Last year the Improving Access to Psychological Therapies Service (IAPT) lost 46% of clients before their 2nd treatment session. No other psychological therapy services has such a sink hole.
IAPT ignores the sink-hole casualties in its’ proclamation of a 50% recovery rate. My own independent study, using a standardised diagnostic interview, Scott (2018) suggests that only the tip of the iceberg recover.
IAPT has a major problem engaging clients. The ratio of those who had one treatment session to those who completed treatment (at least 2 treatment sessions) was 1244386/664087, 1.87 i.e almost twice as many people have just one treatment session compared to those who complete treatment IAPT Annual Report.
The latest IAPT Annual Report states that the recovery rate, with CBT, in IAPT is 40.7%, this is less than the 50% recovery rate claimed for the service as a whole. Its’ 50% recovery rate has been deemed by IAPT as comparable to the results of randomised controlled trials of CBT for depression and the anxiety disorders. Thus, by its own metric IAPT is underperforming.
% overlap Probability of superiority
Effect size is a measure of change. In IAPT for those at caseness on PHQ9 ( a sore of 10 or more), the mean initial score was 15.4 (standard deviation 5.5) for those completing treatment (attending 2 or more sessions) and a score of 9.3 (standard deviation 6.4) at the end of treatment, a within subject effect size of 1.1. But a sample of patients undergoing treatment as usual by their GP (with PHQ9 scores of 10 or more and 87% of the sample not treated by IAPT) Gilbody et al 2015 and followed up for 4 months, show an effect size score of 1.9. This is based on an initial PHQ9 score of 16 (standard deviation 4.2) and an end score of 9 (presumed standard deviation 4.2), adjusted for the size of the correlation between beginning and end of treatment, using IAPT’s correlation of 0.6, inferred from its data analysis. This data was input into an Effect Size Calculator, yorku.ca for a within subjects design. There is thus no obvious added benefit to IAPT, rather the reverse.
The burden of proof is on IAPT to demonstrate that it confers any added value.
Dr Mike Scott