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

What Is The Added Value of IAPT?
Last year the Improving Access to Psychological Therapies Service (IAPT) lost 46% of clients before their 2nd treatment session. No other psychological therapy services has such a sink hole.
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The latest IAPT Annual Report states that the recovery rate, with CBT, in IAPT is 40.7%, this is less than the 50% recovery rate claimed for the service as a whole. Its’ 50% recovery rate has been deemed by IAPT as comparable to the results of randomised controlled trials of CBT for depression and the anxiety disorders. Thus, by its own metric IAPT is underperforming.
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http://www.cbtwatch.com/what-is-the-added-value-of-iapt/
 
Has anyone even bothered to study mental healthcare with the same rigor as physical healthcare?

Some autism research is just as bad as the PACE trial. They use the wrong outcome measures, like reduction in signs and symptoms, which is useless, because autism is not a disease. So young children with autism are given rigid obedience-based therapy that can cause PTSD or other problems functioning that don't surface until adolescence or adulthood. (This is vaguely similar to GET making pwME worse) But that's "okay", because it reduces the signs, most of which are benign (like hand-flapping, having different facial expressions), easily compensated for (sensitivity to noise or certain clothes), or beneficial (intense interests leading to rewarding career)

My journey with autism is vaguely similar to me journey with ME. I learned I was autistic after having it for years, but everything I learned about finding out was from a neurodiversity standpoint. This allowed me to better adapt to my brain differences and resist the shame that who I am is a disease. It parallels how I got ME, didn't know for years, but when I dived in, everything I read was from a biomedical perspective. That allowed me to avoid dangerous treatments and resist the same that ME is my fault.
 
Mis-Guided Self Help In IAPT
A just published study by Duhne et al (2022)found that almost a third (29%) of those assessed by the Improving Access to Psychological Therapies Service (IAPT) and referred to Guided self-help (either face to face or computer assisted CBT) did not attend any treatment sessions. Whilst of those who attended treatment over half (54%) dropped out, defined as attending three or less treatment sessions. These figures are much higher than the 20% Swift and Greenberg (2012) of clients who typically dropout of psychotherapy.
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Curiously the authors miss the obvious implication that GSH is misguided. Instead they recommend further investigating an algorithim for better matching those who would do better in cCBT or better in face to face! Why is this? The authors declare no conflict of interest, but the Department from which it emanates at Sheffield University has a long list of IAPT teachers. There is a complete absence of critical appraisal of IAPT’s metrics suggesting that the Sheffield researchers don’t want to bite the hand of a service that gives them a ready-made data set, it eases the research burden. The Journal in which it was published Behaviour Research and Therapy characteristically ignores any criticism of IAPT.
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http://www.cbtwatch.com/mis-guided-self-help-in-iapt/
 
It's free. People rarely refuse free stuff. It has to be extremely bad for people to be offered free stuff and think it's not even worth their time. You can see this everywhere, offer free stuff to people and even if it's useless they'll take it anyway. Likely to throw it away soon enough but they'll still take it in case it's not as useless as it first seems.

And yet their reaction is simply to figure out how to change the useless junk they're giving away just enough, or maybe how to hand it to passersby, so that fewer people throw it away immediately, completely indifferent to whether they simply end up throwing it away later. As long as it appears to have been accepted, that's all they care about. Results in real life play no role in any of this.

This is possibly one of the most corrupt publicly-funded fraud in the modern world because it has no private industry counterpart, this giant scam is almost entirely out of either public funding or insurance pools, which is ultimately paid by the insured. It's basically an academic scam when you drill down the origins and perpetuation. Possibly the worst academic/scientific scandal in human history... and it's popular, which fully explains how it became so massively disastrous.
 
Sly Saint said:
Mis-Guided Self Help In IAPT

Curiously the authors miss the obvious implication that GSH is misguided. Instead they recommend further investigating an algorithim for better matching those who would do better in cCBT or better in face to face! Why is this? The authors declare no conflict of interest, but the Department from which it emanates at Sheffield University has a long list of IAPT teachers. There is a complete absence of critical appraisal of IAPT’s metrics suggesting that the Sheffield researchers don’t want to bite the hand of a service that gives them a ready-made data set, it eases the research burden. The Journal in which it was published Behaviour Research and Therapy characteristically ignores any criticism of IAPT.
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http://www.cbtwatch.com/mis-guided-self-help-in-iapt/
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So with the current oversight set-up, measuring of outcomes being left to the departments themselves to choose their own measures and methods etc and no requirement of data being made publicly available we basically have a set-up where IAPT will only give the data to those who will be favourable and not criticise them. Ergo there is nothing at all in any constitutions or oversight that means someone independent or not can look at that data in an open-minded critical manner?

Taking 'only positive results get published' to a whole new level isn't it?
 
from Oct
Number using IAPT services rises by one-fifth
More people are accessing NHS psychological therapies, but only half move into recovery, according to new figures
There was a 21.5% increase in access to Improving Access to Psychological Therapies (IAPT) services in 2021-2022 over the previous year, NHS Digital figures show.

The figures are published in a report, Psychological Therapies: Annual Report on the use of IAPT services, England 2021-22, which analyses activity, waiting times and outcomes such as recovery in that time period. The IAPT programme is run by the NHS and offers therapeutic treatment for conditions such as depression, anxiety, post-traumatic stress and phobias. It uses therapies approved by the National Institute for Health and Care Excellence (NICE), including cognitive behavioural therapy (CBT), guided self-help, eye movement desensitisation reprocessing, and interpersonal psychotherapy. Patients can be referred by their GP or self-refer.

