NHS Talking Therapies Glaring Failures, Are Highlighted By A Focus On One of The Long-Term Conditions It Targets : IBS

Are they actually arguing that a 17 pound increase in pay two years after treatment represents success??

And what does this mean exactly: "the probability of being a paid employee within seven years of starting treatment increased to a maximum of a 1.5 percentage points."

Does this mean that of 100 people in the program, 1.5 more people were employed by seven years after treatment? I think so, but I'm not quite sure. And again, they're presenting this as an actual success??
 
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dave30th said:
Are they actually arguing that a 1.5 % increase in employment after 17 pound increase in pay two years after treatment represents success??

And what does this mean exactly: "the probability of being a paid employee within seven years of starting treatment increased to a maximum of a 1.5 percentage points."

Does this mean that of 100 people in the program, 1.5 more people were employed by seven years after treatment? I think so, but I'm not quite sure. And again, they're presenting this as an actual success??
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The standard in psychobehavioral ideology has always been about finding something that looks juuuuuust barely better than nothing and calling it success while doing everything they can to make sure that no one comes up with something that actually works. Sometimes when it doesn't even reach that.

By this standard, 1.5% and £17 would be far above what they usually get and thus a rousing success. In a race to the bottom, everyone loses.
 
rvallee said:
juuuuuust barely better than nothing and calling it success while doing everything they can to make sure that no one comes up with something that actually works. Sometimes when it doesn't even reach that.
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That’s what their analysis says. but when you look at things like drop-out rates you start to wonder if it’s even lower than that, starting to make things worse than better.
 
There’s something rum here. Even the following paper which is trying to argue for cost-effectiveness of IAPT for anxiety and depression: Cost of Improving Access to Psychological Therapies (IAPT) programme: An analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region - ScienceDirect

cites that it was economic argument by Clarke that it was introduced on a mass scale

and that 2 pilot areas ‘tested this’ and then quote Clarke et al (2009) Improving access to psychological therapy: Initial evaluation of two UK demonstration sites - ScienceDirect
This 2024 paper quotes it as:
“Of the 55% who completed 2 or more sessions 5% went from unemployment to part or full time employment”

which is at best just over 2.5% they sold it on.

except looking at this Clarke et al 2009 paper. There were two pilot centres. For Doncaster, 4451 people were referred and by the end it was 1654 who did two or more sessions. They’ve just excluded the ones who were deemed not suitable and mutually decided elsewhere was better or refused treatment but 1654/4454 =0.37

of those only 1257 had their prior condition coded, and of those only 833 had been ill for 6months

all this is in a table on page 4

at the end of treatment some 650 were ‘still cases’ - by their own iapt recovery measures - the recommendation in the paper is to step up therapy to iapt high-intensity BUT therapist was allowed to refer outside the service to counselling if patients expressed a preference for that

it seems at that point there was a clear vote with their feet as only 25 went for high-intensity iapt CBT and some 400+ went to counselling

page 5 section employment and benefits outcomes notes it only had data for 445 (27%) but that of those who ‘had 2or more sessions AND had been on SSP' 4% returned to work, which they claimed correlated with the claims made by Layard etcal (2007) - which I guess was an economic case for iapt to be set up vs claimed costs - of exactly of 4% ‘of those who complete treatment would return to work’ , however I haven’t check whether the Layard paper caveated that as those on Ssp

The follow-up measures for Doncaster were in Jan-feb 2008 contacting those who completed treatment by Sept 2007 (min 5months later) . The eligible group who’d completed treatment was 1444 but 893 people (chosen at random) who’d completed treatment were mailed a survey.

They claim of those who replied with employment data, 343 people, there was a 10% increase in employment from 190 being in work and not claiming sick pay compared to 155 coded as such initially. Except it is commonly known that most sick pay ends at 6months and around that point if you can’t start trying to return to work ‘processes begin’ as well as people having no sick pay? So the 153 left from the 343 who did want to respond (and I’d imagine there is a bias to not wanting to write back with bad news) had no employment and despite id guess by this point many will have exhausted their sick pay.

