Failure to Audit NHS Talking Therapies Archives

How Do NHS Talking Therapies Clients’ Fare Downriver?

The Improving Access to Psychological Therapies River began flowing 15 years ago, rebranded NHS Talking Therapies last year. Yet we still don’t know how clients fare, downstream long-term. Quite why we don’t know is an interesting question. One doesn’t have to be a conspiracy theorist to suggest that there may be an unholy alliance of Service Providers and politicians/media at work. The former fearing independent public audit, the latter wanting to be seen championing the side of the ‘good’.

Clients invariably enter the river destabilised. Some may quickly regain their balance and be part of the 40% of people who do not go on to engage in treatment (defined by the service as engaging in 2 or more treatment sessions). But what proportion of those who have had treatment go on to return to how they were before entering the river? Or to put it another way, what proportion reach the promised land? What proportion continue to thrash about at sea? Despite the much vaunted and extensive NHS Talking Therapies database it is impossible to answer these simple questions. There is clearly something amiss here. The answer cannot be to spend £2billion a year on child and adult services in NHS Talking Therapies. Just throwing money at a problem cannot be an answer to anything.

The best guess from an independent review [Scott (2018)] is that only the tip of iceberg recover. The burden of proof is on those who would claim otherwise, simply reiterating NHS Talking Therapies mantra of a 50% recovery rate is not evidence.

The NHS has proposed that interventions are evaluated using the mnemonic PICOTS. P requires a specification of the population being addressed and presupposes a reliable diagnosis. But NHS Talking Therapies therapists are not trained to make diagnoses. The Service therefore fails at the first hurdle. I stands for intervention and requires the specification of the intervention used so that it could be replicated and evaluated by other clinicians. But there have been no fidelity checks to establish whether a particular protocol has been followed. Rather there is a cacophony of voices claiming to deliver ‘CBT’. The service falls at the 2nd hurdle. C pits the service against a control condition, but there has been no such evaluation of NHS Talking Therapies. There is no reason to believe that its clients fare any better than if they had attended the Citizen’s Advice Bureaux. O refers to outcome, but there has never been a blind independent assessment of NHS Talking Therapies Clients instead there has been entire reliance on self-report measures which are subject to both demand characteristics (wanting to please the therapist and not think you have wasted your time) and regression to the mean (people invariably come at their worst and there is some improvement with time whatever. Finally there is T, which is about the duration of gains (time), never has there been a real world assessment of recovery e.g lasting at least 8 weeks. NHS Talking Therapies fails all the NHS hurdles.

Dr mike Scott

Use of Blinded Clinical Assessment Halves Claimed Remission Rate – Casting Serious Doubts on NHS Talking Therapies Justification

The received mantra of NHS Talking Therapies is that 50% [ IAPT Manual (2019)] of its’ clientele recover. This is the basis for the £1billion a year funding of the service. But the small print states that that the claim is based on clients who completed a self-report measure at their last contact and had attended 2 or more treatment sessions. A just published study by Pigott et al (2023) shows the spin to be had from relying on a self-report outcome measure. These authors re-analysed outcome data on the efficacy of antidepressants. It was initially reported that the average remission rate was 48.4%, but Pigott et al (2023) pointed out that that this was based on the clinic-administered Quick Inventory of Depressive Symptomatology-Self-report, despite stating in the pre-trial protocol that all such measures would be excluded. The results of a blind independent assessment (the clinician Hamilton Rating Scale for depression) went unreported, but revealed a 25.5% recovery rate! The results for NHS Talking Therapies and antidepressants are likely no better than if a client was given attention and a credible rationale as to how to emerge from their chaos. In routine practice there is nothing to indicate that responses to therapeutic endeavours are any greater than placebo. Neither, the NHS Talking Therapies data nor the STAR*D data [Pigott et al (2023)] have involved a control condition. Nevertheless, the hype has continued, on November 8th 2022 the New York Times reported that ‘nearly 70% of people had become symptom free by the fourth antidepressant”’. Interestingly the dropout rate in the Star*D trial was 53.7%, much the same percentage as those who did not complete treatment in NHS Talking Therapies. With regards to NHS Taling Therapies there is no evidence of treatment integrity – a translation of the protocols of randomised controlled trials for CBT to routine practice.

Dr Mike Scott