The Improving Access To Psychological Therapies (IAPT) Programme Is Spreading Into Prisons – Why?

 

The July/August 2020 Issue of the Psychologist has a one page advert from the Forward Trust recruiting IAPT workers and others for positions in  five prisons. The Service Development Manager of the Trust speaking to the Psychologist said  ‘Many of our clients present with complex issues that would preclude then from community IAPT’. Which raises the interesting question of what body of evidence are they to call upon in dealing with these complex cases. Doubtless the Trust has done valuable work in for example giving out self-help leaflets to help prisoners manage the Covid crisis and facilitating connections with family. But such work was done hitherto by probation officers. The Trust was founded 30 years ago to support people in prison with drug problems. Where is the added value of an IAPT input?

IAPT has already published data showing clients with personality disorders do less well in community IAPT.  But IAPT clinicians have no way of reliably identifying clients with personality disorders. Further there is no evidence that they can faithfully administer a treatment protocol for personality disorder.  It seems that this is yet another example of IAPT’s expansionism,  matching its’ foray into treating long term  physical conditions that are medically unexplained. The lack of demonstrated evidence seems not to bother the service, it will likely proceed by running workshops of alleged best practice. It takes it for granted that its’ expansion is an obvious good. This is actually incredibly arrogant, demeaning of pre-existing services.

 

‘Just Give Us The Resources To Treat Personality Disorders’ and then what?

There has been a great clamour this week from mental health bodies, including the Royal College of Psychiatrists (RCP) for more monies  to address the grave problems of clients with personality disorders (PDs). But they have neglected to add that there are few randomised controlled trials of psychological treatments for PDs and those that have been conducted have had very different outcome measures. It is important that clients with personality disorder are given realistic expectations of treatment and are protected from commonplace misdiagnosis.

One of my clients lost access to her children in part because a psychiatrist claimed she had an emotional unstable personality disorder (EUPD), fortunately legal action is being taken against the local authority for their part in this debacle. The latter were insistent she attend a mentalisation group, my protest that she did not have a personality disorder and therefore did not have to  attend went unheard! The stresses of taking the legal action have been colossal. Maybe the energies of the RCP might be better spent making sure its’ members make reliable diagnosis.  As part of the legal proceedings in this case a Psychiatric Expert Witness rejected the opinion of the treating psychiatrist but not before a great deal of distress had already been caused to her and her 3 children.

Dr Mike Scott