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

Blog by OMEGA (the opposing mega group)
I can't vouch for the accuracy.

"A Letter to Jeremy Hunt .............and How Millions of ‘MUS’ Patients Lose Out in the NHS."
Date: May 23, 2020Author: opposingmega 1 Comment

By Goodelf

In my first online post, “Untangling the MUS Web” – https://opposingmega.wordpress.com/2020/05/01/untangling-the-mus-web/ , I revealed how doctors, healthcare commissioners and other healthcare workers have been misled regarding the risks of adopting the current UK strategy towards ‘medically unexplained symptoms’ (MUS) of quickly identifying patients with MUS and diverting them away from biomedical care to cheaper psychological therapies instead.

By splitting their write-up of a key MUS study between two separate papers, the authors – Nimnuan, Hotopf and Wessely – enabled researchers and authors to cite a 2001 paper for its finding of high MUS prevalence rates (averaging 52%) in secondary care without readers being aware of the unacceptably high MUS misdiagnosis rates that accompanied the study that were documented in a sister paper that was published in 2000.

The Nimnuan et al 2001 paper has been referenced hundreds of times and is still being used as evidence of high MUS prevalence rates, but whenever it is cited readers should be made aware of the appalling levels of MUS misdiagnosis that the study uncovered which averaged over 25% of patients initially diagnosed with MUS being wrongly diagnosed and in two specialties reached as high as 40%.

The following is just one incidence of how the Nimnuan et al 2001 paper has been used to persuade or mislead the UK Government to adopt the MUS strategy at policy level.
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https://opposingmega.wordpress.com/2020/05/23/a-letter-to-jeremy-hunt/#comments
 
I’ve been writing about so-called “medically unexplained symptoms,” or MUS, for the last couple of years. Much of that has come in the form of critiques of specific studies making excessive claims about the healing powers of cognitive behavior therapy.

Recently, a blogger named Goodelf has posted a couple of revealing posts about the overall approach to MUS in the UK, especially about how proponents of the concept have presenting data in misleading ways. Both articles have been posted on the Opposing Mega site, originally established a few years ago to counter a stupid proposal from the then-leadership of the CFS/ME Research Collaborative. The first article was about a seminal study on the supposed prevalence of MUS and on rates of misdiagnosis.

I’ve posted below the opening of the second article, which elaborates on the issue and is titled “A Letter to Jeremy Hunt.”
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https://www.virology.ws/2020/06/02/trial-by-error-a-couple-of-blog-posts-worth-reading/
 
IAPT’s Modus Operandi: ‘squeeze the client into the briefest cbt, then eject’
and repeat the mantra that it is ‘world beating’ [ see Thrive by Layard and Clark (2014) and Can We Be Happier? Layard (2020)]. For Mariella her 7 IAPT (Improving Access to Psychological Therapies) sessions were a re-traumatisation of the abuse she had suffered in childhood. Four years after her IAPT treatment she was still suffering from low mood and likely chronic fatigue syndrome. The letter from the IAPT therapist said that she had responded to treatment because there had been a 6 point improvement on her PHQ9 and a 2 point improvement on the GAD7 and was therefore being discharged. Mariella refused to countenance a return to IAPT because she regarded it as having been a waste of time. IAPT specialises in putting square pegs in round holes:
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http://www.cbtwatch.com/iapts-modus-operandi-squeeze-the-client-into-the-briefest-cbt-then-eject/
 
repeat the mantra that it is ‘world beating’
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Uh. Sensing a pattern here. Of sorts. No, that can't be, that would mean IAPT is largely a political project. That would be... yeah entirely consistent with all evidence.
The letter from the IAPT therapist said that she had responded to treatment because there had been a 6 point improvement on her PHQ9 and a 2 point improvement on the GAD7 and was therefore being discharged.
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This is a classic problem on which economics is years ahead. When you make the target of manipulation the same as the end point all you end up doing is making the manipulation the whole point.

