Public Health England’s Breathtaking Naivety On Mental Health

the Government’s flagship mental health provider, Improving Access to Psychological Treatments (IAPT) has been a serial offender when it comes to non-declarations of conflicts of interest. If this were not enough, IAPT has been allowed to mark its own homework. It has not been subjected to publicly funded independent evaluation. All despite the taxpayer paying IAPT’s bill of £4billion. Unfortunately determining which publicly funded ‘Experts’ decided what, when and in collaboration with whom is likely to be as daunting as discovering who decided what with regards to the pandemic.  It’s about as transparent as our major rivers. But there is a pressing need for a public inquiry.

Latest Violation

IAPT’s latest violation occurred in a paper examining the agencies data in last months British Journal of Clinical Psychology https://doi.org/10.1111/bjc.12259., when an IAPT Programme Director and corresponding author  declared no conflict of interest. I protested to the Editor Professor Grisham about this violation and  that the authors, though citing my study of 90 IAPT clients failed to mention the key message of the study was that the recovery rate was 10% https://doi.org/10.1177%2F1359105318755264. These authors positively framed their findings to underline the frequently re-iterated claim of IAPT that it approaches a 50% recovery rate. My Commentary on the Journal article has been accepted for publication in it  in the near future.

Violation By The Prime Movers In IAPT

 In 2018 a study was published in the Lancet, and funded by the Wellcome Trust, and headed ‘Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data’ and states:

‘Role of the funding source
The funder of the study had no role in study design, data
collection, data analysis, data interpretation, or writing of
the report. The corresponding author had full access to
all the data in the study and had final responsibility for
the decision to submit for publication’.

But there is no mention that the lead author is the leading light in IAPT, and that with one of the other authors, Lord Layard, they were the architects of IAPT.

A Systemic Problem 

In July 2017 I protested to the Editor of Behavior Research and Therapy (BRAT), that no conflict of interest had been declared in a paper authored by Ali et al published in that month’s issue of the Journal, https://doi.org/10.1016/j.brat.2017.04.006 focusing on IAPT data on relapse after low intensity interventions. I pointed out that the lead author headed the Northern IAPT research network.

In October 2015 Behavioural And Cognitive Psychotherapy published a paper by Kellet et al about an IAPT service ‘Large Group Stress Control’ https://doi.org/10.1017/S1352465815000491 this was authored by an IAPT teacher and researcher and appears without any statement of conflict of interest. 

 

Dr Mike Scott

IAPT Hoodwinks NHS England

by alleging compliance with NICE recommended evidence-based psychological treatments. But, NICE bases its’ recommendations, largely, on randomised controlled trials conducted on specific disorders, with different protocols for different disorders. It is impossible to implement NICE guidance without reliable diagnosis, but IAPT have never claimed that its’ clinicians make a diagnosis!

Even the notion of a utilising a ‘provisional diagnosis’ was jettisoned in last years IAPT Manual, (see link below) in favour of a ‘problem descriptor’:

https://www.dropbox.com/s/pgmbsoqjqmq04qz/IAPT%20Manual%202018.pdf?dl=0

On the basis of a client’s ‘problem descriptor’ the IAPT Manual requires its’ therapists to specify an ICD-10 [International Classification of Diseases 10th edition, World Health Organisation] code for a disorder, which would allegedly indicate the appropriate protocol. However there are 99 codes for Mental and Behavioural Disorders in ICD-10, there is no bridge between a ‘problem descriptor’ and a disorder. If such a leap were possible ICD-10 ( the World Health Organisation) would not have bothered to specify diagnostic criteria for the 99 conditions! Within IAPT clinicians come up with a ‘problem descriptor’ in just 2/3rds of cases, [ Clark et al (2018)] see link below:

https://www.dropbox.com/s/s7var6llzwt1otd/IAPT%20and%20Transparency%20Clark%202018.pdf?dl=0

and usually following a 20-30 minute telephone conversation, it is therefore a matter of ‘plucking a code’ from thin air for administrative purposes,


if the clinician can remember this particular ticking the box exercise.

The Clark et al (2018) study was published in the Lancet, and funded by the Wellcome Trust, and headed ‘Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data’ and states:

‘Role of the funding source
The funder of the study had no role in study design, data
collection, data analysis, data interpretation, or writing of
the report. The corresponding author had full access to
all the data in the study and had final responsibility for
the decision to submit for publication’.

But there is no mention that the lead author is the leading light in IAPT, and that with one of the other authors, Lord Layard, they were the architects of IAPT. Where is the ‘transparency’ in this? In fairness in this paper they do state that a limitation of their paper is that their data is dependent entirely on client self report, but a conflict of interest stops them going on to say, that there needs to be an independent audit of IAPT, in which the diagnostic status of clients is assessed before and after treatment and at follow up.

My own independent analysis of 90 IAPT clients suggests that, contrary to IAPTs claims of a 50% recovery, just the tip of the iceberg loose their diagnostic status diagnostic status, see link below: https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

NHS England needs to clearly establish whether or not the public is ill served by IAPT and not to rely on the claims of those with a vested interest in providing the Service.

Dr Mike Scott

Bias in CBT Journals

When the organs of communication are controlled by a single ideology we are on a short road to hell. Recently I protested to the Editor of Behavior Research and Therapy (BRAT), that no conflict of interest had been declared in a paper authored by Ali et al published in this month’s issue of the Journal, focusing on IAPT data on relapse after low intensity interventions. I pointed out that the lead author headed the Northern IAPT research network, not only did the editor ignore the conflict of interest but so to did the two reviewers, of a rejoinder to the paper that I wrote. But it is not just BRAT, IAPT sponsored papers regularly appear in Behavioural and Cognitive Psychotherapy without declarations of conflicts of interest.  I have protested to the editor about this, but again to no avail. Unfortunately it is not just a matter of what Editors of CBT Journals allow through the ‘Nothing to Declare’ aisle but also their blocking of objections to the current zeitgeist that is a cause for concern. More about this anon.

Dr Mike Scott