Without IAPT, The Same ‘50%’ Recovery Rate – Why Do CCG’s Fund It?

One of IAPT’s criteria for claiming patient recovery is shifting a patient’s PHQ9 score to less than 10. But in a study by Gilbody et al (2015) [ see link below] involving 179 patients undergoing treatment as usual in primary care with an initial diagnoses of depression and PHQ9 scores of above 10, 101, (56%) of patients recovered within 4 months. [ A study of treatment as usual cases by Moore at al (2012) similarly showed a 47% recovery].  IAPT currently claims a 50% recovery rate, the burden of proof is on IAPT to demonstrate that it produces results significantly different to those treatments engaged in before its’ inception.

Even when the metric is an adequate treatment response the differences between IAPT and treatment as usual (TAU) are not apparent. In the study  by Moore et al (2012) [see link below] of 576 TAU cases of depression who completed the PHQ9 twice (mostly within 3 months)  63% showed an adequate treatment response ( a drop of 5 or more points), this is not  discernibly different to IAPT’s findings.

CCG’s want it seems to be seen to be mindful of mental health, as their masters NHS England dictate, but don’t want to engage in effortful thinking in this domain, bypassing it by talking only of operational matters, numbers, waiting times etc.  It is a new political correctness that also permeates the political parties.

The true metric of recovery is returning a person to their usual self ( a minimum component of which is losing diagnostic status, assessed independently), IAPT has studiously avoided  such a hard outcome measure preferring its’ own surrogate. All this despite that the original randomised controlled trials for anxiety and depression insisting on hard outcome measures.

 

Unfortunately mental health charities are often now dependent on IAPT and private agencies seek to ape IAPTs metrics, the upshot is that for the past decade there has been precious little evidence based psychological treatment of the sort I advocated in Simply Effective CBT London: Routlege (2009).

https://www.dropbox.com/s/awwtpdhv0mxbtht/Treatment%20as%20usual%20recovery%20rate%202015%20Gilbody.pdf?dl=0

https://www.dropbox.com/s/mupj14fq14eba4g/Depression%2050%25%20natural%20recovery%20on%20PHQ9%20within%203%20months%20of%20GP%20diagnosis.pdf?dl=0

Dr Mike Scott

5 thoughts to “Without IAPT, The Same ‘50%’ Recovery Rate – Why Do CCG’s Fund It?”

  1. In answer to your question – why do CCG’s still fund IAPT? – here’s my answer. The evidence strongly suggests that IAPT is a front for cutting physical healthcare services so forcing desperate patients into the private sector. CCGs fund it because they’ve been conned that it will help them reduce their physical healthcare spending, even though the IAPT evaluation exercise showed otherwise…..but I doubt they are told about that. Instead they’ve been advised by a bod at the top that they should consider going ahead with cutting their physical healthcare spending now on the basis of some hyped preliminary IAPT results. How responsible is that?

    1. That irresponsible ‘bod at the top’ wouldn’t happen to be included in the New Year’s Honours List 2019, would they?

      1. It’s no great surprise, you can’t beat the establishment. Look further up the track and you find a CBE for David Clark, co-architect of IAPT, for services to mental health, in the same New Year honours list (2013) as Simon Wessely’s knighthood for services (including) to psychological medicine.

        In the document “Cost-Benefit Analysis of Psychological Therapy” (2007) by Richard Layard, David Clark, Martin Knapp and Guy Mayraz, the case is made that significant savings to the NHS’s physical healthcare budget can be made by addressing unnecessary referrals to outpatient care for patients with medically unexplained symptoms (MUS), and they imply that 50% of referrals could be deemed unnecessary. Think about that – potentially 50% of outpatient appointments under threat. They cite a study by Wessely and co-authors Nimnuan and Hotopf (2001). This removes the safety net that is essential in medicine to deal with the risk of misdiagnosis. By my calculations it means that around 2 million necessary adult new referrals per year may not go ahead as a direct consequence of this policy, that this many ‘physical’ or ‘organic’ problems may in future go undiagnosed. TWO MILLION per year! For paediatrics my estimate is around 80,000.

        You sense that IAPT is a project that will not be allowed to fail. With 2/3rds of expansion of IAPT services going into the MUS and LTC (long term conditions) arms, the reason for the IAPT programme is self-evident. It has little to do with caring for the mentally ill and everything to do with reducing the physical healthcare and secondary care budgets, keeping people in primary care whether that’s appropriate or not. (see today’s headlines).

        1. I’m aware of some of these issues. If the general public were as aware as some academics are slowly becoming aware of what’s going on under the ‘NHS England’ banner they’d be afraid..very afraid. But then media is in thrall to those who promulgate this stuff so the general public won’t know about it until it impacts them directly and it’s all too late. It really rather is ‘all too late’….

  2. This is really interesting, I’m just passing your comments on to a colleague, he and I are in the final stages of writing a paper on on IAPT and MUS/LTC. Tomorrow I’m putting up a blog on a recently published cost benefit analysis of IAPT that suggests that they have not proven their case by any means.

    Mike

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