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

There is a lot going on here - for example if you think about the GP system then with their 7min appt slots combining with other obligations then IAPT simply presents a 'fix' they might have little choice about to cover them legally as having somewhere to send people for conversations they are not provided time to have. And a drop-down menu of things they can refer for, or do something about that gets shorter and shorter.

And yes you are then into barrel-scraping territory when you compare satisfaction scores that are carefully concocted so that they focus only on the bit where 'someone being able to let you finish describing the situation you are in' makes for a one point difference out of politeness which is outrageously interpreted as 'cure' rather than the lowest of the low attitude towards anyone who sits under this.

Maybe a sidenote, maybe not, but I really want detail on the scripts and protocols here. This is actually a huge thing that it represents happenning societally being hidden under ambiguous stuff.

In my mind the interesting thing about the 'BPSM model' is that - if you imagine it in sociology or something - modelled correctly it actually lays out a process for a bigotry or discrimination ie how that 'as a psychology' is used to justify in others behaviours that are not actually appropriate or correct, under a 'belief system' imposed or held or taught into a society.

Indeed it is nothing like any real psychology model because it was always anti-psychology in the sense that it removed all detail and direction, specifically seeking to not find the 'cause' in order to 'treat that' ie diagnose, but instead to as others have said 'persuade the sufferer it is their lot, their fault and their issue to put up with'. This isn't what is in the sales pitch (which is nonsense about 'teach you to cope') and they seem to be incredibly careful about never putting detail about what those referred are persuaded or told as a direction of travel to do - despite it being the most scripted and directed treatment of this sort ever.

If you imagine society expectations of get ill --> someone looks into it --> adjustments made in order that you keep your work between having treatment + having any changes made to allow you to still work and all the legal stuff behind that --> those around you are taught of these issues that they need to support and how their demands need to be adjusted, and all the other legal stuff people talk of like the insurances and policies most people do buy in order to make sure they aren't scrap-heaped if the worst should happen.

I have a feeling from some of those I have watched going through these things that people in the midst of the stress of trying to get their basic rights and battlinga system where that is made inappropriately hard to get their basic legal entittlements and truth that manyof these 'courses' simply persuade people that the better route is for them to admit 'they are the problem' get used to 'you aren't going to get what you deserve' and realise that the isssue is 'you can't cope with stress so should do a smaller job paid less' of course with lots of manipulative sales spiel to persuade that person it is their choice.

I can't think of less specific ways to put this because ill-health instigates all of this if it isn't going to be treated. And pathwaying out that 'total support and push of travel' is mapping whether it is a bigotry or a help. So it is vital. Because it is being used as a replacement for what a few decades ago would be a medic writing appropriate medical adjustments, doing referrals and having functional services and legal protections. And someone needs to map all of this. Because IAPT isn't just what the course pretends to be, just the persuader bit once people are dropped into that nightmare where they realise all that stuff is gone and they've been labelled making them weakened whilst it is all falling apart saying 'well at least this is something other than total dropping through the floor and as it is all you are going to be allowed then learn to be happy about it'. It isn't psychology in the mental health sense at all and we need to look at the entire system.

 

Official statistics announcement
Psychological Therapies: reports on the use of IAPT services, England, November 2022 Final including a report on the IAPT Employment Advisers pilot
Improving Access to Psychological Therapies (IAPT) data for November 2022 Final, and including a report on the IAPT Employment Advisors Pilot.

From:
NHS Digital
Published
22 December 2022
Last updated
22 December 2022 — See all updates

Release date:
9 February 2023 9:30am (confirmed)
These statistics will be released on 9 February 2023 9:30am
https://www.gov.uk/government/stati...-report-on-the-iapt-employment-advisers-pilot

 

Private company wins Nottinghamshire NHS mental health service contract despite concerns
The new provider will take on the service from April

https://www.nottinghampost.com/news/nottingham-news/private-company-wins-nottinghamshire-nhs-7996212

 

Following the usual cycle of biopsychosocial rebranding, IAPT is rebranding. Biopsychosocial is basically 90% marketing and 10% lying about marketing.

Same doll, new hat. Well, OK old hat but it has a sticker that says "novel".

Spoiler: Large image

 

Focusing on anxiety and depression isn’t a bad thing. Makes it less easy to add functional malingering to the IAPT mix, hopefully.

It’s Malibu Stacy but with fewer accessories and costumes.

 

I seem to remember this rebrand had a survey where they were asking people (I think it was general public rather than isolated to those who might use it, which means probably as many or more general public could have swung the vote than users) what name.

I'm always cynical of these that really they've put a few preferred ideas out there so it isn't really 'owned' from scratch either

But my point is that I'm not sure that this is connected to a 'what are we doing' genuine rebrand rather than just changing straplines. So any relief from it not covering us specifically hasn't come from the organisation or anywhere that matters necessarily. You'd think they'd take the hint, but people read into these things what they want.

And I have major concerns with IAPT as I think it is a major part of where they took psychology out of the scientific-based real psychology and put it under the medical/psychiatric model which is BPS and sadly ideology-based with the 'psychology' behind it being that of 'what do the doctors think' which even if they think themselves expert tends to be based on their own presumptions.

