67% have experienced anxiety or depression. 71% have experienced burnout. Sadly, we’re not talking about clients. These are IAPT staff who responded to a recent survey. 41% indicated that they had been asked to manipulate performance data. Despite a recent airing of the survey on Radio 5 Live, I’m still not hearing a sense of outrage? What’s going on?
Let me share with you some words that I happened across recently.
Managers of psychological therapy services in the UK are approaching a crossroads in terms of their role in ensuring the quality of the services which they are responsible for providing. With the means evolving of measuring, monitoring and benchmarking the performance of therapy services and the practitioners within them now with us, the responsibility of managers for quality is fast moving into new and relatively uncharted territory. This is an area which is likely to prove profoundly challenging and anxiety provoking for many of those involved……
Wise words, huh? Could have been written yesterday? More in a moment on this.
Reading the results of the recent Surviving Work survey into the experiences of IAPT staff made me want to cry. It should you too, in case you haven’t read it. It captures the heroism and misery of current and former IAPT staff struggling to provide care in the context of scarce resources, overwhelming demand and pressure to game performance data.
Headlines from the Surviving Work survey
The survey, which at the time of writing is still open, asks questions about the experiences of current and former IAPT staff. These include:
Do you think you are providing good care in your service?
Have you ever been asked to manipulate performance data?
Do you feel that your service is well managed?
Have you ever experienced burnout as a result of working in IAPT?
Have you ever experienced anxiety and/or depression as a result of working in IAPT?
What do you think should happen to IAPT services in the future?
Please tell us anything else you think we should know about IAPT
It is of some comfort that in response to the first question, 67% of respondents said that they thought they were providing a good service. In the context of what follows this seems little short of miraculous and has to be a tribute to their integrity and tenacity.
41% of respondents indicated that they had been asked to manipulate performance data. As indicated by the survey report the most common manipulations are:
Coaching patients to give good answers to questionnaires carried out after each session (GAD7 and PHQ9)
Discharging patients early if they showed good recovery scores to avoid a bad score
Carrying out questionnaires at end of session when people are routinely feeling better discharging patients to reach targets
Repeating questionnaires to get better results
Classifying an assessment as treatment to avoid reporting long waiting times (around 8-12 months)
Completing data for patients who have self-discharged
Waiting lists converted to a holding list where patients continually have to respond to letters in an attempt to reduce the volume of referrals
This isn’t the first time we’ve heard these types of comment. They are consistent with those made on previous TMN blogs and in response to surveys by the New Savoy Partnership.
The human cost of the pressures on the staff from the expectations of both clients and managers is all too evident. 67% responded Yes to the question Have you ever experienced anxiety and/or depression as a result of working in IAPT? And you would imagine that they would have enough tools at their disposal to manage a passable self-diagnosis.
In response to the question Have you ever experienced burnout as a result of working in IAPT? a staggering 71% said Yes.
Common to the experience of respondents were themes of lack of containment when dealing with complex patients, overwork/exhaustion, lack of supervision, not being able to ‘fit’ the IAPT model, patient suicide, bullying within the service and staff shortages.
I was recently ‘interviewed’ by my line manager and operational manager re 5 change of therapist requests. This was over a 12 month period. I have 70+ people on my case load, and see 7 patients per day, back to back, with inadequate supervision (in my view)
I was accused of not being able to build a rapport with patients…. i have worked in mental health services for 28yrs …. the pressure of thi expectation was inormous.
I began suffering anxiety and feelings of panic when i had to go work, or if an email arrived just in case it was another change of therapist request. When i reported this to my line manager and told her i was thinking of leaving and what job i might apply for, she stated “i think you would be good at that, well you have been doing this a long time”.
I fear for my job, and my own mental health, it’s corporate gaslighting.
These are the comments of one of the survey respondents. It makes for heart-breaking reading. I’ve heard similar comments from IAPT staff who have been clients of mine.
How did we get here, and where do we go now?
The situation that we find ourselves in now was wholly predictable. Predictable in the sense that IAPT has become so target driven that in many cases we can’t seem to find creative and humane ways to deal with the pressures. When we fail to acknowledge and push back against those pressures, the temptation to game the data for advantage can feel overwhelming. The worry has to be that this type of behaviour is becoming endemic to the culture of IAPT – part of “how we do things around here.”
The quote at the top of this blog about managers of psychological therapy services in the UK being at a crossroads? It wasn’t written yesterday. It wasn’t even written recently. I wrote those words 13 years ago in a paper in the European Journal of Psychotherapy and Counselling. What is happening now could and should have been foreseen. But to see, we have to want to see.
Maybe we’re too far into a post-truth era, because I feel like I’m getting desensitized to this sort of situation, shrugging it off a weary “well, it happens….” But the truth is we should be mad as hell. Mad as hell because staff are being coerced into fiddling the figures. Mad as hell because we can increasingly no longer trust the veracity of IAPT’s performance data. Mad as hell because at the end of the day this affects work with clients.
No, this data is probably not wholly representative of the bigger picture, but the fact that it’s happening at all means we need to be worried. I can live with spin, because I can generally find a way through to some sort of truth behind it. But what I can’t tolerate is deception, and coerced deception at that. If I had manipulated my performance data as an employed therapist I’d expect to have been sacked. As a former service manager, if I had coerced my staff to manipulate their data I’d expect to have been sacked.
I don’t pretend to have the all the answers to this sorry situation. But I do think that outrage might not be a bad place to start. An independent inquiry might usefully follow. What has developed is a stain on our profession and undermines trust in therapy and therapists. In what parallel universe is this OK?
Please share your thoughts, your sense of outrage or any other feelings come to that, and what you’d like to see happen. On a postcard if you must, but preferably below! ?
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Hi Barry,
like you, I’m finding it difficult to process this information. For me, counselling and psychotherapy are about seeing things as they ARE, rather than through the multiple layers of conditioning that we pick up because of our childhoods, because of our brain structure and the rest of our physiological idiosyncrasies, because of our lives/lies.
I often quote Freud’s saying that the process of therapy is to convert neurotic misery into ordinary everyday unhappiness, and at the risk of sounding trite it looks like exactly the opposite is going on here.
So this goes against everything I believe in. We are all taught that congruence is a core condition for therapeutic personality change, and this seems to indicate the reverse is being encouraged within the counselling service. Those of us who have studied theories of supervision and modern management are familiar with the parallel process, which predicts that the way management deal with their employees influences the way those employees deal with the clients of the service.
I’m not a great advocate of hanging onto shame, but well, have they no shame?
Hi David
As ever, thanks for you comments. It is hard to process isn’t it? I’m not a great advocate of shame either, but it seems to me that in this case I’d be prepared to make an exception!
Keep the faith!