The afternoon session begins with my cross examination by the Defence barrister, ‘isn’t it the case that those who wrote the IAPT Manual and proclaim a 50% recovery rate are emminent in their field?’. I reply in the affirmative. The Defence barrister continues ‘Have IAPT’s findings been publicly questioned by bodies such as NHS England? To which I replied ‘no’. He continues ‘so you set yourself up against the acknowledged Experts? My response is ‘I am not setting myself up against anyone, this is not a gladiatorial combat. I am simply insisting that the psychological therapy provided by IAPT should be evidence-based and not eminence-based. The credibility of any service is called into question when it does not rely on the data of an independent assessment. The Expert’s you cite, authors of the Manual, NHS England all have a vested interest in proclaiming the merits of the IAPT Service’. The Defence barrister retorts ‘NHS England is responsible for the health of the nation, are you seriously suggesting that there has been a derogation of duty? I respond ‘yes, for over a decade it has unquestionably accepted IAPT’s claims, with staff holding posts in both Organisations. Recently at the behest of the Department of Health I asked NHS England seven questions with regards to IAPT, they simply told me to go and ask the questions of the Department of Health’.
I continued ‘With breathtaking skill, IAPT engages in eminence-based medicine, vehemence-based medicine and eloquence-based medicine. It also engages in ‘it won’t hurt to try’, for example running groups for those traumatised despite a paucity of evidence as too efficacy and under waiting list pressures assigning a clear PTSD case to a trainee’. My own findings of 90 litigants who went through IAPT whether or not before or after personal injury was that only the tip of the iceberg recover’. The defence barrister continues ‘this is using your own idiosyncratic view of recovery not that used by IAPT, is that not the case?. My response was ‘No, I was using the criteria that is used in Court in personal injury litigation, is the person still suffering from the disorder acquired as a result of the personal injury, it is very straightforward’. The defence barrister continues ‘IAPT uses a drop in score on a psychometric test as evidence of recovery, is this not more reliable?’ My response is if it were, such a metric would be in routine use in Personal Injury litigation, it has had no such status over my 30 years of medico-legal work. The danger of a psychometric test administered at the end of a treatment session is that the recipient of the services does not wish to appear ungrateful and makes an exaggeratedly positive response’.
Jury members are most likely to use a credible metric in determining whether a Service has failed to deliver and whether or not it has made exaggerated claims for its’ own ends. Expert Witnesses may protest their independence, but the possibility of bias cannot be excluded as they appear either for the Defence or Prosecution. Additionally they may have an academic bias, re-iterating current mainstream opinions, with scant regard for alternative views.
Dr Mike Scott