Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform, 2018, Scott

Hi Sarah - I'm happy to address the questions that you've posted but I'm afraid I have run out of time before I go on annual leave.

While my team doesn't have capacity to regularly monitor and post in S4ME in my absence, they would be happy to respond to questions by email or phone.

I will be back in the office w/c Mon 30 July and hope to return to the forum then.

 

This made me wonder: Does the UK government try to establish what we have in Germany, namely having ME/CFS diagnosed (and re-diagnosed) as F45.0 or F48.0?

 

The F45.0 coding is for patients referred for MUS for IAPT national reporting purposes in this instance.

"For those in integrated care with a medically unexplained symptom (MUS), ‘Somatization Disorder’ (ICD-1016 code F45.0) should be selected as the primary problem to identify their specific condition. The relevant MUS-specific outcome measure can then be used for the calculation of recovery (provided paired scores are available)."

https://files.digital.nhs.uk/publication/7/7/iapt-int-rep-dec-2017-exec-sum.pdf

 

From that, it looks like (although it's not entirely clear) their 'recovery' measure relevant to CFS is just a Chalder Fatigue score of 18 (the same cut-off PACE used for their post-hoc criteria, which overlapped with their entry criteria. Wonder what their justification for that is.

Diagram from Wilshire & colleague's recovery paper to illustrate how this overlaps with the trial's entry criteria:

 

So, what we're actually seeing is that government gives a damn about the PACE trial that was shown to be unscientific and to have no effect, because politically it is desired to put people into MUS. And in politics it holds "What doesn't fit is made to fit". What we see is, for politics, science is irrevelant. Maybe because for most people science is irrelevant and so there is no one who gets loud.

But still, I think it is crucial to show what realitiy is, and this includes science.

So we also need to start with a new direction.

We need more awareness about the on-goings.

 

I think both come together. It's not new in history, it's common practice.

I wrote in another thread about a German psychiatrist who obviously lacks certain skills (I want to be nice) but is determined to spread the word, and authorities are quite thankful, because now they can save money AND say "scientists say so". WE know people of that kind aren't scientists, and actually I sometimes think authorities, governments etc know so, too. But such people now get their forum.

So we need to make public what these people are - no experts. Sadly, we can't attack governments directly at this point because what we say will be called "conspiracy theory".

This is all so frustrating.

 

Does anyone know if the Journal of Health Psychology August issue is a special issue re IAPT or just a feature article?

 

It looks that way as far as the CFQ goes. I'm aware of this from the IAPT-LTC Full Implementation Guidance:

Both Chalder Fatigue Questionnaire and PHQ-9 are bolded.

"Notes: Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair measures highlighted in bold. When the measure in bold in the middle column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD-7, if this is different."

Also, from the IAPT Manual:

The measure in the third column is the Chalder Fatigue Questionnaire

"Recovery, reliable improvement and reliable deterioration rate calculations should be based on the pair of measures highlighted in bold. When the measure in bold in the third column is missing, the recovery calculation is based on the combination of PHQ-9 and GAD7, if this is different."

Also:

" 6.2.2 IAPT-LTC and MUS outcome measures
To support the implementation of The Five Year Forward View for Mental Health, LTC and/or MUS data from participating IAPT providers will be collected before widespread rollout to all IAPT providers."

Roll-out is being implemented, so I'm not sure what this means for data collection. Although in practical terms it probably doesn't make much difference from an implementation perspective, I think Fibromyalgia is reported as a LTC, although it depends on the the IAPT document you read as to whether Fibromyalgia is described as MUS or a LTC.

From the MUS Positive Practice Guide:

"Membership of the IAPT Medically Unexplained Symptoms Evaluation Task and
Finish Group (2012-13):

I seem to recall it will be a dedicated section.

 

I think this is the driving force. Which is why therapist-delivered treatments need to be audited and licensed in the way drugs are and those marketing them treated like pharmaceutical companies.

 

I have not looked at the status of IAPT " deliverers" other than one link which was a private company set up by psychs, physios/ OTs and business managers. Nice pension scheme for former NHS personnel .

 

Insight Healthcare has a dedicated "Chronic fatigue" page:

 

Interesting how they talk about 'chronic fatigue', but link to pages on CFS/ME.

 

How can there be a symptom of a symptom?