More than ten years on from its launch the Improving Access to Psychological Therapy (IAPT) programme is far from delivering on its targets. Why then, given the astonishing rates of attrition in both IAPT clients and staff, are two of our European neighbours seeking to implement similar models? We re-examine some of the evidence and explore what you see when you only look at a small part of a bigger picture.
The recent translation into Dutch of a book published in 2015 by two of the original proponents of England’s IAPT programme has prompted calls in both the Netherlands and Belgium for the adoption of similar initiatives there.
Closer to home, however, it’s clear that however positive the latest headlines about IAPT may be, all is far from well. Levels of attrition among clients remain high, levels of staff burnout and low morale are at epidemic levels, and services seem to be haemorrhaging staff.
Add to that the fact that Sweden has abandoned its pursuit of a single modality national model, and the interest in replicating IAPT elsewhere starts to look particularly curious. Is there part of the bigger picture that is currently missing?
While you’re here, I have a small task for you.
Your task: Commission a therapy service for your country…….
A: Hello!
B: Hello sir, how may I help you?
A: I’d like to purchase a national therapy service please.
B: Of course, sir. What model did you have in mind?
A: Well, I’ve heard that CBT is quite effective?
B: Oh yes, sir, indeed it is. Our model returns a 51% recovery rate. Very impressive performance and a guaranteed return on investment.
A: That’s most impressive. It seems I’ve come to the right place. Does it come with any added extras?
B: Well sir, the latest model comes with a few small extras. CfD, PP and EMDR are all tried and tested and come as standard.
A: It sounds too good to be true! Is there anything else I should know?
B: Well sir, it’s worth being aware that the 51% claimed is based on patients that actually finish a course of treatment and are above caseness level at the start.
A: I see……anything else?
B: Well sir, there is some attrition along the way. All perfectly natural and nothing to be concerned about.
A: How much attrition?
B: Er……42%, sir.
A: 42% of what?
B: 42% of patients that enter treatment only have one session sir.
A: I see. So, of the patients that start therapy, what proportion actually recover?
B: Er…..28%, sir.
A: Only just over one in four patients that enter therapy recover?
B: Yes sir, that’s right.
A: Anything else?
B: Well sir, of the referrals in a year, 29% end without being seen by the service, and 29% have one treatment appointment only.
A: So, of the total referred in a year the proportion that finish treatment is……..?
B: Er…..40%, sir.
A: And the proportion that reach recovery is………..?
B: Er…..19%, sir.
A: Well, I don’t really have anything to compare it to, but given your confidence in the system I’m sure yours is the best model there is. Who should I make the cheque out to?
Seriously?
Is IAPT Thriving?
In 2015, Richard Layard and David Clark published a manifesto for the widespread delivery of empirically supported treatments (EST’s) to the population of England. Thrive is impassioned argument for change in our attitudes to psychological distress and its individual and societal costs. The central proposition is this: spend more money on the large-scale delivery of EST’s such as CBT, and you not only alleviate an enormous amount of human suffering, but the costs will be fully covered by the savings generated. There’s no way round it: it’s a seductive promise.
Thrive has recently been translated into Dutch, and has found its way, not surprisingly, into the affections of CBT adherents in both the Netherlands and Belgium. In June of last year, David Clark presented at a conference in Amsterdam at which the book seems to have been launched. Days later the book and a manifesto were presented to the Secretary of State for Health Paul Blokhuis. The manifesto called for “more and better investments in mental health care” promising that “every euro that is invested in mental health care yields two.”
This coming March, the focus shifts to Belgium, where David Clark will present at a lecture and panel discussion hosted by the Centre for the Psychology of Learning and Experimental Psychopathology. The lecture’s strap line is Investing in psychological treatments, it pays off!
