UK: Improving Access to Psychological Therapies (IAPT) articles, blogs and discussion

[bobbler]

If you can't tell whether something works, then you can't claim that it works. But of course they do it anyway, with a number, which they claim they can't tell us, even as it's behind them on a marketing poster, right above their heads as the spew out BS. And they get away with junk like "on a path to recovery", which is completely meaningless BS, especially on trajectories that are obviously not linear. It makes a joke out of statistics, and it's all based on lies, damned lies and statistics.

And of course they can't even define the problems they're claiming recovery from. They make nebulous claims of recovery out of nebulous issues they can't qualitatively define, let alone count in any way. But they still give out numbers, as if those mean anything at all. But they get away with it so they can't even think of doing things any different.

Good grief the scam is so excessive. And it's all official and beloved, almost no one in the entire profession objects to it. Medicine truly is the last bastion of pseudoscience and fraud. Everywhere else there are serious efforts to improve, never enough, but the efforts are there since everyone who plays into those systems understand that if they can scam others freely, then others can scam them just as easily. I don't understand why MDs don't make that leap for themselves and their families.

I've heard the number £4bn for IAPTS - is it just the LTC part (?) since it started/over how long (?)

To put that into perspective I'm seeing figures of £180Bn for the entire NHS for a year, estimates of £350m for a new hospital etc. There is the following Times article from this year noting that poor housing costs the NHS £1.4Bn a year, well I wonder what fixing the housing from being damp etc would cost instead of IAPT assuming its people's perception and coping mechanisms: https://www.thetimes.co.uk/article/how-bad-homes-cost-nhs-1-4bn-times-health-commission-08zpsdpvn

"The health service spends £383 million a year treating homeowners with illnesses related to cold living conditions.

Yet, the BRE estimates that for less than £1,000 40 per cent of all poor housing that is owned outright or with a mortgage could be remedied and the NHS would start to save money in about seven years."

Well what does it cost the NHS each time someone is referred to IAPT, whether they complete 'treatment' ie 'two sessions' or not, and what is the 'complete treament' actually sold on (are people kidding themselves there are 6-10 sessions that might do some good people are mostly attending so it sounds more feasible as being help?)

 

[Lou B Lou]

2021

https://www.independent.co.uk/news/...0TC1TalNTYDBkykNCvDDH9RqA4z3PrhvtmdnqS7tP1_GY


'NHS mental health therapists pressurised to exaggerate success rates, expert claims'

‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one


'IAPT has been exaggerating success rates to get yet more research funding.

'NHS mental health therapists pressurised to exaggerate success rates, expert claims'

‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one'

'The provision of psychological treatment on the NHS has undergone an “Uberisation”, in which counsellors are pressurised to exaggerate their success in treating patients, a conference has heard.

Elizabeth Cotton, of Cardiff Metropolitan University, an expert in mental health at work, said that more than four in 10 – 41 per cent – of therapists working for the NHS’s talking treatments programme had been asked to manipulate data about patients’ progress'


' ... Dr Cotton, an adult psychotherapist who has written a book on working in health and social care, says the pressure on therapists was such that some had been encouraged by their managers to coach patients to give positive answers to questionnaires.

Patients were urged to repeat the questionnaires until a positive response was obtained, she told the British Sociological Association conference on work.

Where patients discharged themselves without notifying the NHS, the therapist was encouraged to fill in data sheets on their behalf to reflect a positive outcome, said Dr Cotton.'


'....
Dr Cotton carried out four surveys between 2016 and 2020. One, of 1,500 therapists working for the NHS or privately, found that more than a third - 38 per cent - had raised concerns about patient care, a figure rising to 58 per cent among the 223 currently employed by IAPT.

In another survey of 650 IAPT employees, carried out in 2019, 41 per cent said they had been asked to manipulate data.

One therapist had reportedly been advised by their manager that “I could complete forms on behalf of clients to get the best results”.

Another said: “Actual human experience was secondary to creating data which would shore up the evidence base for the model to justify the economic argument and guarantee further investment.

“The whole system represents a big self-reinforcing loop relating to success in terms that had been self-defined by the system.”
.

Dr Cotton warned the downgrading of therapy “into a standardised, manualised, and now digital model” had “opened up the doors for the ending of highly experienced clinical work in the public sector”.

 

[Sly Saint]

If thousands are off work with mental health issues, why is it that so many people are ditching therapy?

Hundreds of thousands are walking away from NHS mental health 'talking therapy' because, in many cases, they believe it is not working, experts have warned.

