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BABCP Response - NICE Consultation January 2022

NHS Talking Therapies – All Talk and No Added Value

The latest published studies of NHS Talking Therapies clients, Thew et al (2023) and Watkins et al (2023) offer no evidence that the interventions delivered are superior to a credible attention placebo condition. It beggars belief that: a) the National Audit Office has not investigated whether spending over £1bn on the Service is justified and b) it has evaded the scrutiny of the Care Quality Commission.

The authors of the Thew et al (2023) study suggest that the 6-week internet delivered CBT package for PTSD, is beneficial and may be deliverable by Psychological Wellbeing Practitioners. But there was no control condition. No diagnostic interview was conducted, there were no blind independent assessors and just 5 clients.

The primary outcome measure in the Thew et al (2023)  study was the PCL-5 but Bovin and Marx (2023) have pointed that reliance on this test leads to both a missing of those with a disorder and the unnecessary treatment of those without a disorder. Their findings were that cut-offs varied with the particular population addressed and the prevalence of the disorder in the particular community. Without attention to these details, clients will be misdirected. Bovin and Marx (2023) suggest that the PCL-5 should only be used as an adjunct to a diagnostic interview (but NHS Talking Therapies clients do not make diagnoses) and should involve a discussion with the client as to the meaning of each item. Given that NHS Talking Therapy clinicians  have to achieve a 50% recovery rate their ‘discussions’ on the PCL-5 are likely to be particularly biased. 

The Watkins et al (2023) study focuses on internet CBT for depression. They repeat the NHS Talking Therapies mantra of a 50% recovery rate for their intervention, but made no comparison with a credible attention control condition. But they claim to have used the depression module of the SCID for diagnosis but present no results on this pre or post treatment.  Whether or not, the SCID was not intended for use with a pre-determined module.

NHS Talking Therapy studies are de facto spin for the organisation. Researchers delight in the ease with which they can access subjects from it. Well-meaning people want to believe their efforts have not been in vain and this trumps seriously listening to those affected.

What the CQC would discover

If the CQC bothered to investigate they would discover a revolving door.

Recently I saw a lady who had had an accident at work. She was distressed at being physically unable to return to the job. This lady had 12 sessions with IAPT (NHS Talking Therapies predecessor) she found the therapist very understanding. But she couldn’t identify what she had learnt and said she was given no diagnosis. At the end of the sessions she was told she could re-refer if she needed to, which she did. The new male therapist seemed uninterested, and after 10 mins or so was  making an appointment for a further session. She dropped out but returned to IAPT with a new male therapists, sessions were similarly very brief and she found him ‘ignorant’ in that in the video link he would disappear from the screen, and she could hear him busy in the kitchen. Again she dropped out. She had unidentified and untreated mild  PTSD and depression from the accident.

If that hasn’t been a waste of the taxpayer’s money I don’t know what is.

 

Dr Mike Scott