The most recent edition of the IAPT Manual, February 2023 states that over 98% of clients completed two psychometric tests at the beginning and end of treatment. This sounds like pretty impressive monitoring of outcome. But less than half of clients (46%) complete treatment, defined as attending two or more treatment sessions. There is a deafening silence from NHS Talking Therapies about the dropouts. Most plausibly half of clients are voting with their feet before treatment begins.
Therapist use the test results to demonstrate to managers that they have achieved the necessary 50% recovery rate with clients. Failure to achieve this target can result in sanctions. It is therefore not surprising to find, as Faija et al (2022) did, that there is considerable variation in the way in which clinicians ask the questions on the tests and in the proffered response options. These authors found that the ritual completion of two tests (PHQ-9 and GAD-7) at the beginning of each session was regarded by clinicians an encumbrance and that it had no bearing on the treatment session. For managers and NHS Talking Therapies the data is nevertheless pressed into service as propaganda. This extensive database is meaningless.
The questionnaires measure the severity of depression and generalised anxiety disorder. But NHS talking therapies clinicians do not make diagnoses. So that the tests are de facto administered in a vacuum. The data are no more meaningful than same tests completed by attenders attenders at a shopping centre or at a GP surgery. By themselves they betoken nothing at all. It can be expected with repeated completion of the tests, in whatever context, scores will come down as people remember previous scores. Announcing as NHS Talking Therapies does that the improved scores indicate recovery from a disorder, is nonsense. Matters become even more bizarre when the Service implies that its’ ministrations have played a pivotal role in the recovery.
Monitoring is an expected part any professional activity, whether it be in an operating theatre or on a plane. It is understood that those charged with monitoring will be able to give feedback to the active players if anything is amiss. Whilst there is an authority gradient between the latter and former, this is not allowed to hold sway. But it is very different in NHS talking therapies the clinician has no means of open dialogue with managers or the Organisation. It is despotic rule. The client is a pawn in a game with combatants of different agendas.
Dr Mike Scott