Improving access to psychological therapies initiative a waste of money?

Well maybe it is and maybe it isn’t, this paper published recently on Chester university’s website suggests that recovery rates / effectiveness of the IAPT initiative would be more accurately reported as

Using those starting therapy as a denominator, the rate falls to 22%. Using as the denominator all patients referred to the IAPT programme, this figure is still lower, at12%

Suggesting that this initiative is a waste of tax payers money

But what has always concerned me about this initiative is how people i.e. the government or scientists are going to ascribe it a success or a failure. The key problem being how do you assess whether therapy of whichever type is helping the patients move into recovery. Now like many people who’ve been through therapy I’ve had to fill in the questionnaire about how I’ve been feeling  in the last 7 days and I guess like many I’ve struggled to complete them particularly in the early days when I was quite frankly very ill. It’s all bad and then it could all be okay again but as time has gone on they really haven’t gotten any easier and seeing any meaningful change in the output from them is difficult. 

Am I bothered?

No because I feel better, it’s not great but it’s better on average. The biggest problem I have is that some weeks are pretty bad and if I was filling the form in this week I would score quite a bit less than on a good week. Now my bad weeks and good weeks have pretty small differences so hopefully this evens out in a large sample set but it does beg the question of whether over all that is the case particularly as I have mentioned this was not always the case. 

One would hope that for most people going through this it does even out and make no overall difference to the outcome of such a large sample.

I might also add that this initiative was rolled out with this description

                   The IAPT programme offers therapeutic help for adults with common 

                   mental health problems using a stepped care model, from low to high

                   intensity care.

 

And having been referred twice to psychological services with a diagnosis of bipolar effective disorder, not a common mental health problem, I completed the questionnaires at the beginning and end of both sets but I am not sure whether I was included in these figures or not. I am not a person with a common mental health problem but I did undertake therapy just like anyone who does have one. I fulfilled all the requirements to be included and the figures published don’t state diagnosis so did I get included. And if I did, is this really very fair on a system that is aimed at those with common mental health problems.

 And I say this because for people such as myself or people with other problems we often get referred to and undergo treatment under psychological services as part of an overall treatment plan that may involve other and further therapies that those with common mental health problems are not expected to.

Padantic? Yes but then if you are assessing something for one thing shouldn’t you really exclude all those who don’t fit the criteria. But who knows they may have done this.

The other thing that concerns me with this particular paper is that although people get referred to therapy they don’t necessarily complete it and I’d be the first to admit that there are a variety of reasons for this happening. One of which is that the therapy is not suitable for them, another being because they decided they didn’t need therapy at this time and why should they be included in a calculation about the rate of effectiveness of a service.

Is this a failure in effectiveness of a service because these people didn’t go forward?

Maybe but I just not sure that it should and although I admit that the overall effectiveness of service ought to include something about the dropout rate I don’t believe this is a fair way to do it.

I guess the biggest thing for me is in answering this question

Do you report the success/ effectiveness of anti depressants based on how many people are offered them and how many people move into recovery, regardless of whether they then take them at all, or take them as directed?

And realistically people don’t! Drug  companies, G.P.s, psychiatrists, you name it they only give results of effectiveness based on the people who actually took them as directed so why are we evaluating a service based on people who entered but didn’t necessarily attend an sessions and how many people moved into recovery?

And yes adherence to treatment is important and is a problem and shouldn’t be ignored but really it seems that this measure of effectiveness should include some understanding of the reasons why people didn’t complete.

They do conclude that

This study’s key finding is that the proportion of patients ‘moving to recovery’ depends on which of the three calculations is used. The difference between the method favoured by the IAPT programme (43·72%) and the proportion of all referrals (11·86%) is too large to be ignored.

Commissioners of psychological therapies in Primary Care will want to exercise their own judgement as to which of these figures offers transparency to support analysis of outcomes. Recognition and understanding of the needs and experience of the high proportion of patients who have one or fewer contacts with therapists should be a high priority in the development of commissioning for psychological therapy.

But don’t offer any explanation or exploration of the problems and I just hope that people and the newspapers don’t just see the figures without considering the problems of assessing a service in this manner without proper attention paid to the reasons why people do not go forward with therapy, which are numerous and involved.