More than a million people are referred for the treatment every year, which is meant to help patients deal with common mental issues such as anxiety and depression.

While many patients see a mental health clinician in-person, a growing number of therapy sessions now take place over the phone, and even in the form of messaging conversations.

Last year, more than 600,000 NHS sessions took place via a chat app. This relatively novel form of care has been backed by the Government as a possible solution for getting thousands with mental health issues back into work.

Official figures have revealed that two-thirds of people claiming incapacity benefits are not employed due to mental health problems – and between 2022 and 2023, it was cited around 870,000 times in claims.

One in ten young people in the UK is unable to work due to illness – predominantly related to mental health issues. Studies suggest a third of those aged 18 to 24 suffer with depression, anxiety or bipolar.

In his Autumn Statement, Chancelllor Jeremy Hunt announced plans to expand the use of so-called digital talking therapies to help tens of thousands more people in England get access to the help they need to return to work.

But damning NHS England figures suggest more than 40 per cent of those referred drop out before completing the course.

Out of 1.2 million referrals to NHS talking therapies in April 2022 to March 2023 only 672,193 completed a full course. Among young teens, the drop-out rate was even higher at over 60 per cent.

NHS England insists half of those who finished talking therapy treatment made a full recovery.

But leading mental health experts argue there is no good evidence that this is true – as there is little or no follow-up to see if patients later relapse.

If thousands are off work with mental health issues, why is it that so many people are ditching therapy? (msn.com)

 

[bobbler]

2021

https://www.independent.co.uk/news/...0TC1TalNTYDBkykNCvDDH9RqA4z3PrhvtmdnqS7tP1_GY


'NHS mental health therapists pressurised to exaggerate success rates, expert claims'

‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one


'IAPT has been exaggerating success rates to get yet more research funding.

'NHS mental health therapists pressurised to exaggerate success rates, expert claims'

‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one'

'The provision of psychological treatment on the NHS has undergone an “Uberisation”, in which counsellors are pressurised to exaggerate their success in treating patients, a conference has heard.

Elizabeth Cotton, of Cardiff Metropolitan University, an expert in mental health at work, said that more than four in 10 – 41 per cent – of therapists working for the NHS’s talking treatments programme had been asked to manipulate data about patients’ progress'


' ... Dr Cotton, an adult psychotherapist who has written a book on working in health and social care, says the pressure on therapists was such that some had been encouraged by their managers to coach patients to give positive answers to questionnaires.

Patients were urged to repeat the questionnaires until a positive response was obtained, she told the British Sociological Association conference on work.

Where patients discharged themselves without notifying the NHS, the therapist was encouraged to fill in data sheets on their behalf to reflect a positive outcome, said Dr Cotton.'


'....
Dr Cotton carried out four surveys between 2016 and 2020. One, of 1,500 therapists working for the NHS or privately, found that more than a third - 38 per cent - had raised concerns about patient care, a figure rising to 58 per cent among the 223 currently employed by IAPT.

In another survey of 650 IAPT employees, carried out in 2019, 41 per cent said they had been asked to manipulate data.

One therapist had reportedly been advised by their manager that “I could complete forms on behalf of clients to get the best results”.

Another said: “Actual human experience was secondary to creating data which would shore up the evidence base for the model to justify the economic argument and guarantee further investment.

“The whole system represents a big self-reinforcing loop relating to success in terms that had been self-defined by the system.”
.

Dr Cotton warned the downgrading of therapy “into a standardised, manualised, and now digital model” had “opened up the doors for the ending of highly experienced clinical work in the public sector”.

I've looked it up and it seems the two people behind IAPT were:

David M. Clark - Wikipedia

Richard Layard, Baron Layard - Wikipedia

So the point made somewhere by someone about psychology having been invaded by economics and its methods seems entirely relevant.

 

[rvallee]

If thousands are off work with mental health issues, why is it that so many people are ditching therapy?


If thousands are off work with mental health issues, why is it that so many people are ditching therapy? (msn.com)

So many of those numbers don't add up. And the insistence that 50% make a full recovery, which was the initial target, when there is no way to even pretend that the therapies have anything to do with any meaningful recovery.

Who could have known that falsely reattributing health problems as psychological problems, then offering completely BS McTreatments wouldn't work? It's so reminiscent of societies that decided to invest everything they have in some BS woowoo instead of listening to the people who understood the problem.

If someone were interested in making a splash, doing an investigative report on this would be explosive. The more you peel away at it the worse it looks. This whole thing is a giant scam from top to bottom.