EDIT: by this I'm saying there is psychology as a science, and their is the laypersons term of 'psychology' which is just that of individual's own personal way of thinking and covers things like misogyny, bigotry ie isn't something that is a therapy just what someone thinks of others based on their own gut feelings (which they can often confuse with 'wisdom' if don't have humility, but tends to be based on what they've been fed from parents,society, in-group and then shapes what they might learn or take away from their experiences which also might be limited to certain perspectives). That's quite different from a subject that is looking at what is helpful, understanding causes of issues and knows the difference between 'healthy' and 'ad populus' or 'commonly accepted'. I think these people think telling people to behave as they 'would accept them/want them to' is confused with 'healthy or helpful' or cause or a psychology - and indeed it is shifting the cause of the issue (situation could be others' treatment of those people) onto 'if only they... it wouldn't happen'. And I'm scared this anti-psychology has been ingrained enough we've now got little real psychology left

It's also trained up leagues of people in BPSM 'people need to think and behave differently' pull your socks up (which they would never acknowledge is what is actually underneath some of the ideas they think aren't that....because they believe they aren't doing that because they've softened words) rather than beginning with looking at whether it is situational and finding the cause before matching to a relevant therapy that is actually correct for what is going on.

That's an issue. Because we don't really have proper psychology as long as it is that - just offering what people want to sponsor to use the 'techniques' to teach people 'to do'. And the subject area won't get back to being science or psychology that notes it can be either harm or nonsense being taught as much as help dependent on whether it is actually properly diagnosed and matched and the 'models' taught are based on science - instead of being 'if it is labelled as mental health it can do no harm and must be good'.

I just feel like distracting people with 'rebrand' is another great diversion of 'look at the shiny keys' to stop the conversations about how much is spent on it and the harm it might be doing. It is a huge power-base, and isn't 'just' about medicine - but is part of encapsulating those needs under that niche power-base further.

And I wouldn't put it past them to keep digging at chronic illnesses whilst then claiming when someone critiques their new strapline somehow means such criticism is less valid. PLus of course it is a nice way for them to try and 'dump the baggage' associated with an old name and make those trying for change apparently need to start from scratch even if they've changed little other than a strapline. I'd want to see massive changes in leadership and approach and how scientific they are before I'm less cynical that this is trying to avoid that.

 

Except if it is mainly CBT I find that very misleading, giving people the impression they can 'talk their situations out and get support on it' (which I think is what most of the referrers think too, unless they are two-faced). Which is misleading given CBT can be pretty combative and wholly get people to 'question their assumptions' as it is about 'think differently' rather than 'terrible situation' and certainly not teamed with functional support.

I'm also a bit shocked at the plural, given I'm unaware it does 'the gamut' to match to the correct condition, rather than 'generic' which in my mind has little evidence of efficacy, usefulness and lack of harm. So the public assume those with OCD, phobias, social anxiety are getting the specific type from someone with expertise in that area (which if done right and matched does have standing) but is that really the case. And for those with situations and issues where there is no best-fit even in the broad generics offered it gives the impression they are getting the right thing when maybe it is nothing near it.

It's an ironic one where maybe it isn't 'untrue' in describing what category what they do/think they do (generic CBT) sits under, but the public might perceive what that means as something different given it is the NHS and I've not heard of changes and impetus to get that correct

 

Yeah absolutely.

This is cover for what has been stolen from us materially in terms of medical care.

This is a part of a system of suppression where by we are taught not to value our lives. To give up the fight.

At this point many of us will be glad to be manipulated in this way rather than directly and publicly trashed as we “diagnosis seekers” so often are.

 

I got a question if a client from IAPT latter discovers a biological explanation can they claim medical negilance.
Allso what about the bad effects from cbt

 

(not a lawyer) I don't think it's possible to extrapolate from that small amount of detail as to whether negligence was involved. Questions such as: Was there avoidable error ? Was there available alternative treatment which was delayed ? Were there avoidable consequences of wrong illness management ? would all come into play.

The question re: CBT is whether or not CBT does anything at all, a lot of the evidence is that it doesn't do anything so there's no obvious harm in the sense that for example having unnecessary surgery or taking unnecessary medication would involve harm. A claim for negligence can be constructed out of pretty thin material but that doesn't mean it would be successful.

 

NHS
Doncaster
Talking Therapies

https://www.rdash.nhs.uk/wp-content/uploads/2023/08/DP8904-Doncaster-NHS-TT-Leaflet-final.pdf

 

“We can’t tell you what proportion recover, we can only tell you what proportion clinically significantly improve”

http://www.cbtwatch.com/we-cant-tel...-proportion-clinically-significantly-improve/

eta: Jeremy Vine BBC Radio 2 'medical monday' (1.0pm) are discussing 'talking therapies'.

 

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.

 

NHS Talking Therapies-Sham Monitoring

http://www.cbtwatch.com/nhs-talking-therapies-sham-monitoring/

 

I refused to complete these idiotic questionnaires on the grounds that (i) they can't distinguish between ME symptoms and symptoms of depression and/or anxiety, and (ii) I know they are useless and used carelessly as evidence of improvement. And yes, doing this at the start of every session was tiresome.

 

My experience is that it's hard to find a lawyer for a medical negligence claim. Then the money for expert witnesses.

No win/no fee lawyers aren't interested. Some legal expenses cover (like the cover sold with household insurance) doesn't always cover medical negligence and those that still do rarely get anywhere.

It's not 'just' with ME it's medical negligence in general. I tried both for myself at one point and then for my partner (who had cancer and the claim wasn't for ME).