Categories
l

The Mistreatment of IAPT Clients – The Smoking Gun

What right has the Improving Access to Psychological Therapies (IAPT) Service to routinely label each client with a diagnostic code (ICD of the International Classification of Disorders, World Health Organisation) when the Organisation’s Manual states that it does not do diagnosis. Fearful of litigation, it states that its diagnoses should not be used for medico-legal purposes, but as the code is the determinant of treatment, IAPT should be in the dock!

The Improving Access to Psychological Therapies (IAPT) service screens clients for treatment using the PHQ-9 but a study published in the British Medical Journal by Brooke Levis et al last year http://dx.doi.org/10.1136/bmj.l1476  indicates that half the  deemed depression cases  have been incorrectly diagnosed. 

In high quality randomised controlled trials of the treatment for depression all clients admitted have been diagnosed as having depression according to a ‘gold standard’ diagnostic interview such as the SCID. The recovery rate in the rcts is 50%. But IAPT claims that it approaches the recovery rate of rcts. This is preposterous! Consider 100 IAPT cases which score above the PHQ-9 cut off of greater or equal to 10. One half of them i.e 50 will not actually have depression and therefore cannot recover from the disorder. Of the other half, 50 cases, if the IAPT clinicians were as good as in the rcts 25 would recover. Thus the maximum possible recovery rate for depression in IAPT is 25% and this is assuming its clinicians are as good as the highly trained clinicians in rcts. More plausibly the recovery rate for depression in IAPT is the 14.9% I found in my independent study of IAPT, http://DOI: 10.1177/1359105318755264 https://doi.org/10.1177/135910531875 using the SCID.

In primary care 22% of patients score over 10 on the PHQ9, so what are the treatment implications for the likely 3 out of 4 IAPT clients who score below 10? For these the PHQ-9 offers no direction.

But IAPT has its’ own answer, IAPT Manual, p 24  (2019), a) come up with a problem descriptor then choose an ICD 10 that that ‘matches’ the descriptor and  then b) a NICE treatment that matches the ICD 10 code.  Consider an IAPT client who reports that they are feeling emotionally numb at work, detached from others and fatigued after little exercise. The therapist could plump for either depression, burnout, chronic fatigue syndrome or the effects of COVID-19, with no guidance as the appropriate label! 

Using IAPT system Delgadillo et al (2020) http://dx.doi.org/10.1037/ccp0000507 classified over 40% of clients as having ‘Affective Disorder’  and over 20%  as having a ‘mixed disorder’. But there are no randomised controlled trials for ‘affective disorder’ or ‘mixed’, so that for 60% of IAPT’s clients there cannot be an appeal to an evidence based treatment (i.e one based on a randomised controlled trial). Considering again a sample of 100 IAPT clients who score less than 10 on the PHQ9 60 of them will have been labelled with a disorder for which there can be no evidence based treatment, this leaves 40 clients who in principle could be treated  with an evidence based treatment. Again assuming that for this population of 40 that allegedly covered GAD (10-12%), panic disorder (4-6%), social anxiety disorder (4-6%), specific phobia (0.5-1.0%), OCD (4-5%), PTSD (6-8%) and other (2-3%) there was an overall recovery rate of 50% only 20% of the allegedly ‘non-depressed’ clients would recover. This 20% would have to regarded as an upper limit because it assumes the IAPT therapist would be as skilled as the highly trained therapists involved in the rcts for anxiety disorders. A more realistic estimate of recovery for the IAPT ‘anxious clients’ would be the 14.2% found in my study of IAPT clients http://DOI: 10.1177/1359105318755264 https://doi.org/10.1177/135910531875

The other metric employed  by IAPT is the GAD-7, a measure of the severity of anxiety, but as according to IAPT it has only been relevant to one in 10 of its service users, any effect of the treatment of this disorder will only effect the above picture minimally. Assuming a 50% recovery the effect will be even less and less still when one compares the training of therapists in GAD acts with the training of the routine IAPT therapist.

IAPTS sole reliance on psychometric tests and fudge has backfired badly, but it is the client who suffers most, with therapists suffering from the recoil.  

