NHS: The Improving Access to Psychological Therapies Manual, June 2018

Indigophoton

Indigophoton

Senior Member (Voting Rights)
I'm not sure if this has been posted yet. Just published with the topic 'Mental Health'.
In line with the implementation of The Five Year Forward View for Mental Health, evidence-based treatment will be extended to people with comorbid LTCs or MUS (See Section 11.2). The newly developed IAPT-LTC services will focus on people who have LTCs in the context of depression and anxiety disorders and will also aim to treat the following conditions:

 irritable bowel syndrome
chronic fatigue syndrome
 MUS not otherwise specified.
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(Emphasis added).
Conditions treated by IAPT services

Chronic fatigue syndrome*

Comprises a range of symptoms that include fatigue, malaise, headaches, sleep disturbances, difficulties with concentration and muscle pain. A person’s symptoms may fluctuate in intensity and severity, and there is also great variability in the symptoms different people experience. It is characterised by debilitating fatigue that is unlike everyday fatigue and can be triggered by minimal activity. Diagnosis depends on functional impairment and the exclusion of other known causes for the symptoms.
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https://www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-manual/
 
The drafting of the document appears to be seriously incompetent.

It starts out by giving the impression that it is about anxiety and depression, goes on to say it deals with LTC's when co-morbid depression or anxiety are present, and then says it is about, inter alia, CFS.

It needs a serious reread.
 
The stakes seem to be getting higher every week. Fortunately it seems that some people are showing their hand. I think I may have a lot of reading to do but I get the distinct impression that my distinct impression that 'evidence-based' talking therapies are all based on stuff as bad as PACE is going to be confirmed. There may be a lot of work ahead but I was interested to hear David Marks flag up that an audit of IAPT is to be published shortly - showing that it achieves nothing much. Peter Barry and Baroness Findlay are going to have an interesting year or two.
 
Sadly politics and money seem to be driving this forward.
This is on the verge of roll out with little more than smoke and mirrors as justifucation , and many illnesses seem unaware as to how they will be affected.

In a country where we struggle to provide adequate/ any support to those struggling with mental health issues already we seem to be proposing a system that surely must make things worse.
 
After looking at these documents a bit, I'm not sure if the root of the problem is in politics. It could also be due researchers making wildly exaggerated claims and promising large increases in effectiveness and large cost savings by sprinkling a dose of psychotherapy over physical health care. Rephrasing: it could be a case of unscrupulous researchers advancing their careers by misleading politicians who cannot distinguish good from bad science.

These documents clearly promise substantially shorter hospital stays, fewer diabetes complications, reduced costs for MUS and so on if only a dose of CBT is added and psychiatry is integrated into physical health care.

I am quite willing to believe that there may be cost savings and perhaps better treatment adherence in some conditions like diabetes, but I'm skeptical that this is necessarily due to treating mental health factors. It could be because the treatment involves repeatedly telling the patient that they need to have better treatment adherence. With MUS, the reduction in costs is probably because the instruction to doctors is to cease medical investigation and not treat, and patients eventually realize that they cannot expect any real care, and therefore stop seeking care.

The impression is that a lot of big claims are made which probably don't hold up to scrutiny. We know they don't in ME/CFS.
 
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I'm a bit confused about the asterisk next to CFS, IBS and MUS on p. 11 in the list of conditions covered. The asterisk is defined as the following: "IAPT services are only expected to treat these conditions if they have developed an IAPT-LTC pathway and have staff who have received training in the treatment of these conditions." Does anyone know if there are IAPT-LTC pathways for CFS, IBS and MUS?
 
I previously posted the following on a separate IAPT thread. Jarman undermines the original IAPT pilots and betrays a willingness for proceeding regardless of evidence.

