assessment in the Improving Access to Psychological Therapies (IAPT) Service takes up 25% of all resources, yet in the NICE approved protocols for depression and the anxiety disorders assessment takes about 8% of resources (roughly an assessment session for 10-15 treatment sessions). Much of the IAPT assessment consists of telephone completed screening questionnaires by contrast the assessment in the NICE protocols consists largely of a reliable standardised diagnostic interview. But there is no reason to believe that the screening measures in IAPT (PHQ-9 and GAD-7) are pertinent to the client’s problems. Despite this in IAPT, these measures are re-administered every session and often made the focus of discussion, thus the actual total time spent in IAPT on ‘assessment’ is likely much more than 25% of the budget. The added value is? IAPT has a credibility gap. Is it really credible that with such a skewed distribution of resources, that IAPT should claim success comparable to that found in the randomised controlled trials that are the basis for NICE recommendations? IAPT claims fidelity to NICE protocols, so that it is not divorced from its’ paymasters NHS England/Clinical Commissioning Groups, but it is a well known philanderer. It provides no evidence of fidelity, just protestations.
I hear that IAPT is looking at introducing artificial intelligence into the assessment process! Whilst there are attempts to develop an algorithim for suicide risk by looking at records etc, the outcome is likely to be some marrying of this with clinician expertise. But this goal is quite a challenge. A meaningful algorithim for IAPT’s assessments is likely to be a whole different ballgame. Time would be better spent doing the simple things such as really listening to clients and making a reliable diagnosis to direct treatment, this would be an exercise in intelligence.
IAPT represents an extreme case of the tail wagging the dog when it comes to screening. A just published editorial in the Journal of the American Medical Association by Mitchell Katz, shows the more general problem of screening: