allowed itself to become a vehicle for the marketing of an organisation which has only ever marked its’ own homework. The published study also calls into question the standard of the peer review employed by the Journal.

Regards

 

Dr Michael J Scott

At least we are getting to open debate, which is more than can be said for BABCP’s in-house IAPT comic, CBT Today.