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

Happy to look at coordinating on something on the patient.co.uk page. Whole sections (which taken together comprise the lion's share) of the Insight Healthcare site look problematic to me.

There is also a medically unexplained symptoms page, which refers to ME & CFS:

Good to see them coming up with their own content. From RCPsych's MUS page:

"What if there is no physical explanation for your physical symptoms? We can often understand and explain such symptoms when we look at how our thoughts, feelings and stresses can affect our bodies."

"To understand them we have to think about how the mind and the body work together."

 

Oh what merry bullshit! It is so like Stanley Unwin:

'To understandiways the sympitoes need to thinkybout howsie mind-a-bodyo worky togetherwise.
Then a nicely goes.'

I guess that would be called Stansplaining these days.

 

What's the only thing worse than a misdiagnosis?

A musdiagnosis (ba-doom tish)

 

If somatization is real and they understand it, why not explain in a sentence how it works and what it is exactly?

Is lack of clear explanation because somatization is not a scientific fact but merely a belief that is useful to ensure jobs for academics and therapists?

An astrologer would probably struggle to give a credible explanation for the following statement:

"To understand these symptoms, we have to think about how the position of the planets and stars influences our bodies."

 

There are two Patient.info pages, a conditions page:

https://patient.info/health/tiredness-fatigue/chronic-fatigue-syndrome-myalgic-encephalomyelitis

And a medical professionals page:

https://patient.info/doctor/myalgic-encephalomyelitischronic-fatigue-syndrome-mecfs-pro

Both pages were authored by a GP, Dr Colin Tidy and appear to have been published in December 2016. According to Wikipedia, if I correctly understand leaflets to mean webpages, they are updated every two years or earlier if necessary.

This sounds like a good approach. An additional approach might be to tackle the professional page, which is referenced, and make some simple clearly referenced suggestions. The author has cited Geraghty a couple of times, and Nacul, which is encouraging. If they take referenced suggestions on for the professional page, that provides leverage for pushing for some changes to the condition page if this isn't automatically done.

 

Indeed!

I thought "Chronic fatigue" has its own ICD code, but I've just searched and found nothing.

Ah, now I found it, "Ermüdungssyndrom" (fatigue syndrome - but not chronic fatigue) is listed under Neurasthenia F48.0. So actually they imply that ME/CFS is the same as Neurasthenia. And they are mixing everything - chronic fatigue, fatigue syndrome, chronic fatigue syndrome...Come on! Oh my, this is such a pain...

Hereby I found that in ICD 9 Chronic Fatigue and CFS had the same code, it seems?Does someone know more?

 

psychology/psychiatry are very good in making circular definitions.

 

@arewenearlythereyet, where is tripe when we need it?

No, seriously, under different circumstances I would think differently, but with LP and the like in mind, where you can get healthy with magic...there's nothing more to offer than tripe.

Edit: Well, if only it was magic!

 

https://twitter.com/user/status/1019107945324470273

 

The JHP Special Section:

http://journals.sagepub.com/toc/hpqa/current

 

Non-Sci Hub Link to full paper, http://journals.sagepub.com/doi/pdf/10.1177/1359105318755264

 

Depressed? The places not to live if you need help
Nick Triggle, Health correspondent bbc.co.uk
19 October 2018
http://www.bbc.co.uk/news/health-45895541

BBC Investigates IAPT – A Stepping Stone To Accountability
Dr. Mike Scott - CBT Watch, 21st October 2018
http://www.cbtwatch.com/bbc-investigates-iapt-a-stepping-stone-to-accountability/

 

I think they (BBC) have completely missed the point and are making out that, largely due to lack of funding, some areas are not reaching targets for access to therapy.
From what I have read before (Marks and Scott), the main issue is the poor recovery rate and bad 'value for money'.

 

I think part of the problem is that Mike Scott does not himself do much to suggest CBT is ineffective. He seems to want it done a different way. He seems to have a view similar to Wessely - that cheap and cheerful rollout is not as good as 'proper training'.

But certainly the BBC seem to have missed any suggestion that maybe the treatment does not actually work very well.

 

This is so like the debate over trickle-down (or supply-side, whatever) economics. The justification for why it fails is always that the tax cuts for the wealthy just weren't large enough. You just haven't done it big enough for it to work. Never mind the budget crisis / suffering it will totally work one day!

Particularly fitting in that no one who defends trickle-down economics actually believes it works. They just make stuff up because it's good for them.

 

"examples of some medically-unexplained symptoms are fibromyalgia, chronic fatigue syndrome (CFS or ME), unexplained pain and non-epileptic seizures"

I have read this before but just actually took in the meaning. They are saying that fibromyalgia and ME are symptoms not syndromes or, god forbid, diseases. I had read other things that led me to believe that they are using fibromyalgia to mean widespread pain and CFS/ME to mean fatigue but it is explicit here.

 

I have seen that many times in the wild.

Naming a syndrome, which by definition means a collection of symptoms, by a single symptom should be considered malpractice. It's complete nonsense.

Not even counting that fatigue is a misleading description in the first place. The hubris and arrogance are astounding. Complete and total failure.