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The Care Quality Commission (CGC) Is Being Duped by IAPT

IAPT is camouflaging what most of its clients receive and has eskewed a focus on clinically relevant outcomes. But one of the domains that the CQC assesses services against is whether they are Outcomes-focused. The CQC needs to conduct an inquiry into IAPT.

Guided Self-Help (GSH) has been the diet of 71% of IAPT’s clients, but therapists have now been advised not to mention GSH, because it may be off-putting! But rather to refer instead to ‘low intensity telephone CBT’ . Notwithstanding that NICE has justified its’ support for low intensity CBT on the basis of studies that were termed ‘GSH’. There is a transparency about offering GSH, clients have a right to know what they are letting themselves in for. Informed consent cannot be meaningfully given to a term like ‘low intensity telephone CBT’.

The matter of informed consent is compounded further by IAPT by their failure to inform clients of what clinically relevant outcome he/she can expect. In particular what minimally important difference the client can expect and clearly see as meaningful. Changes on a psychometric test do not qualify as a clinically relevant outcome by contrast a client can clearly understand say an expectation to be back to their usual self.

IAPT’s ‘low intensity telephone CBT’ itself rests on a fault line, studies that found statistical significance between groups e.g computer assisted CBT vs waiting list, but without a) any discussion of the clinical relevance of the findings and b) blind independent assessment of outcome. Dissemination of the low intensity interventions has been promoted on the back of statistical significance rather than clinical relevance. This makes it imperative that the CQC becomes outcomes focused in a transparent way and is not sucked in by IAPT’s self serving surrogates.

Dr Mike Scott

555 replies on “The Care Quality Commission (CGC) Is Being Duped by IAPT”

Thanks for this post Mike. You’ll probably know better than I what therapists are being advised or told to offer, but what you describe sounds rather like mis-selling. The other point I’d make is that studies (presuming you’re meaning RCT’s here) can find all the statistical significance they like, but you’ll only get an outcome when there’s a client at the end of some process. RCT’s don’t tend to report on drop out in my experience, so even if 90% of the recipients of the intervention with the so-called active ingredients dropped out you can still get a statistically significant difference between interventions X and Y. So we need to look at acceptability as well as efficacy or effectiveness.
Cheers! Barry

I have been told to describe step 2 this way and it makes me very uncomfortable, when I was training I was always advised to refer to step 2 as guided self-help. It puts front line staff in a very difficult, and basically unethical, position.

Hi Liz
This is really interesting and there is so much in the responses to your piece. I must do something on IAPT and work when I get a bit of space
Best wishes

Mike

By Post Author

Thanks once again Liz will contact Sue. I think that there is a fundamental problem about blurring the distinctions between disorders such as depression, medical disorders such as cancer and psychosocial stressors (including poverty). Doubtles there is some interaction between them but they each need dealing with primarily in their own right. Mixing them up and then giving a prime weight to therapy is ridiculous.
Best wishes

Mike

By Post Author

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