David Clark clearly had a busy year last year, because in May of 2018 the Annual review of Clinical Psychology published a paper by him titled Realizing the Mass Public Benefit of Evidence-Based Psychological Therapies: The IAPT Program. The paper highlights some of the latest key metrics (adjacent). IAPT is clearly being presented as a success in England and also beyond these shores. Indeed, in the foreword to the latest IAPT Manual David Clark lauds the success of the programme.
- IAPT has grown to the point where it is seeing (in 2017) over 960,000 people a year
- IAPT currently treats over 560,000 patients per year
- Outcome data is available for 98.5% of these patients
- 51% of patients treated recover and 66% show reliable improvement
As someone who has spent more than two decades working out what quality therapy services look like, however, I think we need to take a critical look behind the headline figures.
The picture behind the headlines
A short while ago I blogged about the latest performance data from IAPT. I wasn’t awfully flattering about it, but then neither was the data. In that review I looked at two slightly different cohorts of clients: those whose referrals started (but may not have finished) in the 2017 – 18 year, and those whose referrals ended (but may not have started) in that year.
I’ve carried out some re-analysis of the data which is presented below. Here I’ve used only the data for clients whose referrals ended in 2017 – 18, so we’re looking at the same group all the way through their journey into and through IAPT in that year. In the end, the proportions that remain at each stage of the journey are very similar to my previous analysis. The overview can be seen in the image below.
With apologies for some repetition of the previous blog, let’s have a closer look at the data. First, the headlines. In the year 2017 – 18, the IAPT report and supporting datafile show that:
There was a total of 1,376,920 referrals that ended in the year
A reduction of 8,744 on the previous year
Recovery rates were 50.8%
This is up one and a half percentage points on the previous year, and for the first time exceeding the target of 50%. (definitions for recovery and caseness are shown in the panel below).
89.1% of referrals were seen within 6 weeks, and 98.8% within 18 weeks
exceeding their respective targets of 75% and 95%
CASENESS
The term used to describe a referral scoring highly enough on measures of depression and anxiety to be classed as a clinical case. If a patient’s score is above the clinical cut off on either anxiety, depression, or both, that are classed as a clinical case
RECOVERY
A patient is ‘recovered’ if they finish treatment and move from caseness to non-caseness by the end of the referral. The patient needs to score below the caseness threshold on both anxiety and depression measures. Referrals that started treatment not at caseness are not included in recovery counts
To reach the point at which they can show recovery, clients that are referred must progress through a series of stages, as follows:
The stages from referral:
29% of referrals don’t enter therapy and 29% have one treatment appointment only.
The stages from entering therapy:
42% of clients that enter therapy don’t complete.
The outcome at therapy ending for all clients:
53% of clients don’t achieve recovery
The outcome at therapy ending for clients that were at case level at the start:
51% of clients achieve recovery. 49% do not.
Below I’ll elaborate on each stage and show data for 2015 – 16, 2016 – 17 and 2017- 18.
The journey from referral – 29% of referrals don’t enter treatment and 29% have only one treatment appointment
The journey starts with all referrals for the three years. The table below shows those referrals as 100%. Subsequent stages in the process, and the proportion of clients referred that still remain are also shown. In 2017 – 18, 71% of those referred entered therapy. This is defined as having one or more sessions of therapy. This is slightly higher than in the previous two years.
As we progress through their journey we can see an emerging story of attrition. 29% of those referred only have one treatment appointment. By the end of therapy, only 40% of clients that were referred now remain, Those that reach recovery represent just 19% of the total referred . That’s less than one in five clients.
Why did only seven in ten referrals enter therapy? I can only speculate, but in doing this it’s important to note that nearly nine in ten referrals were seen within six weeks. Hence length of wait may not be the most important factor. Otherwise, they may no longer have needed therapy, their referral may not have been appropriate, or they may simply not have liked what was offered to them.
Stage 2: The journey from entering therapy – 42% of clients that enter therapy don’t complete
We begin this stage with all clients that entered therapy. That is, all those that had one or more therapy sessions. In 2017 – 18, 58% of those entering therapy are recorded as ending it. This figure has reduced in each of the past two years to the point now that more than four in ten clients do not complete.
