It is inevitable that when a product fails, it is renamed, so to with The Improving Access to Psychological Therapies (IAPT) service, it is now NHS Talking Therapies, for anxiety and depression. In 2021 I published a paper ‘Ensuring IAPT Does What It Says On the Tin’ , over the last 2 years it has signally failed to put its’ house in order. On June 28th 2022 the Lets Talk IAPT website identified ‘a series of seven core problems and failings of the IAPT, including an unproven treatment rationale, a weak and contested evidence-base, biases in treatment promotion, exaggeration of recovery claims, under-reporting of drop-out rates, and a significant risk of misdiagnosis and inappropriate treatment’. None of these problems have been addressed and so it has been given an air of respectability as NHS Talking Therapies.
The avowed focus is depression and the anxiety disorders, but it has extended its scope to include the psychological sequelae of long term physical conditions. Given that almost half the adult population have at least one LTC, this offers massive opportunities for expansion. But the evidence on effectiveness with this population is weak to non-existent. However given that IAPT has usurped the NHS this is likely to matter little.
Professor Clark and Dr Whittington announcing the name change note ‘”Many of those who do find their way to services are looking for help with other difficulties that the services are not set up to treat, such as psychosis or complex emotional needs associated with a diagnosis of “personality disorder”. Clark and Whittington claim ‘You don’t need a “diagnosis” to come for therapy, a skilled practitioner will help work out with you whether and how the service can help’ and add that they offer treatment not only for depression and the anxiety disorders but also OCD, PTSD, body dysmorphic disorder, health anxiety and mixed anxiety and depression. But given that its practitioners are not trained to diagnose according to the latest IAPT Manual, by what magic do they decide who to treat with what? No matter, Clark and Whittington proclaim that 50% of treated people recover, this strains credibility.
Clark and Whittington state ‘Within NHS Talking Therapies services most of the psychological therapy will be quite practical. It may involve working through self-help materials with guidance from a clinician, possibly via a dedicated online platform (which we call ‘digitally enabled therapies’). It may involve help with problem solving skills or practical exercises to examine and overcome your fears. It may involve facing and working through traumatic memories in a safe way’. Can trauma focussed CBT be really regarded as quite practical, in routine practice most clients find it quite toxic Scott and Stradling (1997).
Dr Mike Scott