So actually we don’t know how many people ‘went the other way’ but there is evidence that 35 more people being coded as employed vs number who’d been coded as such before treatment in those who completed and replied (343) for the eligible sample of 1444. They can’t sssume that 343 is an externally valid representation of all 1444 to extrapolate.

it's 35 more people. 10% of 343, but not extrapolatable to claim even 10% of 1444? And no info on how many were employed and went the other way?

Page 7 There is then the Newham centre they had 135 people only with pre and post employment questionnaires. Say the change is 10% not on SSP but then report that 4% of this were in the ‘other’ category with no work, SSP or benefits.

Their follow up (also feb 2008) found only 161 eligible to be mailed the survey, only 60 responded. And they don’t even mention employment for this (just analysis of eg GAD scores).


I’m struggling to find any robust example of 5% in the Clarke eg al (2009) paper that corresponds to the quote that this 2024 paper has referenced to it. And at longer term I can only see actual evidence for 35 people as a change - call it 10% of a very narrowed down field of 343 if they want. But 4454 were referred there - and they’ve used a heck of a lot of ‘not gates’ to narrow that 343/4454 = 7.7% (35/4454 = 0.8%) who even got to the stage of completing a survey? Heck of a selective filter?
 
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bobbler said:
There’s something rum here. Even the following paper which is trying to argue for cost-effectiveness of IAPT for anxiety and depression: Cost of Improving Access to Psychological Therapies (IAPT) programme: An analysis of cost of session, treatment and recovery in selected Primary Care Trusts in the East of England region - ScienceDirect

cites that it was economic argument by Clarke that it was introduced on a mass scale

and that 2 pilot areas ‘tested this’ and then quote Clarke et al (2009) Improving access to psychological therapy: Initial evaluation of two UK demonstration sites - ScienceDirect
This 2024 paper quotes it as:
“Of the 55% who completed 2 or more sessions 5% went from unemployment to part or full time employment”

which is at best just over 2.5% they sold it on.

except looking at this Clarke et al 2009 paper. There were two pilot centres. For Doncaster, 4451 people were referred and by the end it was 1654 who did two or more sessions. They’ve just excluded the ones who were deemed not suitable and mutually decided elsewhere was better or refused treatment but 1654/4454 =0.37

of those only 1257 had their prior condition coded, and of those only 833 had been ill for 6months

all this is in a table on page 4

at the end of treatment some 650 were ‘still cases’ - by their own iapt recovery measures - the recommendation in the paper is to step up therapy to iapt high-intensity BUT therapist was allowed to refer outside the service to counselling if patients expressed a preference for that

it seems at that point there was a clear vote with their feet as only 25 went for high-intensity iapt CBT and some 400+ went to counselling

page 5 section employment and benefits outcomes notes it only had data for 445 (27%) but that of those who ‘had 2or more sessions AND had been on SSP' 4% returned to work, which they claimed correlated with the claims made by Layard etcal (2007) - which I guess was an economic case for iapt to be set up vs claimed costs - of exactly of 4% ‘of those who complete treatment would return to work’ , however I haven’t check whether the Layard paper caveated that as those on Ssp

The follow-up measures for Doncaster were in Jan-feb 2008 contacting those who completed treatment by Sept 2007 (min 5months later) . The eligible group who’d completed treatment was 1444 but 893 people (chosen at random) who’d completed treatment were mailed a survey.

They claim of those who replied with employment data, 343 people, there was a 10% increase in employment from 190 being in work and not claiming sick pay compared to 155 coded as such initially. Except it is commonly known that most sick pay ends at 6months and around that point if you can’t start trying to return to work ‘processes begin’ as well as people having no sick pay? So the 153 left from the 343 who did want to respond (and I’d imagine there is a bias to not wanting to write back with bad news) had no employment and despite id guess by this point many will have exhausted their sick pay.