 

[Sean]

Who could have known that falsely reattributing health problems as psychological problems, then offering completely BS McTreatments wouldn't work?

Not just health problems. Lot of structural social and economic problems that individuals have no control over are being disguised as individual failings.

 

[bobbler]

‘CBT Today’ An Apologist for IAPT Expansionism


http://www.cbtwatch.com/cbt-today-an-apologist-for-iapt-expansionism/

Looking at the Hansard notes from 2002/3 I’ve seen they bite the cost of me/cfs to be huge but the cost due to consultations for proper diagnosis and care by GPs /medical to have been £900 per head.

CBT MUS nonsense I think I’ve seen quotes upwards of £1700 including in old Nice type cost effectiveness ‘calculations’ yeah ‘cheap at any cost’ not.. and that as before their ‘treatment’ actually became asymptotic on cost because on the ‘is it effective for me/cfs or long term health’ becomes at least zero perhaps negative is harm when you update based on the reanss as lysis when they were finally forced to release the raw data on PACE it was all based on

no wonder these individuals want to keep claiming black is white and PACE hasn’t been more than debunked

£350million (in my comment above at top of this page) is I think I’ve seen in the King's Fund figures nearly the price of a new entire hospital .

Iapt had none of these infrastructure or equipment ‘assets’ as well as costs from this number. The staff aren’t needing to include expensive highly qualified consultants or pathology labs or radiology running theatres, chemo, A&E etc

given MUS is just a cover-up for me/cfs and round up £900 to £1k x say 300,000 people - which is how many have it not the ‘year of diagnosis’ but even if they all had that in a year that’s just £300m - or £510 if you are going by the £1.7k force feeding them all CBT courses.

If these figures are right well that’s a new hospital , and it still doesn’t scratch the surface of £22nd even if you’d forced all me/cfs into this in one year.

so where is the £1.5-1.7bn being spent that couldn’t even be going on gaslighting me/cfs patients? Not that even the tiny proportion diagnosed that year snd sent on it generally found it useful enough they did more than 2sessions, I guess they might have taken the money gif the full course. But these figures start to not add up?

cheap at any cost?

my comment above reminded me that BRE stated that for less than £1000 a pop 40% of poor quality housing that is owned or mortgaged could be remedied saying the nhs on costs within 7yrs. That’s less than a course of iapt costs to cope with trying to battle to get it fixed.

they aren’t even making sure those misdiagnosed with something that could be cured with iron tablets costing a few pounds or who another serious condition which significantly cheaper to treat snd recoverable fully from is being checked for instead of the sending there with MUS labelling causing that ‘miss’ etc

someone needs their ‘behaviour’ looking at but it’s not those patients but the ones doing it to them then whistling as if it’s big their outcomes when years down the line that stuff and additional cost that path has added unnumeccesarily ti overall taxpayer bill and their lives crops up.

I struggle to see the good that was sold at all

A letter for adjustments to an employer from a GP or OT to instead stop someone declining and thereby save their lifetime working life costs a fraction of all that.

 

[Lou B Lou]

This post has been moved from a now deleted political thread.

IAPT, Increasing Access to Psychological Therapies, “the most ambitious programme of talking therapies in the world”, now called NHS Talking Therapies, was instigated by New Labour.

The IAPT designer Baron Richard Layard (LSE Economist) proclaimed 'CBT for All', even presenting CBT as the 'cure' for the unemployment figures in 2006/8. IAPT was/is a one size fits all cure-all for anxiety and depression that has grown and grown in size and cost - but never delivered better mental health.



Damning reports on IAPT from 2021:


'NHS mental health therapists pressurised to exaggerate success rates, expert claims'

'‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one'


'The provision of psychological treatment on the NHS has undergone an “Uberisation”, in which counsellors are pressurised to exaggerate their success in treating patients, a conference has heard.

Elizabeth Cotton, of Cardiff Metropolitan University, an expert in mental health at work, said that more than four in 10 – 41 per cent – of therapists working for the NHS’s talking treatments programme had been asked to manipulate data about patients’ progress.'

The action is designed to improve the scheme’s apparent achievement rates, although NHS chiefs insist patients’ views are recorded when therapists are not present.'

'IAPT plans should allow the number of people with anxiety disorders or depression who can access talking therapies increase by an extra 380,000 per year to reach 1.9 million by 2023-24, under NHS plans.

But Dr Cotton, an adult psychotherapist who has written a book on working in health and social care, says the pressure on therapists was such that some had been encouraged by their managers to coach patients to give positive answers to questionnaires.

