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A controversial report has slated the CBT ‘monoculture’ that it says dominates access to counselling and psychological therapies in the NHS and means patients are denied a real choice of treatments that could help
Think-tank report condemns IAPT ‘monoculture’
A controversial report has slated the CBT ‘monoculture’ that it says dominates access to counselling and psychological therapies in the NHS and means patients are denied a real choice of treatments that could help.
Commissioning Effective Talking Therapies is published by the Centre for Social Justice, an independent think-tank set up by Iain Duncan Smith, now Secretary of State for Work and Pensions, while the Conservative party were in opposition.
It says the IAPT success rate to date is just 13–16 per cent of all referrals. It argues that patients are unable to access alternative therapies that might be more helpful because doctors cannot refer them outside IAPT to independent therapists whose treatments are not approved by NICE. It also says the NHS is spending £10 million a year training CBT practitioners when there are 17,000 qualified, accredited therapists in the private sector who could already be treating patients, under contract to the NHS.
But the British Psychological Society has criticised the report’s argument that IAPT should commission any psychotherapies, regardless of their evidence base, and pay only if the outcomes are positive. It says this ‘evidence-blind approach’ would be ‘inconceivable in any other area of health care’ and would ‘serve service users very poorly’. Instead, more research should be done into the effectiveness of other psychotherapies.
BACP supports the BPS critique. ‘We consistently argue for a revision of NICE methodology to include practice-based evidence that would bring a wider choice of modalities within its evidence-based guidelines,’ Nancy Rowland, BACP Director of Policy, said.
Mind, the mental health charity, says the report’s conclusions echo its own findings. ‘Too often people have minimal choice. Mind’s survey in 2010 found that 68 per cent of people were not offered any choice of therapy at all and that, if people are offered a choice of talking therapies, then they are more likely to be happy with it and it is more likely to be effective,’ Paul Farmer, Mind Chief Executive, said.