Mental Health Patients and GPs Caught In IAPT’s Revolving Door

30% of GP referrals to the Improving Access to Psychological Therapies (IAPT) service do not attend, and of those who attend for treatment, 40% do so for only one session [Pulse November 2nd 2018 Home Analysis NHS structures Revealed: How patients referred to mental health services end up back with their GP]. The GP is left to cope with this haemorrhaging , with no input from Clinical Commissioning Groups (CCGs) to rectify matters.  The CCGs are complicit in IAPT ‘cherry picking’ clients, refusing clients under another service, such as substance misuse or an eating disorder.  Further the CCG’s do not bat an eye when IAPT claims to have met its’ target of a 50% recovery rate.  They miss the point that there has been no publicly funded  independent audit of IAPT.  They are blissfully ignorant that using an independently administered standardised semi-structured interview (SCID) only the tip of the iceberg (9.2%) recover Scott (2018) https://doi.org/10.1177%2F1359105318755264.

Evidence based practice involves an integration of best research evidence, clinician expertise and patient’s preferences [ NHS England document ‘Finding the Evidence’ November (2013)].

There are no randomised controlled trials, using a blind evaluator, of IAPT’s modal, low intensity treatment.  Making  the ‘best research evidence’ leg unstable.  GPS do not audit the effect of IAPT on their patients and so their clinical expertise in dealing with these patients is questionable.  Shared decision making is an integral part of  eliciting patient preferences. But in IAPT clients are usually discharged when they have had the pre-determined number of sessions and/or when their score on a self-report measure falls below a certain cut-off.  There is no credible elicitation of client’s preferences. All legs of the evidence based practice stool have fault lines, and it collapses under IAPT’s weight. The Agency is a prime exemple of failed evidence based practice.

Dr Mike Scott