Dr Mike Scott

 

 

 

425 replies on “The Mistreatment of IAPT Clients – The Smoking Gun”

You’ve made some decent points there. I checked on the internet for more information about the issue and found most individuals will go along with your views on this site.

Hello, There’s no doubt that your web site could be having internet browser compatibility problems. When I look at your web site in Safari, it looks fine but when opening in I.E., it’s got some overlapping issues. I merely wanted to provide you with a quick heads up! Other than that, fantastic website.

You are so interesting! I do not believe I’ve read through a single thing like that before. So nice to find someone with original thoughts on this subject. Really.. thanks for starting this up. This web site is something that is needed on the internet, someone with a bit of originality.

Can I just say what a relief to discover an individual who actually understands what they’re discussing on the internet. You actually know how to bring a problem to light and make it important. More and more people ought to check this out and understand this side of the story. I was surprised that you are not more popular given that you certainly possess the gift.

An outstanding share! I’ve just forwarded this onto a colleague who was conducting a little research on this. And he in fact ordered me breakfast because I found it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanks for spending the time to discuss this subject here on your site.

Your style is really unique compared to other people I’ve read stuff from. Thank you for posting when you have the opportunity, Guess I’ll just book mark this blog.

May I simply say what a comfort to uncover an individual who genuinely knows what they are talking about over the internet. You certainly know how to bring an issue to light and make it important. A lot more people ought to read this and understand this side of your story. I was surprised you aren’t more popular given that you certainly have the gift.

Aw, this was an extremely good post. Taking the time and actual effort to create a very good article… but what can I say… I put things off a whole lot and never seem to get nearly anything done.

You have made some really good points there. I checked on the internet to learn more about the issue and found most people will go along with your views on this website.

zithromax 500 price [url=https://zithromaxbestprice.pro/#]zithromax cost australia[/url] purchase zithromax z-pak

I really love your site.. Great colors & theme. Did you build this site yourself? Please reply back as I’m looking to create my own website and would like to learn where you got this from or what the theme is called. Kudos!

You’re so cool! I don’t suppose I’ve truly read anything like this before. So wonderful to discover someone with a few original thoughts on this issue. Really.. many thanks for starting this up. This site is one thing that’s needed on the internet, someone with a bit of originality.

You are so awesome! I do not believe I have read through a single thing like this before. So nice to find another person with some original thoughts on this topic. Really.. thanks for starting this up. This web site is something that’s needed on the web, someone with a bit of originality.

The next time I read a blog, I hope that it won’t fail me as much as this particular one. After all, I know it was my choice to read, but I actually believed you would probably have something interesting to say. All I hear is a bunch of whining about something you could fix if you were not too busy seeking attention.

Hello there, I do think your blog could possibly be having web browser compatibility issues. When I take a look at your website in Safari, it looks fine however when opening in I.E., it has some overlapping issues. I just wanted to give you a quick heads up! Apart from that, excellent website.

An outstanding share! I have just forwarded this onto a friend who had been doing a little research on this. And he in fact bought me breakfast because I stumbled upon it for him… lol. So allow me to reword this…. Thanks for the meal!! But yeah, thanx for spending time to talk about this subject here on your internet site.

Hello there, There’s no doubt that your blog could possibly be having web browser compatibility problems. Whenever I look at your site in Safari, it looks fine but when opening in IE, it has some overlapping issues. I merely wanted to give you a quick heads up! Besides that, fantastic site!

An interesting discussion is worth comment. I do believe that you need to publish more about this issue, it might not be a taboo subject but generally people do not talk about these topics. To the next! Kind regards.

This is the right website for anybody who hopes to find out about this topic. You know so much its almost tough to argue with you (not that I personally will need to…HaHa). You definitely put a fresh spin on a subject which has been discussed for ages. Excellent stuff, just excellent.

Howdy! This post could not be written much better! Going through this article reminds me of my previous roommate! He constantly kept talking about this. I am going to forward this information to him. Fairly certain he’s going to have a great read. I appreciate you for sharing!

