The BPS and IAPT – another failure?

We publish below (in full) a post from another blog – CBT Watch (http://www.cbtwatch.com) – which reflects the very same sort of issues that we have been raising in this blog over the past few months. We are grateful to Mike Scott for this succinct critique of the BPS’s approach to a matter of significant public policy in respect of mental health service provision. We also thank him for allowing us to re-post this.

The Improving Access to Psychological Therapies (IAPT) Programme and the British Psychological Society (BPS)

The BPS has enthusiastically supported IAPT from its inception in 2008.  Improving access to psychological therapies is clearly a laudable goal, as most people with a mental health problem are not offered psychological therapy. The Society has led the course accreditation process for IAPT’s Psychological Wellbeing Practitioners (PWPs) low-intensity training since 2009. Features on individual PWP’s have featured periodically in the pages of The Psychologist. In 2009, The Psychologist published a letter from the then President of the British Association for Behavioural and Cognitive Therapies (BABCP) stating that BPS members on the IAPT Education and Training Project Group supported BABCP’s accreditation of high intensity training programmes and noted that there were BPS members on the Accreditation Oversight group.

But the enthusiasm of BPS to give away psychological therapy has not been matched by a concern to listen to the concerns of service users. Specifically:

1. At no point has BPS suggested that it is inappropriate for IAPT to mark its own homework. The latter’s reliance entirely on self-report measures completed often in the presence of the IAPT therapist, should have had any self-respecting psychologist crying ‘foul’ and calling for independent assessment. 
2. A concern for service users, should have led BPS to insist that a primary outcome measure must be clearly intelligible to the client. But there has been no specification of what a change in X as opposed to a change of Y would mean to a client on the chosen yardsticks of the PHQ-9 and GAD-7. 
3. BPS has been strangely mute on the fact that two self-report measures have been pressed into service to validate IAPT’s approach, with no suggestion that such an approach needs to be complemented by independent clinician assessments that go beyond the confines of the 2 disorders (depression and generalised anxiety disorder) that the chosen measures address.
4. If a drug company alone extolled the virtues of its psychotropic drug, BPS members would quite rightly cry ‘foul’ insisting on independent blind assessment using a standardised reliable diagnostic interview. But from the BPS  there has been a deafening silence on the need for methodological rigour when evaluating psychological therapy. This reached its zenith In the latest issue of The Psychologist, September 2021, when the Chief Executive of an Artificial Intelligence Company, was allowed to extol the virtues of its collaboration with four IAPT services. No countervailing view was sought by The Psychologist, despite it being obvious that the supposed gains were all in operational matters e.g. reduced time for assessment, with no evidence that the AI has made a clinically relevant difference to client’s lives.

In 2014 I raised these concerns in an article ‘IAPT – The Emperor Has No Clothes’ I submitted to the Editor of The Psychologist which was rejected and he wrote thus ‘I also think the topic of IAPT, at this time and in this form, is one that might struggle to truly engage and inform our large and diverse audience’. This response was breathtaking given that IAPT was/is the largest employer of psychologists. 

Fast forward to 2018 and I wrote and had published in 2018 a paper ‘IAPT – The Need for Radical Reform’ https://doi.org/10.1177%2F1359105318755264 published in the Journal of Health Psychology, presenting data that of 90 IAPT clients I assessed independently using a standardised diagnostic interview only 10% recovered in the sense that they lost their diagnostic status, this contrasts with IAPT’s claimed 50% recovery rate. The Editor of the Journal devoted a whole issue to the IAPT debate complete with rebuttals and rejoinders. But no mention of this at all in the pages of The Psychologist.

It appears that BPS operates with a confirmation bias and is unwilling to consider data that contradicts their chosen position. If psychologists cannot pick out the log in their own eye how can they pick out the splinter in others. In 2021 I wrote a rebuttal of an IAPT inspired paper that was published in the British Journal of Clinical Psychology, ‘Ensuring IAPT Does What It says On The Tin’, https://doi.org/10.1111/bjc.12264 but again no mention of this debate in The Psychologist. 

In my view the BPS is guilty of a total dereliction of duty to mental health service users in failing to facilitate a critique of IAPT. It has an unholy alliance with BABCP who are similarly guilty. Both organisations act in a totalitarian manner.

Dr Mike Scott (CBT Watch)

Blog Administrator note: An additional two sentences which had been omitted in the editing process have been added to point 4 (24 August 2021).