Following the journey through, we can see that just 28% of those entering therapy achieved recovery. In other words, clients entering therapy appear to stand just over a one in four chance of recovering.
Why are only 58% of clients recorded as ending therapy? Again, it’s hard to know. In my experience, however, clients more commonly drop out because they feel that therapy isn’t working for them for some reason. Often, they simply disappear without the opportunity to explore this with their therapist, and make adjustments that may better serve their needs.
Stage 3: The outcome at therapy ending for all clients – 53% of clients don’t achieve recovery
Here we start with all the clients that are recorded as finishing a course of treatment. The first point to note is that not all clients were at a case level of symptoms or distress at the outset. No matter how much improvement they make, therefore, they cannot achieve recovery. In the 2017 – 18 population, 93% of clients were at case level, and could potentially recover.
This is slightly higher than in the previous years.
Those reaching recovery represent 47% of all those that finished treatment. For 2017 – 18, this is an increase of nearly 2% over the previous year.
Stage 4: The outcome at therapy ending for clients that were at case level at the start – 51% of clients achieve recovery
The final leg of the journey, starting with clients who finished treatment that were at case level at the point they started. In this population we have all the clients who have the potential to achieve recovery.
In 2017 – 18, 51% of clients achieved recovery, of those that finished therapy and were at case level at the start. To be precise, the figure given in the IAPT report is 50.8% (against 49.3% for 2016-17).
The figure for those achieving recovery for 2016 – 17 is 1.5% higher than in the previous year. This is the first time that the recovery rate has exceeded the target of 50% that was established for the IAPT programme.
While this improvement is clearly welcome, however, it remains the case that almost as many clients do not recover as do. At nearly 51:49, the odds of recovering or not recovering are almost even.
What does good look like?
When judging the quality of a service it’s easy to get so overwhelmed by data that we lose sight of what’s important. In a previous blog I’ve argued that we should start with two key performance indicators, and let the rest fight for their place. For me, the key characteristic of high-quality provision is the ability to enable clients to maintain engagement in therapy to the point where we and the client can point to a tangible and lasting improvement. That leads directly to my two key indicators:
The proportion of clients entering therapy that have a measured ending to their therapy
The proportion of those clients that show a demonstrable improvement
The graphic below plots the proportion of clients that have reliably improved, against clients with a measured ending to their therapy. Each circle represents a service.
In the service circled in green, 84% of clients reached a measured ending to their therapy and 85% of those clients have reliably improved. In the service circled in orange, 75% of clients reach a measured ending and 67% have reliably improved. In the service circled in red, 58% of clients reach a measured ending and 66% improve.
Where does the data come from?
Circled in green: performance data from the Royal College of Nursing Counselling Service from 2003 – 4, where I was Head of Service between 1994 – 2005
Circled in orange: performance data for 2017 – 18 from Mankind, a service I provide consultancy to, that specialises in supporting men affected by unwanted sexual experiences
Circled in red: the mean level of performance across IAPT services
Tearing down the house?
A study from 2006 profiled the improvement rates of 32 primary care counselling services using the CORE Outcome Measure. (CORE-OM). The mean level of reliable improvement (including clients that also recovered) was 72%. Across IAPT, the reliable improvement figure was 66%.
IAPT improvement rates are based on GAD-7 and PHQ-9. It is likely that they would yield somewhat different results from the CORE-OM. Nonetheless, on the basis of the reported reliable improvement rates it would appear that IAPT, after some ten years of operation, falls significantly short of the rate found in the 2006 study.
I worked with a number of the services that donated their CORE data to the 2006 study, and many of them were truly outstanding. Sadly, many no longer exist. They were either decommissioned or subsumed into the emerging IAPT structure.