Sarah said:
Professor Ken Laidlaw (UEA) discussing the aims of the IAPT programme with Kevin Jarman, IAPT Programme Manager 2008-15 and Work and Health Joint Unit DWP/DH Lead:

Kevin Jarman: '...we moved very quickly into roll out. In fact, to be honest, the evaluation of IAPT at those Newham and Doncaster services wasn't actually published until 2010, by which time we were at least two years into the roll-out of the programme, which er, if you look at I suppose improvement science, that's not probably the best way of doing it. But we were fortunate that the original erm the original er way the programme was set up and the sort of original results were so positive that people thought and policy makers thought that it was worth going forward into the next roll out phase.'

https://www.uea.ac.uk/medicine/depa.../-about-iapt-and-the-history-of-the-programme
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dave30th said:
I'm a bit confused about the asterisk next to CFS, IBS and MUS on p. 11 in the list of conditions covered. The asterisk is defined as the following: "IAPT services are only expected to treat these conditions if they have developed an IAPT-LTC pathway and have staff who have received training in the treatment of these conditions." Does anyone know if there are IAPT-LTC pathways for CFS, IBS and MUS?
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I'm not sure how much this answers your question, but from the IAPT - LTC Full Implementation Guidance p. 27 (see ss. 5-6 p. 25 onwards):

'5.4 Pathway principles
Pathways should be developed locally, with appropriate resources and training in place to ensure that they can deliver highquality, coordinated care (see Section 6). There are a number of principles that should be followed when establishing and maintaining IAPT-LTC pathways. Many of these principles are built on the key principles and standards of care that exist already in IAPT services (see Section 3.1 and the IAPT Manual).'

https://www.rcpsych.ac.uk/workinpsy...arepathways/improvingaccess.aspx?theme=mobile
 
Sarah said:
I'm not sure how much this answers your question, but from the IAPT - LTC Full Implementation Guidance p. 27 (see ss. 5-6 p. 25 onwards):

'5.4 Pathway principles
Pathways should be developed locally, with appropriate resources and training in place to ensure that they can deliver highquality, coordinated care (see Section 6). There are a number of principles that should be followed when establishing and maintaining IAPT-LTC pathways. Many of these principles are built on the key principles and standards of care that exist already in IAPT services (see Section 3.1 and the IAPT Manual).'
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Well, that shouldn't take a minute to organise, then.
 
imo this is the states way of replacing a crumbling not fit for service system with a much worse system with the primary purpose of cutting costs and benefits to anyone unfortunate enough to have long term illnesses that they can imply has having a mental health component . the same old right wing trick of divide and conquer after all it will supposedly only effect those with mental health problems possibly undoing the great work of various charities who have put many years of work into removing the social stigma of mental health illnesses .
 
I fear that I may not be able to give this matter the attention it deserves so will make some inadequate comments for others to pick up, if they wish.

In construing documents there is what is known as the "eiusdem generis rule", which means that, in case of uncertainty, general terms should be limited in meaning to fall within the class implied by earlier more specific words.

The problem arises in this case because of the use of the terms IBS, CFS and MUS after the clear earlier statements that the document was intending to deal with anxiety and depressive conditions. It was accepted by Wessely and White in !989 that around 30% of CFS patients do not suffer from these conditions. Does this document mean that those without anxiety and depression do not have CFS, or does it mean that only those with CFS and comorbid anxiety and depression are intended to be covered by it, or is it intended that responsibility be claimed for the whole of CFS.

It looks like negligence to force people into a treatment program for conditions for which it was not designed.
 
chrisb said:
I fear that I may not be able to give this matter the attention it deserves so will make some inadequate comments for others to pick up, if they wish.

In construing documents there is what is known as the "eiusdem generis rule", which means that, in case of uncertainty, general terms should be limited in meaning to fall within the class implied by earlier more specific words.

The problem arises in this case because of the use of the terms IBS, CFS and MUS after the clear earlier statements that the document was intending to deal with anxiety and depressive conditions. It was accepted by Wessely and White in !989 that around 30% of CFS patients do not suffer from these conditions. Does this document mean that those without anxiety and depression do not have CFS, or does it mean that only those with CFS and comorbid anxiety and depression are intended to be covered by it, or is it intended that responsibility be claimed for the whole of CFS.

It looks like negligence to force people into a treatment program for conditions for which it was not designed.
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More recent studies put co-morbid mood disorders at about 40% in ME, which is comparable to other chronic illnesses.
 
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