Moving The Goalposts So That The Cheapest Talking Therapy Option Always Wins

Managerial goals have been scored for the last decade by putting the focus on numbers, waiting lists and the brevity of therapeutic contact. Couple this with capitalising on:

a) the passage of time – people are likely to present at their worst

b) people’s desire to please the provider of any service face to face

c) people’s need to feel they haven’t wasted their time

This ‘capitalisation’ comes to pass by the client completing a psychometric test, such as the PHQ9, in front of the therapist. Enabling the Improving Access to Psychological Treatment (IAPT) provider to claim effectiveness to its NHS funders the local Clinical Commissioning Group. 

My own CCG, Liverpool, is top of the league in gullibility (should have kept to football). Last Autumn, Talk Liverpool claimed an 87% recovery rate. I protested in writing to the Chief Officer of the Liverpool LCG, that this is a preposterous claim, as it would mean that Liverpool Improving Access to Psychological Treatment  (Talk Liverpool) were well exceeding IAPT’s claimed national average rate of 40-50% and the recovery rates in randomised controlled trials. The Chief Officer of the LCG did not even have the courtesy to acknowledge my letter. The Liverpool Echo asked the CCG about the discrepancy in the recovery rates and their representative told them that it was a 40-50% recovery rate. It is difficult to belief that the LCG had not been influenced by the claimed recovery rate in funding Liverpool IAPT to the tune of £10 million this financial year. It is a fine line between extraordinary claims and fraud.

It is cunningly hidden from CCG’s that most clients are offered a ‘cost’ saving low intensity treatment, such as guided self-help, a group or computer assisted cognitive behaviour therapy, only a minority actually get a psychological therapy. CCG’s seem blissfully unaware that none of the randomised controlled trials (rct’s) of the utilised low intensity interventions go anywhere near meeting the requisites of the CONSORT checklist, in particular there is no blind independent evaluation and the researchers are investigating the effectiveness of their own developed materials.

Dr Mike Scott

 

National Audit Office Failed To Audit Improving Access To Psychological Therapies Service

 

because it was ‘too busy’. In response to a freedom of information request, from Liverpool, Consultant Psychologist, Dr Mike Scott, the NAO said on November 1st 2019 that amongst its’ reasons for curtailment of its’ investigation were Brexit, the collapse of Carillion and spending increases on generic medicines.  Further the cost of its’ incomplete investigation in 2017-2018 was £74,000. But Dr Scott comments that the reasons that prompted the investigation still remain. He adds that the IAPT service has cost the taxpayer over £3 billion in the last decade with no independent audit of outcome. Clinical Commissioning Groups have simply taken at face value IAPT’s marking of its’ own homework – whither accountability? The NAO response is a yet further illustration that despite official assurances mental health is at the bottom of the agenda. Is it beyond the political parties to go beyond the rhetoric on mental health at the forthcoming general election and commit to an independent inquiry as to how IAPT client’s actually fare? 

In his submission to the NAO Dr Scott pointed out that IAPT had never been subjected to independent audit using the ‘gold standard’ methodology that has been used to assess the effectiveness of a drug. His own published research see link https://journals.sagepub.com/doi/10.1177/1359105318755264 has suggested that only the tip of the iceberg of IAPT client’s recover much less than the 50% claimed by the Organisation. The Journal of Health Psychology also published 3  commentary papers and a rebuttal paper by Dr Scott.  He suggests  that Clinical Commissioning Groups should in the short term refuse to fund the low intensity interventions (guided self- help, computerised cognitive behaviour therapy and educational classes)  that the majority of IAPT clients receive and for which the evidence base is particularly weak, in favour of funding the face to face psychological therapies and for the long term insist that they will be guided by an appropriate independent audit.

Dr Mike Scott