Governments considering the adoption of a national system of provision of the kind provided by IAPT would do well to look wider than simple recovery rates. These form only a small part of a much bigger picture. They would also do well to consider the experience of Sweden, which undertook enormous investment in CBT to address rising rates of disability due to mental ill-health.
In 2012 Sweden’s National Board of Health and Welfare announced an end to the CBT monopoly. Later, their National Audit Office concluded that “Steering towards specific treatment methods has been ineffective in achieving the objective.”
Another look behind the headlines
Behind the headline recovery and improvement rates for IAPT lies a range of performance by Clinical Commissioning Group area and individual providers. In his paper David Clark highlights the variability across services in the year 2015 – 16. The lowest recovery rate was 21% and the highest 63%. The lowest rate of reliable improvement was 35% and the highest 80%. There are clearly some high performing services out there that we can learn from.
Clark identifies a range of organisational variables that impact on performance. These include waiting times, therapy dose, rates of missed appointments and whether services are predominantly focused on providing therapy. Clark also identifies the critical importance of clinical leadership in setting the tone and culture for services to be learning organisations.
“Improving Access to Psychological Therapies is a politically-driven monster which does not cater for staff feedback/input in any way. All we are told is TARGETS!!! And work harder.”
This will not come as news for the many service managers and practitioners who have been involved in delivering high quality services for the past couple of decades and more. Was it really necessary to tear down the whole house to now rediscover what was already known to many? As it is, we seem to have taken ten years and a vast amount of expense to get to a point that, in outcome terms, feels some distance short of where we were 2006.
A ‘politically-driven monster’ too big to fail?
Has ‘IAPT’ eaten itself? is the title of a recent article in Mental Health Today. The article profiles September 2018 figures from the Department of Health and Social Care showing that 2,000 mental health staff per month are leaving NHS services, increasing waiting times for both high and low intensity cases. The New Savoy Partnership (NSP) has been conducting annual surveys of mental health staff since 2014 to assess the wellbeing of NHS mental health staff.
Their latest survey, profiled in Mental Health Today, found that 43% of staff report feeling depressed in the prior week; 42% reported feeling like a failure in the past week; 72% think that the service they work in was understaffed and not fit for purpose; and 23% were actively considering leaving the NHS.
One of the respondents to the NSP’s 2015 survey described IAPT thus: “Improving Access to Psychological Therapies] is a politically-driven monster which does not cater for staff feedback/input in any way. All we are told is TARGETS!!! And work harder.” Jeremy Clark, NSP’s founding chair, recently described IAPT as “too big to fail.”
All’s well that ends well?
There was never anything wrong with the aspiration of providing high quality therapy at scale, simply the execution. IAPT has become deeply politicised, and as a result, too big to fail.
As early as 2014 the British Association for Behavioural and Cognitive Psychotherapies (BABCP), lead body for CBT in the UK and Ireland, deplored the “NHS management culture of bullying and intimidation, preventing [members] from openly raising their concerns and undermining their clinical judgement.”
Just like Brexit, it is very hard to know how this will end. I simply hope that we (and others) will not repeat the same mistakes.
If you carry old bricks from your past relationship to your new one, you will build the same house that fell apart before.
We thrive on feedback, so please let us know what you think about what you’ve read in the comment section below. Only the name you use to identify yourself will be shown publicly. Thank you!
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Barry as a former nurse it is great to see the results of good counselling practice within RCN services. I appreciate this detailed analysis of IAPT services. It certainly does seem too big to fail and taking on a life of its own. I have worked in an excellent Cancer charity and an excellent community counselling service in Belfast but the changes are coming in relation to strictly limiting the number of sessions to clients and counsellors having to make a strong case for a few extra sessions for often extremely vulnerable complex clients who have often been let down by statutory services. I am semi-retired and remain hopeful that counselling/psychotherapy will find its place as a recognized profession within mainstream health and well-being services nationwide. Thank you for a most detailed synopsis of IAPT outcomes and comparisons with other services.
