Monday, February 18, 2019

The realities of working in IAPT

Despite me saying (eg. see previous post) that people must be more realistic about the effectiveness of Improving Access to Psychological Therapies (IAPT) and stop saying that it is a "marvellous treatment", a recent self-congratulatory event (see programme) celebrating 10 years of IAPT led to a further bout of overhype for the programme (apparently to obtain further funding - note that the Chief Executive of the NHS and the Secretary of State for Health and Social Care were both speaking). For example, Claire Murdoch, NHS England's National Mental Health Director, in a tweet to me said that she was sad that I was dismissing the "brilliant IAPT work".

I'm actually not undermining the work of IAPT. I just want IAPT therapists more recognised for the difficult work they do. Helping people is not always as straightforward as following an IAPT protocol. Luckily the natural history and spontaneous improvement of anxiety and depression over the short-term is about 50% or above, which is what the IAPT programme calls its recovery rate (see previous post). But, particularly over the long-term, it's not always easy to help people deal with their suffering, dependency and vulnerability (see another previous post). IAPT is perverting care, as Rosemary Rizq said (see her article). It shouldn't be seen as a simple programme that people just need to follow and everything will be alright, which is how Claire Murdoch's comment could be interpreted. Politicians seem prepared to invest in IAPT further, maybe to meet the so-called 'parity of esteem' target required to treat mental health services at least as well as they do physical care, even though we don't hear much now about the original reason for the programme being agreed, which was because politicians were persuaded it would take people off benefits.

David Clark (who I have mentioned before, see eg. previous post) in his blog on IAPT at 10, seems to see the only challenge for the IAPT programme as being the need for further expansion. As I said in my talk, David Clark has said that his initial research interest was in psychotropic medication not psychotherapy. He has merely succeeded in encouraging the exploitation of the placebo effect with psychological therapy in the same way as for medication. Although people on average may well prefer talking therapy to medication, let's try and be more realistic about how we develop mental health services.