IAPT’s Black Hole – Accountability

I recently asked the National Audit Office to restart it’s investigation into IAPT. I am expecting their reply in the next week or two. There has been no independent scrutiny of IAPT. They have been answerable only to Clinical Commissioning Groups, which have consisted largely of GPs and allowed IAPT to mark its’ own homework.

But the accountability gap also extends downwards, where is the evidence that front line staff or clients have been consulted or involved in decision making?  Most recently IAPT has offered webinars, for its staff on helping those with long term COVID.   There is a tacit assumption that this will be within the expertise of IAPT therapists just as helping those with long term physical conditions such as irritable bowel syndrome. But the IAPT staff working with LTCs were never consulted, before this new foray. Client’s with LTCs were never asked whether they were back to their old selves (or best functioning) before this proposed further extension of IAPT’s empire.  

In the forthcoming issue of the British Journal of Clinical Psychology I have challenged IAPT’s account of its ‘performance’ see ‘Ensuring IAPT Does What It Says On The Tin’ https://doi.org/10.1111/bjc.12264. There is a reply in rebuttal see ‘The costs and benefits of practice-based evidence: correcting some misunderstandings about the 10-year meta-analysis of IAPT studies’ https://doi.org/10.1111/bjc.12268 that reveals a breathtaking level of conflict of interests. IAPT and its’ fellow travellers should be held to account. But importantly they also need to account to their therapists and clients. [ The original IAPT paper is available at https://doi.org/10.1111/bjc.12259]

 

Dr Mike Scott

“IAPT The Myth and The Reality” Scuppered By Two BABCP Presidents

last week I received an extraordinary e-mail, not from the editor of CBT Today, to whom I had submitted the aforementioned article, but from the President of the British Association of Behavioural and Cognitive Therapies (BABCP), Paul Salkovskis and the President-Elect, Andrew Beck declining my article. I protested that this was an infringement of editorial freedom. Further there was a conflict of interest (COI)  because my article was written in response to one by Paul extolling the virtues of IAPT.  This issue of editorial interference was highlighted a year ago when the Editor of CBT Today and Paul declared that there would be no further discussion of IAPT following a piece by Jason Roscoe ‘Has IAPT Become A Bit Like Frankenstein’s Monster?’  and a rebuttal by David Clark. In a response Andrew Beck has now agreed to take the issues of editorial freedom and conflict of interests to the BABCP Board. But this also happened 5 years ago under the Chris William’s Presidency, to no effect!

 the then President sent me an e-mail on December 16th 2015 which read:

‘I don’t want to pre-empt what the Board might decide – as I am only one member of that board – however I am the Board member on the journal committee and am personally very keen we have clear COI statements. My own view is that probably most of these authors doing research in IAPT and also employed in such services aren’t even considering this as an issue as they don’t see themselves as being influenced by IAPT centrally – however that isn’t the point. What matters is perceived conflict and it’s quite clear that you and at least some others have a concern. I would be very happy on a personal basis to advocate we remind authors and associate editors of COI more in such cases and will do so in person or by email at the next journal committee meeting and provide you with feedback as to what happens then’ 

The IAPT Skulduggery Has Continued 

In answer to Jason Roscoe’s question ‘Has IAPT Become A Frankenstein’s Monster? ” –  I  can answer in the affirmative – the latest issue of the British Journal of Clinical  Psychology DOI:10.1111/bjc.12259 contains a supposed 10 year review of IAPT data. The authors all declare no conflict of interest, but the corresponding author for the study is Stephen Kellet who is an IAPT Programme Director! 

Other Examples of IAPT’s ‘Failure To Declare’

  1. In an article that mirrors the Kellett et al paper,  by the prime lead in IAPT David Clark, in the Lancet (2018) https://www.dropbox.com/s/s7var6llzwt1otd/IAPT%20and%20Transparency%20Clark%202018.pdf?dl=0 there was no declaration of a conflict of interest. Ironically the title has in it the word ‘Transparency’!
  2.  In a paper by Boyd, Baker and Reilly (2019) https://www.dropbox.com/s/q1120m0cbvqb882/IAPT%20Stepped%20care%20model%202019.pdf?dl=0 interventions it is written ‘The authors have declared that no competing interests exist’ , but the lead author presenting at a Conference in Amsterdam in May 2016 is described thus: ‘Lisa Boyd, IAPT service, Tees Esk and Wear Valley Mental Health Trust, UK Impact of a Progressive Stepped Care Approach in an Improving Access to Psychological Therapies Service: An Observational Study’
  3. In the paper ‘How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study’ was written by Ali et al (2017) , Behaviour Research and Therapy 94 1-8. the authors declared no conflict of interest but the corresponding author was Chair of the Northern IAPT Practice Research Network

Enough is enough the very credibility of BABCP is at stake and as for IAPT! But I guess this blog would be found ‘unsuitable’ for CBT Today!

Ethical standards have become a joke

Dr Mike Scott