Hi Marie and very many thanks for posting your reply.
I’m really sad to hear of the impending changes in the services that you mention. In my experience these sorts of decisions to limit sessions are made without any reference to their impact on outcomes. There is a clear link between the two, however. That was acknowledged by David Clark in the paper I profile in this blog. The relevant piece is below:
4.1.3 Dose of therapy—The dose of therapy effect identified in Gyani et al’s (2013) analysis of the first year of the IAPT program replicated when re-examined seven years later. Services that gave a higher average number of treatment sessions achieved better outcomes. The optimal mean number of session appears to be 9-10, but many patients recover with less sessions and some need substantially more.
It couldn’t be clearer. Creating a strict limit flies in the face of the evidence and is counter-therapeutic. Sadly, sometimes a stiff rearguard action is required.
Thanks again! Barry
I was quite disgusted by these figures, quite frankly. I spent an afternoon working out my own stats, which (fortunately for my self-esteem) were a completely different story. I did a post on them here; http://davidandsue.net/how-do-my-results-compare-with-iapt-nhs-therapy/
Until reading your post I was under the impression that IAPT was merely under-resourced, but if you were lucky enough to be accepted then the results were good. No longer. It’s so disturbing. It appears that they have lost sight of what is possible, achieveable outside the NHS, altogether, prioritising one model which you have demonstrated to be inadequate over the excellent services that were dismantled. at its inception.
Hi David and thank you so much for your post.
I applaud you for having the courage and transparency to put your data out there, and I’m glad that the post prompted you to do your own comparison and write your own blog. Your data is very impressive. So not only have you been able to rebut the issue of the NHS being cheaper than private therapy, but you have your own data to demonstrate the quality and effectiveness of what you provide.
One final thought: if you haven’t already, the IAPT website has an interactive tool where you can drill down to your local CCG level and see recovery and improvement rates. It’s here and the relevant page is 14. https://app.powerbi.com/view?r=eyJrIjoiZmRhNTNiOWQtYzRmZi00YzdjLTgwOTMtZTFjMWRkMTEwNTNhIiwidCI6IjUwZjYwNzFmLWJiZmUtNDAxYS04ODAzLTY3Mzc0OGU2MjllMiIsImMiOjh9
Thanks again and keep in touch! Barry
Hi Barry,
The link you provided is no longer available, do you know where i can find updated information,
Alexz
Hi Alex – it appears there are a number of broken links now. It’s very annoying when URL’s are not redirected. I’ll have to look at this in due course and can only suggest you come back in due course when I hope to have had a chance to fix or delete link. Thanks for drawing it to our attention!
Barry
Thank you SO MUCH Barry for such a rich, detailed and sobering analysis of the state of IAPT. Having worked in the private and EAP sector for 17 years I’ve watched IAPT be born, grow and continuously fall short to the detriment of everyone involved. You articulate this so eloquently and have made my job of shining a light on why employers need to support their staff less of a battle when I signpost them to your article!
Sharon – thank you. It’s great to hear your feedback, which makes it all worthwhile!
Thank you for the analysis. Here’s some of the worst new rules to the IAPT gaming game following on from the already known traditions of marking triage as treatment etc.:
Why are so many not finishing treatment? A growing game is to re-class those who don’t recover as “non-iapt” during treatment so that you don’t have to include them at all in your recovery figures and they just drop off somewhere as discharged non-IAPT, having though served their purpose towards access rates and waiting times.
Removal of Anxiety Disorder Specific measures from the system – many services now telling staff to not record the ADSMs in the main system as much easier to achieve recovery on PHQ and GAD only. Seems to be no checks and balances from NHS Digital to ensure ADSMs are used.
