Saturday, December 08, 2012

IAPT propaganda truly impressive

The chief executive of the NHS in a foreword to a report on the 3 year review of Improving Access to Psychological Therapies (IAPT) (see my previous comments about this programme eg. Is mental illness curable by CBT?) thinks that the progress made has been "truly impressive". The Care Services minister emphasises that by the end of March 2012 "more than 1 million people have used the new services, recovery rates are in excess of 45% and 45,000 people have moved off benefits".

What isn't spelt out from the figures in the report is that only 60% of the people using the service complete a course of treatment. The percentage of people completing a course of treatment has decreased as the service has grown.

Rccovery is no longer defined in a report of this sort. Maybe we are just supposed to assume we all know what recovery means. To be considered cases at the start of treatment patients are required to score above 9 on the PHQ-9 and/or above 7 on the GAD-7 at assessment. They are said to have recovered if their score goes below these cut-off levels at the end of treatment. The higher patients’ initial PHQ-9 and GAD-7 scores are, the less likely they are, therefore, to recover. Recovery rates have steadily improved from 17% to over 45% over the first three years of the programme, which the report boldly states shows that services are becoming more effective. However, no data is given about whether there have been changes in baseline scores. Is the apparent increase in effectiveness due to milder cases being taken on?

Nor are the so-called economic gains controlled. How many of the 45,000 said to have moved off benefits would have done so without IAPT? Depression and anxiety get better with time without treatment. How many would have recovered without IAPT? The programme cannot make claims about effectiveness as it is not a controlled clinical trial.

This is political exploitation of psychological quackery. The programme now seems to be making a case for more funding to deal with its growing waiting list. Let's have a proper evaluation first.

8 comments:

Anonymous said...

To be considered cases at the start of treatment patients are required to score above 9 on the PHQ-9 and/or above 7 on the GAD-7 at assessment. They are said to have recovered if their score goes below these cut-off levels at the end of treatment.

Is this in the report itself? Cant see it.

I would love to see where this is written down.

Thanks in advace.

Duncan Double said...

"Recovery rates are defined by patients moving to below caseness on clinical outcomes scores as a proportion of the number of people ending contact with services and receiving at least two sessions of treatment." Taken from Realising the benefits. IAPT at full roll-out. Feb 2010. I agree it's remarkable that recovery is not defined in the report.

Anonymous said...

Thanks.

Recovery should be defined personally. imo. I find the whole idea of a clinician showing a patient a GAD or PHQ or Hnos score and saying look you're recovered absurd. But that seems to be what they are suggesting.

AS you know the quality of the CBT offered at ones local CMHT is usually nothing like that at academic centres where all the research is done. I can only imagine that the average IAPT session is pretty dire.

Anonymous said...

I see non-Doctors are to be wacky down ICD-10 provisional diagnosis as well. You must be gutted you bothered with medical school. Time would have been better spent learning how to mix the perfect G&T.

Anonymous said...

" You must be gutted you bothered with medical school."

Almost every psychiatrist except for a very select few brave ones who have the courage to oppose forced psychiatry and have the courage to really speak their mind and endure the enmity of their colleagues, should be gutted they ever wasted their opportunity to become real doctors.

Arguing about a bureaucratic report, while Rome burns.

It's all propaganda, not just this report, the entire profession is propaganda.

Double-speak.

Anonymous said...

Surely it is not possible to measure quality of life by quantitative means.

People will seek treatment when they feel unwell, not when they prove statistically likely to be suffering from one condition or the other.

Money is quantitative, and it will only be allocated by government for treatments which can be quantitatively justified.

Unfortunately, people who don't feel well often need something more qualitative.

This is why I am training to be a psychotherapist rather than a psychiatrist, but it's already clear that many of the people who could benefit from working with me will not be able to afford to do so.

I will have to charge for my time in order to make a living, but within that time I will offer compassion, empathy, unconditional positive regard, encouragement etc. - ie the things money can't buy, but which are essential to health and wellbeing.

Anonymous said...

I've seen some really appalling attempts to redefine what 'recovery' means in order to justify treatments.

The results of the largest trial of CBT and GET for 'Chronic Fatigue Syndrome' led to patients being classed as 'recovered' even when they still fulfilled the criteria for 'severe and disabling fatigue'. The researchers involved are currently fighting against an FOI that would require them to release the data for 'recovery' as it was defined in their published protocol: http://www.whatdotheyknow.com/request/pace_trial_recovery_rates_and_po

It needs to be recognised that 'recovery' is widely thought by patients to mean a return to a prior state of health. If 'treatments' are only leading to minor changes in questionnaire scores and on-going disability then we need to be honest about that, both to patients and to commissioners.

Anonymous said...

Recovery is defined - it's discharge from services and not being on benefits. This is what all policies are based on now