What Works For Whom In High Intensity Talking Therapies?

It doesn’t matter if the person has high intensity CBT or high intensity counselling or if they have had low intensity CBT beforehand, according to a study by Barkham and Saxon (2018) https://dx.doi.org/10.1186%2Fs12888-018-1899-0, of the Improving Access to Psychological Therapies (IAPT) service. This raises important questions:

  1. What has been the value of low intensity CBT for those who have high intensity treatment?  
  2. NICE recommends CBT for depression and the anxiety disorders, with different protocols for different disorders and not counselling, have IAPT proved them wrong? 
  3. Given that IAPT provides no evidence of the setting and monitoring of homework, a hallmark of CBT, can there be any certainty that CBT was actually delivered?
  4. What is the evidence that the stepped care model employed by IAPT works?
  5. Why has the British Government just given an extra £38 million to IAPT?
  6. On what basis does NHS England’s National Mental Health Director, Claire Murdoch claim proclaim our ‘world-leading talking therapies’?
  7. Are there conflicts of interest between being a Department of Health Adviser and playing a leading role in IAPT? 
  8. Why has IAPT been allowed to mark its’ own homework? In similar vein ‘why has there been no independent audit ion IAPT using ‘gold standard’, standardised diagnostic interviews?’.

In the 3 years since the publication of the Barkham and Saxon (2018) study there has been a deafening silence from IAPT in answering questions 1-4. The Government is likely to be similarly mute in answering questions 5-8, fearing that it would have to admit to having wasted about £5 billion on IAPT.

There is a clear need for a public inquiry to ask the above questions. The Government likes to portray itself as ‘progressive, waving the mental health banner’,  the last thing Labour wants is to appear otherwise. The unspoken mantra is don’t ask the consumers of mental health services about whether they have had their lives restored, ‘let us get on with being politically correct’.

 

Dr Mike Scott

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