The IAPT Survey Results

Talking about IAPT should come with a health warning. Whether you’re a therapist, a service user or just an MP on the campaign trail really talking about mental health services involves opening up a Pandora’s box with all the professional and personal consequences this entails. 

 

So it is with the following qualifier that we’re sending you some preliminary results of the IAPT Survey carried out in preparation for today’s discussion on BBC5Live about what’s happening in services. 

 

We do not underestimate the heroic and kind efforts of people working in IAPT or the noble ambitions of the service to deliver care to more people. IAPT services are patchy, diverse and often providing genuine care. We do however want to talk about how IAPT has become downgraded as a talking therapy and pay attention to the clear concerns being voiced now about the gaming of recovery data. It’s time to talk about IAPT.

 

Here is a summary of what 550 current and past IAPT workers told us about services over the last two weeks:

 

Have you ever been asked to manipulate performance data?

41% said Yes

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

 

Do you feel your service is well managed?

57% said No

Most common comments were:

  • •Fair degree of sympathy for service managers who are subject to the same targets coming from senior levels
  • •Link made between recovery targets and micro-management/performance management in the service
  • •Absence of robust service managers who are willing and able to challenge senior management and the target culture

 

 

Have you ever experienced burnout as a result of working in IAPT?

71% said Yes

Common themes

  • 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
  • staff shortages

 

 

Have you ever experienced depression or/and anxiety as a result of working in IAPT?

67% said Yes

Common themes:

  • a dominance of anxiety in relation to targets/responsibilities/duty of care
  • ethical dilemmas about working in a system that is not adequate
  • experiencing failings of service as personal failure

 

 

What do you think should happen to IAPT services in the future?

Common themes

  • stop using targets
  • de-link IAPT services from the benefits system (Universal Credit/PIP/WCAs)
  • look at the pressure to support primary care services that are failing
  • increased investment in high skilled therapists in the NHS so that complex cases can be treated and IAPT services can be reserved only for low intensity needs
  • capping the number of clients per day
  • stop gaming data and change the measurements we use to create the evidence base
  • increased flexibility in the modality and therapeutic process

 

 

Please tell us anything else you think we should know about IAPT

Common themes:

  • stop using a one-size-fits-all model of CBT ‘lite’
  • recognition of the range of therapeutic models that people use and their value
  • more investment in staff so that they can develop and progress
  • support for the overall vision of IAPT but not the model
  • lack of recognition of the personal cost to people working in the service working within this system
  • lack of monitoring of employers and working conditions within the service e.g. Mind

 

 

Do you think you are providing good care in your service?

67% said Yes.

 

Read that again. 

 

Although nobody here said that they felt that the IAPT service was adequate, many people said that they did their best to provide good care. 

 

The combination of 67% feeling they are providing good care and the highest rates of burnout I’ve ever seen should be the subject of whole libraries. We have to understand the reasons why so many people with good intentions are still working within an inadequate service and the consequences of that. 

 

It should be unnecessary to point out that to have a debate about this we have to let people talk, to listen and look reality in the face. Although the box has now been opened in part due to the anonymity afforded on social media and online surveys,  financial and political interests are at play and an attempt to shut down debate and dismiss experience as negativity has shifted into gear.

 

In this debate two things matter. Data and the experience of navigating IAPT right now. I am firmly of the view that if you’re not living it right now you don’t understand what is happening to mental health services so it is our job to inform the people who design policy and political party manifestos about the NHS about what is really happening.

 

Here is what you can do.

 

Send this survey to anyone you know who is or has worked in IAPT so we can collect some actual facts https://www.surveymonkey.co.uk/r/timetotalkIAPT. The survey will be open for one more month and the results will be distributed before the end of the year by Surviving Work.

 

If you can, engage with the debates going on BBC Radio 5 Live today 13th November https://www.bbc.co.uk/sounds/play/live:bbc_radio_five_live. You can tweet on @BBC5Live text on 85058 and phone on 08085909693. IAPT will be debated this afternoon and evening.

 

I will tweet when the IAPT debate continues on @survivingwk. 

5 Responses to “The IAPT Survey Results”

  1. Elizabeth Cotton

    M: “I am currently training as a child & young person’s Psychological Wellbeing Practitioner. My contract due to end on 31/12/2019 was extended to 31/03/2020. This enabled the service to recruit another cohort of trainees. With an abundance of trainees paid for by NHS England there are no paid positions for us when we qualify. There are no CYP IAPT positions available for me or my entire cohort. The government initiative to train 10.000 additional therapists will be realised though it will not transfer into a workforce as we are being trained to join the unemployment queue or if we are very lucky to return to previous professions. Training at university was so poor that CYP courses are not accredited so the qualification is meaningless. Many of us are already experiencing burn out even before graduation. I feel duped having left a previous permanent and well paid role in another area but my main concern is the welfare of CYPs whose mental health services are dwindling due to the gross misappropriation of funding that will not result in the widening of services to support early intervention as was intended following the Layard report.”

    Reply
  2. Elizabeth Cotton

    From S: “Who can we go to to discuss difficulties in IAPT Services. As a staff member we are in a precarious position. Staff who highlight difficulties are ignored or seen as difficult. On contrast those who turn a blind eye, ask no questions and comply are rewarded. Most people just try to keep there heads down.

    Staff have high case loads and little support. We constantly work with clients who are above our training remit. Then therapists are blamed when targets are not met, people drop out or ask for a change of therapist.

    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.

    There is none impartial in work i can take this too. My line manager is friends with my supervisor, they are both friends with our team lead. Our operational managers have no experience in mental health.

    I feel at risk daily from being in this toxic environment and from clients that I feel i’m out of my depth with. I think its endemic within all IAPT services.”

    Reply
  3. Elizabeth Cotton

    From P: “I was a patient of IAPT and found it incredibly inflexible. We went through a set list of topics week by week and despite me repeatedly saying I only needed help with one of those topics I was told we had to work through the other 4 irrelevant ones first. One of the skills I was taught was to purposely spend 20 minutes a day worrying about things. Given that when I worry I end up having full blown panic attacks, this was not helpful advice. I didn’t find the treatment helpful in the slightest but felt bad for the young trainee who was working with me and also wanted it to seem I had a clean bill of health on my medical forms because I was concerned about the stigma so after 3 sessions of no improvement I made the decision to fake my outcome measures and lie that my anxiety was improving each week.”

    Reply

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