IAPT’s Failure To Engage

the IAPT Annual Report (2018)/2019] see link below, reveals that a third (31.2%) of new referrals drop out before treatment and approximately two thirds (61.1%) do not complete a course of treatment (using IAPT’s liberal definition of treatment as attending 2 or more session) with almost a third (29.54 %)  attending only one treatment session.

https://www.dropbox.com/s/hwn9ncuuyds8qfa/IAPT%20Annual%20Report%202018-2019.pdf?dl=0

IAPT’s disengagement is illustrated by Jock’s records which revealed that at age 6 he had behaviour problems and threatened to stab himself.  By age 14 he was diagnosed with oppositional defiance disorder and was short tempered. At age 19  he was diagnosed as having an anxiety state low mood drinking 10 units in a binge once or twice a fortnight  and cannabis 2-3 times a week. Despite his extensive history he was assessed by IAPT and assigned to a step 2 (low intensity) workshop, unsurprisingly he DNA’d. Two years later he is referred to them again for depression and unsurprisinly he does not respond to their opt in letter. Five years later the GP notes that he is struggling with an online CBT course has had to enlist his father to help because he is not computer literate. Then after a major negative life event he develops a depressive psychosis. Had IAPT bothered to listen this troubled soul of longstanding, the results could have been very different.

Institutional Disengagement

Engagement difficulties are built into the fabric of IAPT. Daniel consulted his GP 2 years after a major trauma and was found to have PTSD and depression and was promised a referral to IAPT. 4 weeks later he was prescribed an increase in medication and a different GP gave him IAPT’s telephone number to ring. Daniel was furious, he felt that he had explained that his mood was very up and down and that he could not be relied on to ring them. His interpretation of the organisational setup was that no one was really interested. This perception was likely to be compounded if and when he underwent a telephone assessment as had already had lots of acrimonious telephone conversations with the housing Dept and DWP since his trauma.   

It is surely time f or the Care Quality Commission and the National Audit Office to take note of the near universal disengagement of clients, voting with their feet, and institute an independent review of IAPT to determine what if any real world difference it makes. There is considerable media interest in these failings.

Dr Mike Scott

 

 

The Care Quality Commission (CGC) Is Being Duped by IAPT

IAPT is camouflaging what most of its clients receive and has eskewed a focus on clinically relevant outcomes. But one of the domains that the CQC assesses services against is whether they are Outcomes-focused. The CQC needs to conduct an inquiry into IAPT.

Guided Self-Help (GSH) has been the diet of 71% of IAPT’s clients, but therapists have now been advised not to mention GSH, because it may be off-putting! But rather to refer instead to ‘low intensity telephone CBT’ . Notwithstanding that NICE has justified its’ support for low intensity CBT on the basis of studies that were termed ‘GSH’. There is a transparency about offering GSH, clients have a right to know what they are letting themselves in for. Informed consent cannot be meaningfully given to a term like ‘low intensity telephone CBT’.

The matter of informed consent is compounded further by IAPT by their failure to inform clients of what clinically relevant outcome he/she can expect. In particular what minimally important difference the client can expect and clearly see as meaningful. Changes on a psychometric test do not qualify as a clinically relevant outcome by contrast a client can clearly understand say an expectation to be back to their usual self.

IAPT’s ‘low intensity telephone CBT’ itself rests on a fault line, studies that found statistical significance between groups e.g computer assisted CBT vs waiting list, but without a) any discussion of the clinical relevance of the findings and b) blind independent assessment of outcome. Dissemination of the low intensity interventions has been promoted on the back of statistical significance rather than clinical relevance. This makes it imperative that the CQC becomes outcomes focused in a transparent way and is not sucked in by IAPT’s self serving surrogates.

Dr Mike Scott

Unannounced Visits To IAPT Reveal……..

The Care Quality Commission (CQC) pay unannounced visits to establishments for vulnerable people and have thereby revealed tragedies such as Winterbourne View in 2011.  But the clients of IAPT are no less vulnerable, yet there is no inspection on their behalf.  I wonder what the CQC would make of a lady on the autistic spectrum accepted into IAPT for management of her anxiety,  catered for by a high intensity therapist who is allowed only 6 sessions, with no knowledge of autism or of the grey are between OCD rituals and aspects of autism.  The CQC would surely cry foul, but this is not an isolated example.

If IAPT practitioners are to be based in GP practices they could fall within the CQC’s orbit of ‘people with poor mental health’.  Had they visited the establishment where   the would be Bake Off winner,          Kim-Joy https://www.theguardian.com/tv-and-radio/2018/nov/12/i-was-preety-much-mute-at-school-the-bake-offs-kim-joy  worked they would have heard her tell, that she has a Master’s in psychology, she could provide only up to 6 half hour sessions in low intensity and was heading off to other pastures.  If they needed an independent window on what is going on in IAPT I would have given them the following comments from amongst the 90 clients that I saw:

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

There are valuable TV programmes such as ‘GPs Behind Closed Doors’, I wonder what the public would make of ‘;IAPT Behind Closed Doors’ but such a programme would have to escape censorship by NHS England (and IAPT leadership)  something GPs would not tolerate.

Dr Mike Scott