Businesses Could Break IAPT’s Monopoly Stranglehold

Business can make the case to the Conservative Government, that IAPT’s monopoly of the organisation of primary care mental health services (Talking Therapies) is not in the public interest.  Adding that independent assessment of performance is crucial to the delivery of any service, but IAPT has operated for a decade without such accountability – at a cost of £4billion to the taxpayer. 

A businesses could:

A. Ensure that Talking Therapies make a real world difference to clients lives, one that they could recognise. By insisting on i) the independent monitoring of services, on a sampling basis, that assesses client satisfaction and ii) the assessment of the proportion of clients who are returned to their old selves post treatment i.e how many loose their diagnostic status. 

B. Inform Government ministers that it could make an administrative cost saving  by removing the need for therapists to spend time administering psychometric tests at each appointment.

C. Simplify training needs by abolishing the distinction between low and high intensity therapists.

The Businesses could also make the point to Government that their mental health advisers in Public Health England are essentially paid civil servants, who can only speak out with the permission of Government and whose dealings with IAPT are not open to public scrutiny.  There is a pressing need for a wholly independent transparent body charged with assessing the added value of all organisations that deliver Talking Therapies with Government funds. Such a body must go beyond operational matters of numbers and waiting lists and assess the clinical impact of services in a way that is scientifically credible.

With regards to assessing satisfaction, the Business could claim that they intend to ask an independent body to monitor satisfaction with their service by asking:

  1. Overall, How Satisfied Were You With Your Talking Therapy? on a scale 0-10, were a score of 0 is ‘not at all satisfied’ and 10 ‘very satisfied’

My nephew Greg, a Businessman, suggested two very useful supplementary prompts:

       2. Please explain your score

       3. What would need to have been done for you to have given a higher       score?

The data collected can highlight individuals who really were pleased (they
are called promoters – scoring 9 or 10). It will also show those who were
ambivalent (passives scoring 7 or 8), and those who were not happy at all
(the detractors, scoring 6 or less). Understanding why the promoters are
happy is key as the lessons learned here could be applied to the other
groups. Equally, the feedback from passives and detractors can point to
issues that need to be addressed.
[ Greg, also suggested that this framework can also be used in a practitioner
centric way to help  determine  if a practitioner him/herself is ‘performing’
well – you calculate a score by subtracting the percentage volume of
detractors from the percentage volume of promoters. The resultant number is
called the net promoter score.  But my thought is that it  would need to be
complemented by some agreed measure of complexity of caseload. It  could be
easy to satisfy clients on your caseload if you only take  on easy cases. The
problem of complexity can be circumvented by ensuring therapists make
reliable diagnoses, including the assessment of comorbidity. So that the chief
outcome measure is loss of diagnostic status, but satisfaction is a 
complementary measure].

Businesses could make a real world difference to mental health provision

and the lives of clients. They are well equipped for negotiation at the

highest level and many have pockets, deep enough to surmount any

teething problems. Businesses could also greatly reduce the high stress

levels that are endemic in IAPT’s modus operandi. 


Dr Mike Scott