Half of IAPT Clients Attend Only One Treatment Session

according to the UK Governments Improving Access to Psychological Therapies (IAPT)  annual report for 2019-2020 -https://files.digital.nhs.uk/B8/F973E1/psych-ther-2019-20-ann-rep.pdf,  489,547 people curtailed involvement after having one treatment appointment,  whilst 606,192 had two or more treatment sessions. If half of people never returned to a particular Cafe in their locality it would not be a good advertisement. But the IAPT Cafe is the only affordable one for most people, with a third of its’ clientele returning for further courses of ‘sustenance’, Hepgul et al (2016) https://doi.org/10.1186/s12888-016-0736-6.  Doesn’t sound like this Cafe confers health.

This haemorrhaging of clients is not a feature of the NICE recommended treatments, yet IAPT claims fidelity to such treatments! What then does one make of IAPT’s claim of a 50% recovery rate? This would be a fitting subject for Radio 4’s ‘More or Less’ statistical programme. To set the context, of 1.69 million referrals to IAPT in 2019-2020, 1.17 million left the starting gate, 30.77% (almost 1 in 3) were non-starters. Further only 1 in 3 (36.8%) got around the course (defined curiously by IAPT as attending 2 or more treatment sessions). IAPT’s terrain is much like that of the Grand National horse race. The ‘50% recovery rate’ refers to the significant minority who cross IAPT’s finishing line. Thus even using IAPT’s own yardstick  the true recovery rate is much less than 50%.

With regards to those who cross IAPT’s finishing line, there is no indication that their ‘success’ is lasting. It is not known what proportion of them ever ‘race’ again. Thus, the true recovery rate is likely to be far less than 50%. My own independent study of 90 IAPT clients, Scott (2018) https://doi.org/10.1177%2F1359105318755264  suggests that in fact only the tip of the iceberg, 10% , recover in any real world sense.

It serves all Organisation’s well to be vague about its’ criteria for success, they almost certainly operate with a confirmatory bias, cherry picking data that would justify its’ existence in the eyes of its paymaster. Biases or heuristics do not necessarily operate consciously but are nonetheless powerful and likely to be employed if survival is at stake. See for example Lilienfeld and May’s (2015) https://doi.org/10.1002/9781118625392.wbecp567 critique of reliance on self-report measures, a particular penchant of IAPT. These authors also point out that the only sure way of de-biasing is to have independent review, but IAPT has never been subjected to publicly funded independent review. 

Dr Mike Scott

 

The Department of Health Has Failed To Regulate Routine Mental Health Services

Improving Access to Psychological Therapies (IAPT) services are out of bounds to Care Quality Commission inspection.  In 2016 the National Audit Office (NAO) asked the Department of Health to address this issue and it has done nothing.  The Department sets the agenda and budget for NHS England, who in turn do the same with Clinical Commissioning Groups to determine local provision of services. But NHS England staff are lead players amongst service providers, these conflicts of interest exacerbate the parlous governance of IAPT. There is a need for Parliament to step in and take the Department of Health to task.  

 

Whilst no one doubts the importance of improving access to psychological therapies, it was remiss of the NAO in 2016 to take at face value IAPT’s claim that it had the appropriate monitoring measures in place.  Incredulously the NAO accepted at face value IAPT’s claim that it was achieving a 45% recovery. It is always tempting to look only as far as evidence that confirms your belief. But it is equally important to consider what type of evidence would disconfirm your belief. The NAO has failed to explain why it has not insisted on independent scrutiny of IAPT’s claims. 

The The Improving Access to Psychological Therapies (IAPT) programme has exercised a confirmatory bias in its’ audit by focussing only on self-report responses on  psychometric tests (the PHQ9 and GAD7). The service has never looked at a categorical end point, such as whether a person lost their diagnostic status as assessed by an independent evaluator using a standardised diagnostic interview.

Organisations, are inherently likely to be self-promoting and will have a particular penchant for operating, not necessarily wholly consciously, with a confirmatory bias. It is for other stakeholders, NHS England, Clinical Commissioning groups, MPs, the media, Charities and professional bodies (BABCP  and BPS) to hold IAPT to account. For the past decade they have all conspicuosly failed to do so. How have IAPT evaded critical scrutiny, despite the taxpayer having paid £4billion for its’ services? Friends in high places is the most likely answer. I have called for an independent public inquiry for years and will continue to do so  but there is likely to be an echo of a deafening silence as the only beneficiary would be the client with mental health problems.  

Dr Mike Scott