Cost Of Improving Access to Psychological Therapies (IAPT) Last Year, Over £1bn, But No Independent Corroboration of Effectiveness

A contemporary of Mark Zuckerberg has been arrested because there was no independent evidence that her scanners could furnish 100’s of blood results from just a few drops. There is it seems more accountability in Silicon Valley  than in the UK mental health services. The IAPT (Improving Access to Psychological Therapies) target for 2021 was 1.5 million clients at a cost of £680 per client [data from Clark (2018) https://doi.org/10.1146/annurev-clinpsy-050817-084833] the anticipated cost of the service was £1.02 billion. Where is the evidence that this was value for money?

 Recently I saw a lady who was suffering from a DSM-5 defined phobia about travelling as a passenger in a car, as assessed with a ‘gold standard’ diagnostic interview. But this was not targetted by IAPT, the Psychological Wellbeing Practitioner wrote to the GP thus  ‘completed an assessment .. presenting problems identified  (please note : this is not a formal diagnosis): GAD and depression. .. waiting list Step 2 CBT Guided Self-Help PHQ9 11 GAD7 8′. This lady was not suffering from GAD or depression and appropriate treatment was not flagged up. There is no evidence that GSH is an evidence based treatment for a specific phobia. IAPT uses diagnostic terms to confer legitimacy on its’ endeavours but then seeks to avoid being held accountable by saying that it does not make reliable diagnoses! With IAPT the NHS has bought a pig in a poke.

Dr Mike Scott

Stopped Care Replaces Stepped Care in IAPT

over 70% (73.3%) of the Improving Access to Psychological Therapies (IAPT) clients are offered low intensity treatment (such as computer assisted CBT, group psychoeducation or guided self-help) first, and only 4% (4.1%) are then stepped up to high intensity treatment. The first transition appointment is the least well attended [ Davis et al (2020) https://doi.org/10.1136/ebmental-2019-300133]. 

IAPT clients haemorrhage from the system at the outset, 40% of first appointments are missed and 42% of clients attend only one treatment session. But IAPT’s claimed recovery rate of 50% applies only to those who complete two or more treatment sessions. The suspicion is that real world recovery rate is much less. Examination of the trajectory of 90 IAPT  clients using a gold standard diagnostic interview [ Scott (2018) IAPT The Need for Radical Reform, Journal of Health Psychology https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0.] suggests only the tip of the iceberg recover.

A small proportion of IAPT clients (16.4%) are offered high intensity first. The IAPT Manual recommends that this should occur for clients suffering from PTSD, social anxiety disorder or severe depression.  But offers no reliable methodology for deciding who is in what category. The agency claims it does not do ‘formal diagnosis’. 

 

How are clients to be directed to appropriate care?

 

Dr Mike Scott