I work in secondary care as a band 7 CBT therapist within a CMHT. Often I will have referrals sent directly from IAPT who describe the patient as being too ‘complex’. Indeed this seems to have become an actual care pathway (not that we have too many of those). As far as i can tell at this stage the patient may have not had a face to face assessment, rather has been deemed too complex simply because of the stated diagnosis e.g if they have a so called personality disorder. I have also been told that if someone scores a above a certain score on the HADS scale (I don’t understand why this particular measure is being used as the ‘cut off’) they too are apparently ‘too complex’. I am also told that the outcome measures used by IAPT apparently mean that the ‘too complex clients’ would impact on these performance scales which in turn could mean further funding for the service is jeopardized.
This concerns me on two fronts. Firstly in principle… this seems to completely go against the ethos of the IAPT envisioned by Layard & Clark (although how workable or realistic this ever actually was in another thread) and another example of how it seems management are ‘cooking the books’ . Secondly on a more personal level I am employed in same Trust as a band 7 cbt therapist , i have no support from care coordinators and supposedly have the same amount of sessions to offer patients so how can possibly i offer anything different to IAPT? I suspect management know I can’t , but i ( and my colleague) serve as i convenient sponge to soak up all the pts that may threaten the outcome measures…
I wonder has anyone else working in secondary care had similar experiences or is this an isolated thing ?