Where patients are entering measures remotely, a growing trend – ensuring that you talk through the measures with the patient in the last session, with pressure to edit them lower
Of course staff are depressed. They come to understand how the stats are used and what the individual manipulations that they do in order to save themselves from service management bullying and public humilation (many services share recovery rates etc among staff as if they were a call centre celebrating sales made), lead to the destruction of good care and the very evidence needed to obtain more budget for more staff and more client hours. The misery and realisation they are trapped in a system sets in. Only the very unaware or the narcissitic don’t care – not really the profile you’d be wanting from your therapy team….
Dear Anon, I don’t know who you are but my heart goes out to you and thank you for your comment.
As you say, your points help to illustrate the evolution of the gaming of the system. Given the political and managerial pressures there was always the potential for this. Sadly, it’s the absolute antithesis of a learning environment. We seem to be increasingly dehumanising both clients and staff, and that’s not only tragic, it’s avoidable.
Thank you once again for speaking up for what’s right.
Take care, Barry
Hi
An interesting analysis. Working in an IAPT service, I can concur with a lot of what you present, though I do not necessarily agree with it all. I believe that the data collection can be manipulated by all parties, by both those who support and agree with IAPT as a way forward, as well as by those who see the benefit to patients behind the data, and those who do not. Recent articles in BACP therapy today and discussions threads on BABCP CBT café are prime examples of the latter
One area I would like to challenge though is;
‘Why are only 58% of clients recorded as ending therapy? Again, it’s hard to know. In my experience, however, clients more commonly drop out because they feel that therapy isn’t working for them for some reason. Often, they simply disappear without the opportunity to explore this with their therapist, and make adjustments that may better serve their needs.’
As a service, we were also concerned by this. I spent many long hours looking at why this was happening. It transpires, after looking at many hundreds of ‘drop outs’, that the primary reason was that the majority patients were actually moving to recovery (the efficacy of PHQ & GAD as a measurement tool which measure is another debate), and that patients would possibly not feel the need to let us know. Something that quite regularly happens with any NHS service such as GP non attended appointments. Of course, this is not the sole reason why patients drop out, but I do think that this is an example of looking behind the raw data.
I can only speak for my service when I say yes, IAPT is a machine, but it is a machine with a heart. In the 12 years I have been working for this service, it does it best within the very narrow remit that we have been commissioned for.
There are good and bad IAPT services, as there are good and bad services within any organisation.
Keep challenging and lets all continue to look at the qualitative data behind the quantative. If we don’t challenge we will keep doing the same old thing, the same old way.
Hi Brendan and very many thanks for your comment – it’s always great to hear the perspectives of those working on the ‘inside’ – wherever the inside is.
I totally agree with you on the potential for data to be manipulated for wider ends which are sometimes nothing to do with users or patients. In an ideal world that wouldn’t happen, but…..
I’m impressed by the time you’ve spent trying to understand the significance of your dropouts, assuming I understand you correctly. I’m curious as to how you came to conclude that the primary reason was that patients who were moving to recovery weren’t letting you know. I would have assumed that if a client attended a session they would complete the GAD and PHQ, and therefore that you would know their trajectory (improvement or otherwise)? If they didn’t attend, then how would you know whether they were moving to recovery or not. I realise I may be missing something here – apologies if I am!
I echo your thoughts about challenging and keeping on trying to better understand what lies behind the numbers. Only that way can we be sure that patients and clients receive the best we can provide.
Thanks again!
Barry
Hi Barry,
Reading Brendan’s comments reminded me of some analysis I did of my work last year that gave a similar result for some clients.
The analysis showed that 41% of male private clients did not arrive for their final session either cancelling or simply not arriving and not getting back in touch. As this was only a small number (7) I reviewed their notes and found that all had been heading towards positive outcomes. It suggested to me that maybe they had difficulties with endings.
However, because none of them counted as a planned ending, they made a dent in the results when I calculated my success rate using the IAPT system. This has encouraged me to use the CORE 10 form on a frequent basis so hopefully I will get a clearer picture of what is happening this year.
