‘Two thirds of GPs providing specialist mental health support beyond their competence’ this was the headline in Pulse, May 9th 2022. This has been brought about by NHS pressures. With 38% of consultations having a mental health element compared to 25% pre-Covid. But there is no evidence the patients have fared less well than if they had been referred to the Government’s Improving Access to Psychological Therapies (IAPT) business (or secondary care mental health services). In similar vein there is no evidence that those attending the Citizens Advice Bureau with mental health problems do any less well than those attending IAPT [http://www.cbtwatch.com/no-evidence-that-the-improving-access-to-psychological-therapies-iapt-service-does-any-better-than-contact-with-the-citizens-advice-bureaux-cabx]. It appears that IAPT is no better than an attention placebo.
Ideally IAPT would have been subjected to a randomised controlled trial in which clients were alternately assigned to the services ministrations and to a credible placebo intervention. With outcome gauged by blind assessors, using a standardised reliable diagnostic interview. But no such study has been forthcoming or seems likely to happen anytime soon. Though less than ideal comparisons can be made with the trajectory of attendees of GPs and Citizens Advice Bureaus.
The burden of proof is on IAPT to demonstrate that its’ staff have a competence beyond that of GP’s and Citizens Advice Bureau Workers, that makes a real world difference to client outcome. My own research [Scott (2018) https://doi.org/10.1177%2F1359105318755264] suggests that only the tip of the iceberg of IAPT clients recover .
GPs acknowledge the limits of their competence, IAPT staff do not, at least publicly. Unfortunately nobody holds them to account, they are a law unto themselves. We continue to throw away over a £1 billion a year on IAPT, with the National Audit Office, NHS England and Clinical Commissioning Groups showing a radical apathy about the matter.
Dr Mike Scott