Patients were urged to repeat the questionnaires until a positive response was obtained, she told the British Sociological Association conference on work.

Where patients discharged themselves without notifying the NHS, the therapist was encouraged to fill in data sheets on their behalf to reflect a positive outcome, said Dr Cotton.....'


Edit Add:

'In another survey of 650 IAPT employees, carried out in 2019, 41 per cent said they had been asked to manipulate data.

One therapist had reportedly been advised by their manager that “I could complete forms on behalf of clients to get the best results”.

Another said: “Actual human experience was secondary to creating data which would shore up the evidence base for the model to justify the economic argument and guarantee further investment.

“The whole system represents a big self-reinforcing loop relating to success in terms that had been self-defined by the system.”

Dr Cotton warned the downgrading of therapy “into a standardised, manualised, and now digital model” had “opened up the doors for the ending of highly experienced clinical work in the public sector”.

.
https://www.independent.co.uk/news/health/nhs-therapists-patients-manipulate-data-b1908629.html

.

 

[rvallee]

I wonder what the new bullshit excuse will be, now that this making everything about anxiety and/or depression excuse seems to have run out of steam and has been revealed to be a delusional con job. My guess it will be simply that people need to pick themselves up, own their health, do some exercise and work hard. Going back to basics. They never work, but they're easy to go back to.

The government's line appears to be mostly about getting people to work. Which is just as delusional, and anyway about 45% of the population in rich nations is employed. I wonder if there's some historically famous way of putting this.

Most people who think they have anxiety and depression don't, warns one of Britain's most eminent GPs
https://www.dailymail.co.uk/health/article-14278769/Tony-Blair-anxiety-depression-doctor-warns.html

The eminent GP? Clare Gerada. Who has been heavily pushing this BS. As if people are self-diagnosing with anxiety and depression, rather than this being over-labeled 10-100x by failed systems relying on cheap questionnaires.

If this were a simulated universe, it would deserve to be booed for being too ridiculous. But instead it's even dumber than that.

 

[bobbler]

I've found this: https://www.hee.nhs.uk/sites/default/files/documents/CBT LTC - Curriculum Revised October 2022.pdf

Which is "IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES: NATIONAL CURRICULUM FOR CBT IN THE CONTEXT OF LONG TERM PERSISTENT AND DISTRESSING HEALTH CONDITIONS, version 2.1 Oct 2022"

1 This curriculum was developed on behalf of NHS England and Health Education England by members of the Talking Therapies Education & Training Group and review ed and amended following the first wave of implementation.

Contributors: Professor Anthony Roth, Professor Trudie Chalder, Sheena Liness, Pam Myles, Dr Kirstie Anderson, Clare Baguley, Dr Angela Busuttil, Professor David Clark, Felicity Dormon, Dr Rachel Handley, Professor Willem Kuyken, Professor Stephen Pilling, Dr John Pimm, Professor Rona Moss -Morris, Professor Paul Salkovskis, Dr Heather Salt, Dr David Veale, Dr Michael Worrell, Dr Adrian Whittington, Professor Eileen Joyce, Dr Jennifer Foley, John Pimm, Harjinder Kaur-Heer, Julie Doughty, Vicky Cartwright, Naheem Akhtar

And page 18 has the section on CFS.

I've tried to have a scan and don't think it is pasted elsewhere and think it is relevant because it is a year after the 2021 guideline had been signed off. And still contains some corkers to do with things like assumptions on personality (perfectionism etc)

Ability to help the client monitor sleep, identify specific sleep problems that exacerbate fatigue and discuss sleep strategies such as an up time and bed restriction

Ability to draw on knowledge of factors considered to contribute to the development of CFS/ME (including physical illness/ serious infections (such as glandular fever), lifestyle, stress, perfectionism and distress)

Ability to draw on knowledge of factors considered to maintain CFS/ME (such as patterns of activity characterised by boom and bust cycles, unhelpful fear avoidance beliefs leading to avoidance of activity), attentional biases towards symptoms) and how these link to physiological mechanisms including poor sleep and deconditioning

Ability to introduce the CBT model, collaboratively identifying predisposing and precipitating factors and a vicious cycle of fatigue

I know that IAPT has changed their brand name but have they changed their curriculum from this?

ALso thought of @Joan Crawford and the project with BPS (British Psychological Society) on how to better meet the needs of those pwme who would want/need to access psych support for various things.

 

[Utsikt]

Ugh, that update was made after NICE..