David
Hi David, I think your experience really underlines the need for us to pay attention to the figures. Clearly the clients you reviewed seemed to be progressing in the right direction at the point they disengaged. The numbers may be small but I’m guessing they may have made a significant difference to the percentages. I’ve long wondered about the relationship between our initial contracting and setting out our expectations of the clients, and the likelihood that they will simply end up as a no show one day. I’m not suggesting we say “if you drop out I’m coming after you….” but simply reinforcing the message that we’d really appreciate knowing if they feel they have got what they came for?
Thanks again! Barry
‘recovery’ in IAPT is complete and utter nonsense based as it is self assessment measures such as the PHQ9 and GAD7.
Life falling apart on multiple levels, no matter if we can stimulate enough people pleasing and manipulation you are now ‘below clinical’ and in ‘recovery’.
How on earth did this happen? self interest seems a likely candidate – once the parameters are set up it seems people are happy to conform.
I’ve lost count how many clients when completing the self assessments tell me they think they are useless and I fully agree. So do it seems many therapists but speaking up might mean a challenge to our own wages so best shut up and keep churning out the empty data.
Even without the tick box measures what sort of magical thinking has people believing that 6 – 10x 50 minute sessions of anything will do much for the majority of people?. Amazing how once things are embedded culturally the feeding frenzy just keeps it all going.
And indeed the term recovery has multiple definitions. There can be a value in using measures, if they are used as one means (among others) of eliciting feedback about how therapy is progressing, and responding as required. But given that IAPT performance figures seem to have flatlined year after year, there seems to be little evidence of that in practice. Thanks for you comment Topher!
I would highly recommend reading Psychotherapy and the Social Clinic in the United States, soothing fictions, by William M Epstein. He carefully deconstructs what is considered the best research into psychotherapy effectiveness and what he demonstrates is not at all what this overblown self interested corrupt mess of a system promotes. How such careful critics of the psychotherapy research literature are just ignored is terrible but not surprising – we’ve all got our snouts in the trough it seems.
Thanks for the recommendation. To be honest I’ve always winced when I hear the term ‘clinical’ in therapy, as if it confers some kind of legitimacy. I can’t get away from the image of someone in a white coat, and if that’s my reaction, what about the client’s? I’ll be writing another blog shortly on the latest IAPT annual data, so stay tuned. Spoiler alert, it’s not got any better 🙁
Was referred to IATP twice (for ‘medically unexplained symptoms’). The first time I had about 6 sessions, which seemed to consist of nothing more than repeatedly going through a questionnaire to determine that i still felt terrible. There seemed to be nothing of substance to it.
Then the practitioner decided he needed to consult with colleagues and decide ‘where we go from here’ and said he’d get back to me. Nothing happened for maybe 6 months, at which point I phoned them and left a message asking what was happening (perfectly politely). Then I got a letter discharging me saying they couldn’t help me. To me this seemed a peculiarly passive-aggressive approach to getting rid of someone.
Then I went back to the GP and then spent about 18 months going round a game of pass-the-parcel, with multiple ‘assessments’ and bounced-back referrals to three-or-four different mental-health services, with a brief diversion to CMHT, before ultimately, to my surprise and puzzlement, being sent back to IATP again. This time I got 2 sessions before they decided to discharge me again – the trigger seemed to be me showing them the letter they sent the first time saying they couldn’t help me and asking (again, perfectly politely) why they had changed their mind.
It seems quite obvious to me that IATP is about gaming the system and massaging the numbers to make the performance metrics look good. It exists to keep the practitioners in employment, not to actually help clients. They very obviously filter for the easiest cases, that is, they are clearly looking for referrals of people who don’t have any real problems and hence can be easily nudged to tick the box saying they are “all better now”.
Thanks for posting about your experience. Wow, how you have been failed by IAPT. It’s shocking to read. I hope you’ve managed to get some better help eventually.
Thanks again, Barry