Lessons from snakes in India:
The cobra effect occurs when an attempted solution to a problem makes the problem worse,[1][2] as a type of unintended consequence. The term is used to illustrate the causes of incorrect stimulation in economy and politics.[2]

The term cobra effect originated in an anecdote that describes an occurrence in the time of British rule of colonial India. The British government was concerned about the number of venomous cobras in Delhi.[3] The government therefore offered a bounty for every dead cobra. Initially this was a successful strategy as large numbers of snakes were killed for the reward. Eventually, however, enterprising people began to breed cobras for the income. When the government became aware of this, the reward program was scrapped, causing the cobra breeders to set the worthless snakes free; the wild cobra population further increased.[2][4]
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Another example is the No child left behind initiative in the US. It made standardized testing the only target of education, with budgets being increased based on good results on standardized tests and defunding whole schools if they didn't meet targets. The end result? Schools literally orchestrated massive cheating for their students, helped supply test answers, manipulated scores, etc. The principals and faculties were all involved, because if they didn't cheat they were out of a job.

All of this for the low low cost of billions in direct spending and billions more in indirect productivity losses from just leaving disabled people out of the workforce by refusing to actually help them. What a bargain! Compared to just burning money in a very large pit, it definitely is!
 
Coming late to this thread, I have found it interesting. I was referred to a pain clinic and found it a crushing disappointment, but reading this, I realise that some of the confusion was because she was trying to give me ways of coping to lessen my distress without ever asking me what I already did. Of course I had only survived the previous twenty years because I had discovered all the things like distraction for myself and was not experiencing the distress of struggling to do things I previously did.

I had expected my pain medication to be reviewed and to talk about what things could help that she would know from experience but I had not thought of. Instead I was told I was experiencing anxiety (we never discussed my pain in 5 sessions) and when I denied it was assumed to be in denial. When she said she experienced anxiety and it was nothing to be ashamed of I asked why I was in a wheelchair when she wasn't. She said therapy was obviously not helping and I was discharged - in pain.

Something I have never understood in all the discussion of pain is that I do not feel I have chronic pain. I believe that every day I get acute pain because of whatever is going wrong with my body. There doesn't even seem to be an acknowledgement such a thing exists.

I would have liked to discuss that in a clinic but not to be.
 
Mithriel said:
Something I have never understood in all the discussion of pain is that I do not feel I have chronic pain. I believe that every day I get acute pain because of whatever is going wrong with my body. There doesn't even seem to be an acknowledgement such a thing exists.
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An interesting observation. I hadn't thought of it that way.

I had a look for definitions of acute and chronic and the difference seemed to be simply duration, nothing to do with severity. It's called acute if it is anything from very mild to very severe and stops after a shortish time - hours, days, weeks, a few months. It is called chronic, regardless of severity, if it continues for many months or years.

So is it possible to have long term acute pain, or is that a misunderstanding of the definitions?

I would say I have chronic muscle pain that has been with me for 30 years. When I have PEM, or when I have overused a particular muscle and it screams at me to stop, is that acute pain, or is it exacerbation of chronic pain? No idea.

And then of course I can add acute additional pain like stomach pain, headache or injury. I guage the severity of these other acute pains by which bit of my body is screaming at me loudest.
 
Trish said:
An interesting observation. I hadn't thought of it that way.

I had a look for definitions of acute and chronic and the difference seemed to be simply duration, nothing to do with severity. It's called acute if it is anything from very mild to very severe and stops after a shortish time - hours, days, weeks, a few months. It is called chronic, regardless of severity, if it continues for many months or years.

So is it possible to have long term acute pain, or is that a misunderstanding of the definitions?

I would say I have chronic muscle pain that has been with me for 30 years. When I have PEM, or when I have overused a particular muscle and it screams at me to stop, is that acute pain, or is it exacerbation of chronic pain? No idea.

And then of course I can add acute additional pain like stomach pain, headache or injury. I guage the severity of these other acute pains by which bit of my body is screaming at me loudest.
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The definitions are interesting. My muscles hurt when I have overused them, usually the next day. It is a deep burning pain that is usually affecting some part of my body but which part and how severe depends on what I have been doing. So I do not have chronic pain in my arms, just severe pain when I have used them beyond a certain point. My legs burn horribly if I stand for any length of time so it is not bad enough to stop me sleeping if I have barely stood on a given day.

