The Therapy Industry Part 6

The largest NHS mental health programme in the UK is the Increased Access to Psychological Therapies (IAPT) service.  Over 23% of our survey respondents work in IAPT services, but many more are working under services that have adopted an IAPT model. This is what they said. Obviously, our survey was anonymous which is why you might have an eye watering moment reading these quotes.




Just to repeat, these quotes are from workers providing the largest NHS mental health programme in the UK. If you go to your GP asking for help this is the service you will be referred to. 


What emerges from is that it is through the use of the IAPT model of performance data and performance management techniques there is a systematic downgrading of clinical practice across mental health services. This is not the contentious debate about cognitive behavioural therapy versus psychotherapy, it is about degradation of clinical into non-clinical work. A growing number of people working in mental health services have ambiguous clinical status. Psychological Wellbeing Practitioners (PWPs) were introduced through IAPT to provide manualised short term interventions and carry out initial phone assessments. This trend of employing non-clinical roles to provide services is reinforced in the UK Government’s mental health workforce strategy announced in July 2017 which includes the employment of 8000 non-clinical jobs to deliver mental health services. And this is before the digital healthcare industry manages to convince government ministers that you can cure depression with an App.


This downgrading is justified on the basis of an ‘evidence base’ of the impact of the IAPT model claiming that it achieves 50% recovery rates. With the best will in the world, this is an obvious gaming of the recovery data fabricated through the use of feel good questionnaires the completely fail to ask the patient how they actually feel. In 2017 the National Audit Office carried out an inquiry into performance data in IAPT services. Despite the evidence submitted by practitioners and the 10 page summary of the findings of, the NAO has failed to produce a public report. When I submitted an FOI request for the correspondence between the NAO and the Department of Health in relation to the decision making process not to make this report public this is what I received.




Ironically for the talking profession, it appears the NAO doesn’t really want to talk about any public safety concerns raised about our government’s mental health policy.


There has been a deep reluctance on the part of IAPT providers, training and professional bodies to challenge this fabrication of the evidence base for IAPT because of the financial interest in the sector to keep this system in place. IAPT is one of the largest and growing sources of employment in mental health explaining the fear of clinicians to raise their concerns that the wrong things are being measured and the that the failures in patient care are being evaded.


Where mental health workers do raise concerns about patient care and working conditions, the vast majority of issues are not resolved. In our survey 38% of people raised concerns about patient care but only 25% were adequately resolved. This cuts against the received wisdom that if you present workplace issues as a matter of patient care then management take it seriously. This compares to 36% of mental health workers who have raised concerns about working conditions. Only 6% were addressed adequately. There is a significantly higher propensity for IAPT workers to raise concerns about working conditions at 55% and 58% in relation to patient care.


The insecurity of jobs in the sector is important in explaining why it is that the IAPT model has been introduced without much internal resistance. The dominance of the IAPT model combined with a shrinking independent psychotherapeutic sector and limited sustainability of private practice, whatever your views are as a practitioner, securing paid work is becoming dependent on an acceptance of the IAPT model.


There’s a problem in mental health services that nobody feels secure enough to face up to. This is something worth banging on about.



Dr Elizabeth Cotton’s book chapter “The Industrial Relations of Mental Health” will be published in 2019 in The industrialisation of Care: counselling and psychotherapy in a neoliberal age edited by Risq & Jackson, PCCS Books.


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