IAPT is camouflaging what most of its clients receive and has eskewed a focus on clinically relevant outcomes. But one of the domains that the CQC assesses services against is whether they are Outcomes-focused. The CQC needs to conduct an inquiry into IAPT.
Guided Self-Help (GSH) has been the diet of 71% of IAPT’s clients, but therapists have now been advised not to mention GSH, because it may be off-putting! But rather to refer instead to ‘low intensity telephone CBT’ . Notwithstanding that NICE has justified its’ support for low intensity CBT on the basis of studies that were termed ‘GSH’. There is a transparency about offering GSH, clients have a right to know what they are letting themselves in for. Informed consent cannot be meaningfully given to a term like ‘low intensity telephone CBT’.
The matter of informed consent is compounded further by IAPT by their failure to inform clients of what clinically relevant outcome he/she can expect. In particular what minimally important difference the client can expect and clearly see as meaningful. Changes on a psychometric test do not qualify as a clinically relevant outcome by contrast a client can clearly understand say an expectation to be back to their usual self.
IAPT’s ‘low intensity telephone CBT’ itself rests on a fault line, studies that found statistical significance between groups e.g computer assisted CBT vs waiting list, but without a) any discussion of the clinical relevance of the findings and b) blind independent assessment of outcome. Dissemination of the low intensity interventions has been promoted on the back of statistical significance rather than clinical relevance. This makes it imperative that the CQC becomes outcomes focused in a transparent way and is not sucked in by IAPT’s self serving surrogates.
Dr Mike Scott