So actually we don’t know how many people ‘went the other way’ but there is evidence that 35 more people being coded as employed vs number who’d been coded as such before treatment in those who completed and replied (343) for the eligible sample of 1444. They can’t sssume that 343 is an externally valid representation of all 1444 to extrapolate.

it's 35 more people. 10% of 343, but not extrapolatable to claim even 10% of 1444? And no info on how many were employed and went the other way?

Page 7 There is then the Newham centre they had 135 people only with pre and post employment questionnaires. Say the change is 10% not on SSP but then report that 4% of this were in the ‘other’ category with no work, SSP or benefits.

Their follow up (also feb 2008) found only 161 eligible to be mailed the survey, only 60 responded. And they don’t even mention employment for this (just analysis of eg GAD scores).


I’m struggling to find any robust example of 5% in the Clarke eg al (2009) paper that corresponds to the quote that this 2024 paper has referenced to it. And at longer term I can only see actual evidence for 35 people as a change - call it 10% of a very narrowed down field of 343 if they want. But 4454 were referred there - and they’ve used a heck of a lot of ‘not gates’ to narrow that 343/4454 = 7.7% (35/4454 = 0.8%) who even got to the stage of completing a survey? Heck of a selective filter?
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Oh and the paper says for Doncaster:

Clinical staffing levels in the service varied during the reporting period, rising to their highest in phase two when whole time equivalent (wte) appointments were 10.1 trained CBT therapists (including the Lead Clinician) and 6.0 case managers (low-intensity workers). 7.0 wte of these staff (3.0 wte therapists and 4.0 wte case managers) only joined in phase two.
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I note this is just clinical staffing levels.

The associated employment service is provided by a voluntary organization (Mental Health Matters) and operates side-by-side with the CBT service. Employment coaches help patients to gain employment or resolve employment problems.
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The median salary according to google / AI for a trainee IAPT CBT therapist is £34,600 and then there are costs related to the benefits (pension, National Insurance and so on) and training. This obviously is higher for trained therapists, and case managers.

I don't know whether voluntary organisation means no cost. A google for EMployment advisor roles at Mental Health matters is coming up with salaries around £24k
 
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tornandfrayed said:
Here's the link to the ONS report -
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This report seems to have some spectacularly bad writing: "Monthly employee pay reached a maximum average of £39 in year three for the Asian ethnic group and £17 more in year two for the White ethnic group."

I'm assuming that they mean that monthly pay in year three for Asian ethnic group was £39 more than it had been. As written, the sentence says that their salary was actually £39/month. Idiots.
 
dave30th said:
Are they actually arguing that a 17 pound increase in pay two years after treatment represents success??

And what does this mean exactly: "the probability of being a paid employee within seven years of starting treatment increased to a maximum of a 1.5 percentage points."

Does this mean that of 100 people in the program, 1.5 more people were employed by seven years after treatment? I think so, but I'm not quite sure. And again, they're presenting this as an actual success??
Click to expand...

The Office of National Statistics is supposed to be neutral, producing data (in this case seemingly very poorly) that can be used both to devise policy and scrutinise it.

The point of the article I first linked to and quoted from by John Pring of the Disability News Service is that increasing access to Talking Therapies and (probably) making participating in them compulsory for benefits claimants is at the heart of the UK Government's plan to increase workforce participation. Liz Kendall, Secretary of State at the Department of Work and Pensions referred to the upcoming ONS evaluation when launching the White Paper -
https://www.gov.uk/government/publi...g-white-paper/get-britain-working-white-paper

but now it's too bad for anyone to spin favourably it's been buried.
 
I know that IBS has been "treated" with CBT for quite a long time now. I was given a diagnosis of IBS in the 1990s with no treatment offered except anti-depressants, but luckily for me the cause was found and fixed (several years later) when a surgeon was looking for something else. The problem was physical and no amount of CBT would have fixed me. I'm sure this must be true for lots of other people. I simply don't find the idea that IBS is a mental or psychological problem even remotely convincing.

