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BABCP Response - NICE Consultation January 2022

Where IAPT Has Never Happened, No Evidence Of Worse Outcome

Clinical Commissioning Groups (CCG’s) should consider why other parts of the UK have not followed England’s lead on IAPT, after more than a decade. Wales, Scotland and Northern Ireland  have remained unimpressed by IAPT’s groundbreaking claims and have not followed suit.  In Wales almost 40% of people surveyed said ‘yes’ or ‘mostly’ when asked had the services they accessed led to improved mental health and wellbeing  [Gofal (2016) Peoples experiences of primary mental health services in Wales Three Years On].  The results show that the largest proportion of respondents (79%) were offered prescription medication. The proportion of people who felt that they has been offered advice and information was 77%. 21.5% were offered Cognitive Behavioural Therapy, while 32% were offered another form of psychological therapy. 36% were offered a further mental health assessment. 26% were referred to another service and 17% were signposted to another service. Just 12% were offered physical exercise, 10% were offered books on prescription and 3% were offered befriending. If you have a mental health problem in Wales it is not obviously worth the trip across the border to an English IAPT service.

There are undoubtedly serious problems with mental health services across the UK, but these are no less in England despite IAPT. .

Dr Mike Scott

12 replies on “Where IAPT Has Never Happened, No Evidence Of Worse Outcome”

So…I am a fairly cynical pwp in a step 2 iapt service. I think we do pretty well with people with mild difficulties. I have no idea what happens with the people with more complex difficulties who i step up to step 3 iapt which is supposed to offer counselling or cbt or even referral on to psychotherapy or other therapies. I suspect iapt means that far more people are being assessed and referred to higher services than previously, which could be a good thing. I agree with you that as the least qualified person in this hierarchy , I may well not be best placed to assess exactly what people need. In my workplace staff enter data around recovery (phq9/gad7) and are incentived with extra days holidays for above average “performance” which I find questionable ethically. I think my service is genuinely helpful to some people but absolutely not everyone r.

With respect to IAPT/talking therapies in Wales, this document (perhaps from a year or two ago) may be of interest –
[PDF]
We need to talk Wales – Mind

It mentions that the IAPT programme in England ‘has not been perfect’, but that Wales deserves a ‘similar focus’ on psychological therapies.

Thanks Paula for having the courage to enter a debate over IAPT, many people are understandably terriffied to do so openly.Issues such as a 22% annual turnover of staff in low intensity and 68% burntout [Westwood et al (2017) Journal of Mental Health] need to be discussed. I have no doubt that there are individual therapists in IAPT doing a good job, just as there were before the inception of IAPT. But there is no evidence that it is better than ‘business as usual’.
Thanks Liz for bringing the Mind Wales document to my attention, Charities are very fuzzy about criteria for evaluating effectiveness, they do not ask questions such as ‘what proportion of clients, said they returned to their usual self post treatment, when asked by someone independent of the service? How long had they been back to their old selfs? What proportion of clients were found to have lost their diagnostic status after treatment when assessed independently’ As such Charities such as Mind can easily succumb to the marketing of IAPT particularly when there is the prospect of a financial arrangement with them. It is not appreciated that PHQ9/GAD7 scores are next to meaningless when not used in a diagnostic context.
Mike

It’s great to hear the views of someone from inside the service. I’m sure that those of us who are campaigning against various aspects of IAPT bear no ill will whatsoever towards the thousands of PWPs on the front line who are doing their utmost for the people that they see in what must be, at least at times, quite a stressful environment.

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