You have made some good points there. I checked on the internet for more information about the issue and found most people will go along with your views on this website.

This is the perfect website for anyone who hopes to understand this topic. You know so much its almost hard to argue with you (not that I really will need to…HaHa). You definitely put a brand new spin on a topic that has been written about for years. Excellent stuff, just excellent.

An impressive share! I have just forwarded this onto a colleague who had been conducting a little homework on this. And he actually bought me dinner simply because I stumbled upon it for him… lol. So allow me to reword this…. Thanks for the meal!! But yeah, thanks for spending the time to discuss this subject here on your web page.

Can I simply say what a relief to discover somebody who truly understands what they’re discussing on the web. You actually realize how to bring a problem to light and make it important. A lot more people must look at this and understand this side of your story. I was surprised that you aren’t more popular since you certainly possess the gift.

An outstanding share! I have just forwarded this onto a friend who was conducting a little homework on this. And he actually bought me dinner due to the fact that I stumbled upon it for him… lol. So allow me to reword this…. Thank YOU for the meal!! But yeah, thanx for spending some time to discuss this topic here on your web site.

Hi, I do think your website may be having internet browser compatibility issues. When I look at your website in Safari, it looks fine however, when opening in I.E., it has some overlapping issues. I simply wanted to provide you with a quick heads up! Apart from that, excellent site.

Oh my goodness! Amazing article dude! Thanks, However I am going through problems with your RSS. I don’t know why I cannot join it. Is there anybody else having identical RSS issues? Anyone that knows the solution will you kindly respond? Thanx!

I really love your website.. Very nice colors & theme. Did you create this web site yourself? Please reply back as I’m attempting to create my own personal site and would love to learn where you got this from or exactly what the theme is named. Cheers!

You are so interesting! I don’t think I have read something like this before. So great to discover another person with some original thoughts on this subject. Really.. many thanks for starting this up. This website is something that’s needed on the web, someone with some originality.

Howdy! This article could not be written much better! Looking at this post reminds me of my previous roommate! He continually kept preaching about this. I am going to forward this post to him. Fairly certain he will have a very good read. Many thanks for sharing!

I would like to thank you for the efforts you have put in writing this website. I’m hoping to check out the same high-grade blog posts from you later on as well. In truth, your creative writing abilities has motivated me to get my own blog now 😉

I truly love your site.. Very nice colors & theme. Did you develop this web site yourself? Please reply back as I’m attempting to create my own site and want to learn where you got this from or just what the theme is called. Thank you.

Oh my goodness! Incredible article dude! Many thanks, However I am experiencing difficulties with your RSS. I don’t understand the reason why I am unable to subscribe to it. Is there anybody else getting identical RSS problems? Anybody who knows the answer can you kindly respond? Thanks.

Can I simply just say what a relief to find somebody that really understands what they are discussing over the internet. You certainly realize how to bring a problem to light and make it important. A lot more people should look at this and understand this side of your story. I was surprised you are not more popular because you certainly possess the gift.

Aw, this was an incredibly good post. Taking a few minutes and actual effort to produce a good article… but what can I say… I put things off a whole lot and never seem to get nearly anything done.

Hey! I’m Charles, and if you’re tired of the 9-to-5 grind and think office coffee tastes like anguish, I’ve got good news for you. Welcome to the 1K a Day System, where we switch coffee for capital and desks for financial self-reliance. Are you all set to trade in your tie for a ticket to freedom? Let’s turbocharge your revenues and have some fun along the method!

What’s up, future millionaires? Charles here, your captain on this journey to the treasure island of affiliate marketing. Ever imagined making $1,000 a day without breaking a sweat? Well, pinch yourself, due to the fact that you’re not dreaming! Get your eye patch and your sense of experience, and let’s sail the high seas of opportunity. All aboard the revenue ship!

An outstanding share! I’ve just forwarded this onto a co-worker who was conducting a little research on this. And he actually ordered me breakfast because I stumbled upon it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanx for spending the time to talk about this subject here on your site.

Leave a Reply

Your email address will not be published. Required fields are marked *