In the last week or two I read (but can't remember where) that a new condition is now on the list for being treated with CBT because it is, apparently, a common problem for women, and that is "muscle tension". And again I don't believe this is a mental or psychological problem. I sometimes have tight shoulders at night that I can't keep relaxed - I can relax them very briefly but they tighten up again almost immediately, and I have had this problem intermittently since I was a child or a teenager. I have discovered that low levels of potassium and/or magnesium can cause this, so I keep some of both in stock to help my muscles relax when necessary.

Nobody will ever convince me that CBT will fix an issue that has a physical cause. My body can't magic up some potassium when my levels are low, and nor can someone talking to me do it either. But if someone has a physical issue these days there is very little done to even investigate a possible cause and treatment, particularly if the treatment needed can't be patented.

Edit : Typo
 
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Yann04 said:
That’s what their analysis says. but when you look at things like drop-out rates you start to wonder if it’s even lower than that, starting to make things worse than better.
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Oh they're definitely delivering negative RoIs and cheat profusely to present their fake benefits. It's multi-trillion dollar losses over decades ruining tens of millions of lives from billions in wasted resources that can, at best, cheat their way into showing a few thousands in imagined benefits. It's probably the worst RoI ever produced aside from the war on drugs, but just like the war on drugs, the public goal and the real goals have nothing to do with one another.

But even when they cheat, and they have to in addition to using the lowest quality of research with the highest possible level of bias, the very best they can boast of is: the barest minimum blip. And not even always.

Then again, when you steal an election, never go for a 90% win. That's too suspicious. Winning with 51% is the same outcome and it seems more legit. That's what good cheaters and liars do, and this discipline is basically a systemic application of lying and cheating to win. What's amazing is that even when they have this tiny blip where the best they can support is that a few people get some small subjective gain, it all gets washed out into "this is 100% a cure that is safe and effective for everyone". Now, that, even a total dictator can't always pull this off without everyone knowing it's total BS because it's just too unrealistic.
 
tornandfrayed said:
The Office of National Statistics is supposed to be neutral, producing data (in this case seemingly very poorly) that can be used both to devise policy and scrutinise it.

The point of the article I first linked to and quoted from by John Pring of the Disability News Service is that increasing access to Talking Therapies and (probably) making participating in them compulsory for benefits claimants is at the heart of the UK Government's plan to increase workforce participation. Liz Kendall, Secretary of State at the Department of Work and Pensions referred to the upcoming ONS evaluation when launching the White Paper -
https://www.gov.uk/government/publi...g-white-paper/get-britain-working-white-paper

but now it's too bad for anyone to spin favourably it's been buried.
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From years of this boondoggle being reported in bits and pieces, one of the main point of criticism has been terrible attendance. The majority of people referred to don't even bother, as they should because it's BS, and even of those who do very few bother sticking to it until the end. And I assume that most who do go through have eye strain from rolling them so much, know very well they are basically checking boxes so that someone else checks their own boxes.

So in good psychobehavioral tradition, it seems that they are trying to solve their terrible attendance problem by simply making it compulsory, as a requirement for keeping benefits. They take the problem, ignore it, create another, unrelated, problem, and try to fix that one, in a way that simply ignores the reason and context for this problem. This is pure uncut freebased psychobehavioral, a series of increasingly bad decisions whose growing failures only ever get addressed with more increasingly bad decisions.

But another problem this failed program seems to have is that it's massively expensive, the workers are poorly, and barely, trained, themselves have poor retention, and you even have to account for rampant cheating within the system, so the real numbers for engagement are probably even worse. So by making it compulsory, they will be creating another problem alongside it: the system doesn't even have the capacity for it, and would quickly be mostly consumed by those compulsory condition-for-benefits, leaving few resources for everyone else. Which is no loss to anyone, as such a service is obviously of no use to anyone, being so inept, but still out of one problem that they ignore, they end up with 3 additional problems, plus all the losses from ignoring the problem in the first place. Which is like burning down your house because of a leaky faucet, which is leaking because someone bashed it in frustration at the foundations of the house crumbling, and leaking in the basement. Just super smart stuff.

