No Evidence That The Improving Access to Psychological Therapies (IAPT) Service Does Any Better Than Contact With The Citizen’s Advice Bureaux (CABx)

 

IAPT claims 50% of its treated clients recover. But this effectiveness claim refers to the minority sub-population, who attend two or more treatment sessions. There is a deafening silence about the majority and that IAPT has marked its’ own homework. By contrast the CABx reports results for all-comers and as assessed by independent researchers.  In its’ latest report the CABx states that the proportion of people who reported improved mental health as a result of contact was 70% in the last quarter of 2020/2021.

In the CABx population almost 80% of clients said that their problems made them feel stressed or anxious and over 60% said they had difficulty in getting on with daily life. With just over 20% of CABx clients stating that contact had helped them a great deal to get on with their life, and just less than 20% saying that contact helped a little and 20% saying that it helped somewhat..The latest CABx report  states that this year they carried out ‘robust client follow up research. National Outcomes and Impact Research (NOIR). This asked detailed questions about why people came to us for advice, what their problems were and how we helped’. NOIR research was conducted over the telephone with a nationally representative sample of clients. The NOIR asked 60,000 clients about their experience of CABX in the last year. THE CABx research was funded by the National Institute for Health Research.  

In 2020-2021 the CABx saw 58,000 people face to face, with 624,000 receiving help by email or webchat and 1.48 million people using the CABx phone service.  The throughput of clients in CABx is about double that of IAPT.

It can be objected that IAPT population is more ‘complex’ than the CABx but the diagnostic status of neither population has been assed by a gold standard diagnostic interview. The burden of proof is on IAPT to demonstrate more ‘complexity’ and that it is especially equipped to treat such complexity. The CABx also provides a Gambling Support Service, it screened 19,000 clients and found 5% at risk of harm from gambling. Gambling was not a problem descriptor used by any of the IAPT therapists in the Saunders et al study. In both the CABx and IAPT populations (Davis et al (2020) populations 1 in 2 people are unemployed.

In 2020/21, for every £1 invested in Citizens Advice they generated:

£1.94 in savings to government and public services (fiscal benefits). By helping stop problems occurring or escalating, we reduce pressure on public services like health, housing or out-of-work benefits.

£13.36 in wider economic and social benefits (public value). Solving problems improves lives and this means better wellbeing, participation and productivity for the people we help.

£8.35 in value to people we help (financial outcomes following advice). As part of our advice we can increase people’s income, through debts written-off, taking up benefits and solving consumer problems.

To my knowledge there are no comparable figures for IAPT.

The value for money of CABx is readily apparent, it is much less obvious with IAPT.

 

Dr Mike Scott