According to the report, 1.24m referrals accessed IAPT services in 2021-2022, compared to 1.02 million in 2020-2021. The total number of referrals increased from 1.46 million to 1.81 million from the previous year 2021-2022, a rise of 24.5%.

The number of referrals completing a course of treatment increased by 4.6 percent, with 50.2 percent of referrals moving into recovery, down 1.2 percent from the previous year.

Paul Spencer, head of health, policy and campaigns at the mental health charity, Mind, told Pulse: “There’s such a long way to go. We know timely and appropriate treatment can make all the difference for those of us with mental health problems, so we’re pleased that the NHS has rightly met some of its ambitious targets for people who need access to talking therapies. However, we’re still concerned that IAPT only meets the needs of 50% of the people who access it.”
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https://futurecarecapital.org.uk/latest/number-using-iapt-services-rises-by-one-fifth/
 
Sly Saint said:
from Oct
Number using IAPT services rises by one-fifth
More people are accessing NHS psychological therapies, but only half move into recovery, according to new figures

https://futurecarecapital.org.uk/latest/number-using-iapt-services-rises-by-one-fifth/
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That rise is from a major fall off the previous year because of COVID - comparable numbers are 2019/20 = 1.17m accessed IAPT services (increase of 5.6% 2021/22) and 1.69m total referrals (increase of 5.5% 2021/22) . The gap between total referrals and both 'entered treatment' and 'ended treatment' grew, although that is hardly surprising given the impact of COVID.

https://app.powerbi.com/view?r=eyJr...iZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9
 
IAPT’s Capitalisation on Time Is A Great Healer
The natural recovery rate for depression is 50% within 6 months. The Improving Access to Psychological Therapies (IAPT) claim a 50% recovery rate for its clients. It is therefore not at all obvious that psychological treatment has conferred any benefit. The rate of natural recovery from depression is about 2% per week. Looking at natural recovery in generalised anxiety disorder (GAD), of those who had ever suffered GAD, 72% had not had it in the past year. Whilst recovery rate from depression and anxiety disorders at 2 year follow up was 41.7%. These high rates of natural recovery offer Service providers, such as IAPT, a golden opportunity to claim that they have played a pivotal role in client’s recovery.
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http://www.cbtwatch.com/iapts-capitalisation-on-time-is-a-great-healer/
 
Wow, what a surprise that this is the same pattern everywhere in BPSland, where they simply attribute themselves credit for natural outcomes along with generic constructs and arbitrary definitions. As if the entire ideology is built on it.

So much coincidence.
 
‘CBT Today’ An Apologist for IAPT Expansionism
CBT Today is the Official Magazine of the British Association of Behavioural and Cognitive Therapy, the supposed lead organisation for CBT. But today it is a vendor for cheap and easy solutions to human difficulties. This sits comfortably with its’ friends in high places, politicians and the media. The funds flow, almost £2billion a year for IAPT adult, children and young people services. With £988.0m the projected spend on children and young people in 2022/23. But no independent valuation of whether either service is value for money. This would beggar belief at any time, but in these days of financial stringency it has to be insanity, corruption or some combination thereof.
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Dr Whittington (2022) continues ‘we need to support a a psychological approach as the norm for major health conditions. We know that these developments can support people to adjust and manage long term conditions more effectively, reducing unwarranted medical consultations’. A further null hypothesis is that psychological therapy makes no difference to the management of these conditions. Again the burden of proof is with those who would rebut the null hypothesis. Who is it that judges that there are ‘unwarranted medical consultations’? What is the world view of a person who sees many consultations for long term conditions as unwarranted?
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http://www.cbtwatch.com/cbt-today-an-apologist-for-iapt-expansionism/
 
Dr Whittington (2022) continues ‘we need to support a a psychological approach as the norm for major health conditions. We know that these developments can support people to adjust and manage long term conditions more effectively, reducing unwarranted medical consultations’. A further null hypothesis is that psychological therapy makes no difference to the management of these conditions. Again the burden of proof is with those who would rebut the null hypothesis. Who is it that judges that there are ‘unwarranted medical consultations’? What is the world view of a person who sees many consultations for long term conditions as unwarranted?
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My bolding in the quote.

This really suggests to me that Dr Whittington (whoever he is) wants to throw in the towel when it comes to curing disease and just wants to train people to put up with their ailments until they die.
 
Whittington says "need", when it means "want". There is absolutely no need for this, it's strictly a supply-side wish model based on a clearly false "what if". And actually we know the opposite of that, "can support" is simply not a valid standard for a program of any size, let alone a giant multi-billion boondoggle that basically acts as a jobs program.

Billions wasted in direct spending, and the very best they can boast about is still and ever was that it "can be of help to some" and some generic hand-waving that has exactly the same validity as astrology: stars and planets definitely can influence life on Earth, in fact without Jupiter our current models indicate that life on Earth would not have been possible without Jupiter acting as a tug on asteroids coming in the inner system. Still doesn't make horoscopes and zodiac signs anything more than narratives and myths, just like the BPS model.
 
I asked an IAPT psychologist what 'recovered' meant when reported to NHS commissioners, they said when the person no longer reaches 'caseness'.

As google will tell you, caseness is the term used to describe a referral that scores highly enough on measures of depression and anxiety to be classed as a clinical case.

So *I THINK* that if (totally random numbers here) 6/10 was 'caseness' and the person went from 6/10 before therapy to 5/10 immediately after therapy then they count them as recovered.

If I had the time and the inclination I'd want to dig into the reporting and see whether they balance that against the average number of people who would go from caseness to not caseness over six weeks without any intervention, and also whether they do longer term follow ups (pretty sure both are a no).

Reliable improvement "requires that any improvement in scores on the appropriate outcome measures between pre and post treatment exceeds the measurement error of the scales".
 
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