‘What Is Going On, When The Dose of Psychological Therapy Is Less Than Half That Recommended By The National Institute for Health and Care Excellence (NICE)?’

 

a recent study by Saunders et al (2021) Journal of Affective Disorders 294 (2021) 85-93 found that the average client in the Improving Access to Psychological Therapies  (IAPT) low intensity therapy has 3 sessions ( a mean of 2.85 sd 2.81) whilst the average client in high intensity therapy has 5 sessions ( a  mean 4.79 sd 5.51). But the IAPT Manual (2021) p51 states ‘should be offered up to the NICE-recommended number of sessions for the relevant clinical condition. For high-intensity work this would generally be in the range of 12 to 20 sessions’, Further the low intensity intervention such as the Stress Control Programme typically involve 6 sessions. Clearly IAPT clients are receiving a sub-therapeutic dose of treatment. Yet astonishingly IAPT claims that it is NICE compliant!

But IAPT uses a language that is reminiscent of Alice In Wonderland, treatment is defined as attending at least two treatment sessions. This means that those who miss their first treatment appoint [40% according to Davis, A., Smith, T., Talbot, J., Eldridge, C., & Betts, D. (2020). Predicting patient engagement in IAPT services: a statistical analysis of electronic health records. Evidence-based mental health, 23(1), 8–14. https://doi.org/10.1136/ebmental-2019-300133] or attend only one session [42% according to Davis, A., Smith, T., Talbot, J., Eldridge, C., & Betts, D. (2020). Predicting patient engagement in IAPT services: a statistical analysis of electronic health records. Evidence-based mental health, 23(1), 8–14. https://doi.org/10.1136/ebmental-2019-300133] are not counted as part of those treated, but they in total constitute 64% of those passing through the IAPT starting gate. Thus approximately two thirds of the would be beneficiaries of IAPT’s ministrations refuse to take their medicine! Add this into the equation and the services performance looks woeful.

 

IAPT uses a sleight of hand to claim NICE compliance (a sine qua non of funding by Clinical Commissioning Groups CCGs). It asks its’ therapists to use ‘problem descriptors’ to select an ICD code (the World health Organisations coding system for diagnosed disorders). But an ICD code is only as reliable as the diagnosis and IAPT therapists do not make diagnoses, how then can they provide treatment ‘for the relevant clinical condition’ p51 IAPT Manual (2021)?  GPs clearly make diagnoses and their records often mention problems associated with the diagnosis, but they do not make the diagnosis on the basis of those problems, they are qualitatively different types of information. An IAPT therapist like a social worker may note psychosocial stressors but any mention of disorder would not be taken as evidence of disorder in a Court of law.  Where IAPT therapists to claim they made a diagnosis that would be subject to legal challenge and the Organisation steers its employees away from this.

Many IAPT therapists are delighted with this as they see ‘diagnosis’ as akin to blasphemy. NHS England and CCG’s, refuse to acknowledge the elephant in the room, they have chosen to totally avert their gaze from this problem, preferring to sup with the IAPT hierarchy.

 

Dr Mike Scott