This psychobehavioral ideology can truly be summed as: what if we create the absolute worst lose-lose-lose-lose system and cheat our way into pretending that it's all good. By comparison, most pyramid schemes are a bit more ethical. By, like, 0.1, but still.
 
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Arnie Pye said:
I know that IBS has been "treated" with CBT for quite a long time now. I was given a diagnosis of IBS in the 1990s with no treatment offered except anti-depressants, but luckily for me the cause was found and fixed (several years later) when a surgeon was looking for something else. The problem was physical and no amount of CBT would have fixed me. I'm sure this must be true for lots of other people. I simply don't find the idea that IBS is a mental or psychological problem even remotely convincing.

In the last week or two I read (but can't remember where) that a new condition is now on the list for being treated with CBT because it is, apparently, a common problem for women, and that is "muscle tension". And again I don't believe this is a mental or psychological problem. I sometimes have tight shoulders at night that I can't keep relaxed - I can relax them very briefly but they tighten up again almost immediately, and I have had this problem intermittently since I was a child or a teenager. I have discovered that low levels of potassium and/or magnesium can cause this, so I keep some of both in stock to help my muscles relax when necessary.

Nobody will ever convince me that CBT will fix an issue that has a physical cause. My body can't magic up some potassium when my levels are low, and nor can someone talking to me do it either. But if someone has a physical issue these days there is very little done to even investigate a possible cause and treatment, particularly if the treatment needed can't be patented.

Edit : Typo
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The sad thing is that one sounds like a cheaper fix even including any blood tests? So people don’t even imagine that you’d have people being sent off for more expensive therapy that doesn’t work or gaslights instead of some blood tests and tablets that might be paid for by the person themselves and cheap or not even need tablets etc
 
Sean said:
Professional life wasters. Our lives. :mad:
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I don’t think it’s even great as a job - there seems to be a lot of papers looking into issues of burnout and stress in both staff and trainees , so it’s a crap way of dividing up the work to sausage machine the low intensity stuff causing stress and dissatisfaction of in efficacy and then leaving those doing the high intensity stuff with one tool that mightnt fit the issue well (CZbT isn’t the right thing for all people even if they all had the same thing - it’s fifty fifty who fit other things better, and psychologists proper ones would /should be able / allowed to use all the tools on the tool belt but I suspect the data comes first ) among other things . Plus there’s no checking the diagnoses properly - when the most crucial thing with all of these is the match between the problem and situation and the treatment and he first hit should come first but it seems this supply-obsessed offering has been warping that for years.
 
Guardian article on compassion fatigue in GPs -

https://www.theguardian.com/society...k-suffer-from-compassion-fatigue-survey-finds

certainly an important issue in an overworked, resource constrained sector, mentions also GPs feeling helpless to improve societal problems their patients face.

However quotes Clare Gerada extensively who doesn't think the likes of us should be entitled to compassion, and maybe that goes for all patients.

Also finishes -

A Department of Health and Social Care spokesperson said: “The wellbeing of all those working in the NHS is vital, and extensive coaching support and practitioner mental health services are available for all staff.

“We are providing support for GPs to lessen their workload, through cutting red tape to reduce bureaucracy and reducing outdated performance targets – so they can spend more time with patients and doing the work that really matters.

“The budget also provided an extra £26m to open new mental health crisis centres and funding to provide talking therapies to an extra 380,000 patients.”

So charging right ahead despite proven uselessness.
 
Guardian article said:
extensive coaching support and practitioner mental health services are available for all staff
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Aren't they suffering enough?!

Although it's kind of funny and I assume that most of them don't bother with those as they know it's BS, but it's all performative anyway so it's not like it matters.
 
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