I also get pain because my hands will twist. It would hurt anyone of they hold a hand in an unnatural position for hours at a time. No twist, no pain. I take pills which are not painkillers; they stop the pain because they stop the twisting

ME is a disease that causes damage in different parts of the body and that damage causes pain until it heals. The research which said there was no damage to muscles so it must be a central pain was not conclusive because of all the usual problems but it has been taken as gospel.
 
Private mental health services in Bristol investigated
After Dominic Vickars killed himself at the age of 25, failings were identified in his care at Cygnet Kewstoke, a privately-run mental health hospital on the North Somerset coast. Today, we tell Dom’s story, with the permission of his family, as part of a new series about local private mental health services.

We will be asking: Is Dom’s story a tragic anomaly or the result of systemic issues in need of fixing? And how is it that those in need of the very best mental health treatment are being treated by huge private companies, whose quality of care has come under fire in recent years?

The private sector is playing a growing role in mental health services in the UK. Estimated at £1.8 billion in 2018 and predicted to grow to £2.3 billion by 2023, the market is dominated by large providers such as Cygnet Health Care and the Priory Group, who deliver services paid for by the NHS worth hundreds of millions of pounds.
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https://thebristolcable.org/2020/06/inside-private-mental-health-services-in-bristol-investigated/
 
Roy S said:
What does "taken down in work" mean in the UK?
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I would imagine it means being chastised, or gotten into trouble somehow. To take someone down usually means to topple them, maybe remove them from their position or simply win an argument against them.

I think that tweet by Anna Batho is pretty damning of a profession that provides talking therapy. If they can't have a discussion among themselves weighing pros and cons of the treatment they provide then they certainly won't be honestly evaluating that service and feeding back issues so as to improve matters for their patients.

If they can't even be honest with each other.....
 
Invisible Woman said:
I think that tweet by Anna Batho is pretty damning of a profession that provides talking therapy.
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Indeed. It seems that the primary aim of this type of clinical psychologist is to ingratiate oneself with ones peer group (even if that means including James Coyne) and to patronise patients. To advocate for patients in a way that is critical of peers is beyond the pale (as I was told by Michael Sharpe). And the strange belief that you can do this without anyone noticing betrays a complete lack of understanding of, what was it.. pissology, snipeology, I forget..., more or less human nature to everyone else.
 
Jonathan Edwards said:
Indeed. It seems that the primary aim of this type of clinical psychologist is to ingratiate oneself with ones peer group (even if that means including James Coyne) and to patronise patients. To advocate for patients in a way that is critical of peers is beyond the pale (as I was told by Michael Sharpe). And the strange belief that you can do this without anyone noticing betrays a complete lack of understanding of, what was it.. pissology, snipeology, I forget..., more or less human nature to everyone else.
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I hate to say it but to me this just describes a typical MO of institutions in my lifetime. It's just another special-interest group and any benefit to the broader society is incidental to the actual underlying goal orientation.
 
rvallee said:
The end result? Schools literally orchestrated massive cheating for their students, helped supply test answers, manipulated scores, etc. The principals and faculties were all involved, because if they didn't cheat they were out of a job.
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In some areas, yes. But the much bigger problem was that school curricucla were all about "teaching to the test"--in other words, everything was geared toward improving the test scores rather than what made sense educationally.
 
James Morris-Lent said:
I hate to say it but to me this just describes a typical MO of institutions in my lifetime. It's just another special-interest group and any benefit to the broader society is incidental to the actual underlying goal orientation.
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What seems odd to me about this group is their openly discussing doing it, apparently unaware that human beings who are not psychologists might been earshot. In my experience mutual appreciation and troublemaker dumping amongst other communities is done rather more discreetly. Have suspicion that these psychologists think that other human beings are a bit like Labrador puppies.
 
James Morris-Lent said:
I hate to say it but to me this just describes a typical MO of institutions in my lifetime. It's just another special-interest group and any benefit to the broader society is incidental to the actual underlying goal orientation.
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https://rationalwiki.org/wiki/Iron_law_of_institutions
The people who control institutions care first and foremost about their power within the institution rather than the power of the institution itself. Thus, they would rather the institution "fail" while they remain in power within the institution than for the institution to "succeed" if that requires them to lose power within the institution.
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