Last month I asked Dr Coffey, the Health Minister the following questions, in italics I have summarised the responses from an aide. The full text that I received on October 12th 2022 follows.
1.The Government Improving Access to Psychological Therapies (IAPT) Service is experimenting with public, direct access to a Psychological Wellbeing Practitioner. But PWPs are not trained in diagnostics nor are they qualified therapists. Why then are they being given this gatekeeping role?
Best answered by NHS England
2. The IAPT service has cost billions of pounds, since its’ inception in 2008. Why, then has there been no independent audit of the service?
3. With regards to physical health the Government is funding Community Diagnostic Centres, with regards to mental health why is there no facility for reliable
diagnosis in IAPT?
Interesting, but diagnosis in mental health is ‘less straightforward’, it would be too costly, no plans.
4. With regards to mental health there is no evidence that those availing themselves of IAPT fare any better than those attending the Citizens Advice Bureaux? What then is the added value of funding IAPT?
5. How is the experiment of making PWPs gatekeepers being evaluated and who decided on the criteria?
6. IAPTs claimed recovery rate of 50% has not been independently verified. The independent evidence of an Expert Witness to the Court [Scott (2021) British Journal of Clinical Psychology] suggests that in fact only the tip of the iceberg recover. Is this not grounds for a publicly funded independent audit?
7. How do we know IAPT is value for money?
Dear Dr Scott,
Thank you for your correspondence of 18 September Improving Access to Psychological Therapies (IAPT) programme. I have been asked to reply.
NHS England has oversight for the IAPT programme, so would be best placed to respond to your queries. However, delivery of IAPT services is the responsibility of local commissioners. Integrated care boards (ICBs) replaced clinical commissioning groups in the NHS in England from 1 July 2022. A list of ICBs can be found at www.nhs.uk/nhs-services/find-your-local-integrated-care-board/.
In response to question 4, people seek treatment through talking and psychological therapies provided through local IAPT services for anxiety, depression and a range of other mental health conditions such as agoraphobia, post-traumatic stress disorder, obsessive compulsive disorders, panic disorders and social phobias. Treatments can include therapies like counselling, cognitive behavioural therapy (CBT) and peer support. In 2021-22, 1.24 million referrals accessed talking therapies through IAPT services. The recent annual report available at https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-annual-reports-on-the-use-of-iapt-services/annual-report-2021-22 contains information on referrals, waiting times and patient outcomes such as recovery. In addition, the report covers a range of demographic analyses including outcomes for patients of different ages, ethnic group and separately for ex-British Armed Forces personnel.
For your questions relating to Psychological Wellbeing Practitioners, the IAPT workforce consists of low-intensity practitioners and high-intensity therapists who together deliver the full range of NICE-recommended interventions for people with mild, moderate and severe depression and anxiety disorders, operating within a stepped-care model. All IAPT clinicians should have completed an IAPT-accredited training programme, with nationally agreed curricula aligned to the National Institute for Health and Care Excellence (NICE) guidance (or they should have acquired the relevant competences or skills before joining an IAPT service). All clinicians should be accredited by relevant professional bodies and supervised weekly by appropriately trained supervisors.
Many people with mild to moderate depression or anxiety disorders are likely to benefit from a course of low-intensity treatment delivered by a psychological wellbeing practitioner. Individuals who do not fully recover at this level should be stepped up to a course of high-intensity treatment. The NICE guidance recommends that people with more severe depression and those with social anxiety disorder or post-traumatic stress disorder (PTSD) should receive high-intensity interventions first. NHS England’s available at www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual-v5.pdfcontains further detail on the IAPT workforce, including PWPs.
Question 3 raises an interesting point; however, there would be significant challenges to making this approach work for mental health conditions. Diagnosis for mental health is less straightforward and replicating Community Diagnostic Centres would require a significant expansion in numbers of mental health staff, above and beyond what is already set out in the NHS Long Term Plan that there will be additional 27,000 mental health professionals in the NHS workforce by 2023/24. Therefore, we have no plans at present to replicate this model for mental health.
I hope this reply is helpful.
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care
Dr Mike Scott