Observer article re threats of cutbacks

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
LaLeonessa
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Observer article re threats of cutbacks

Post by LaLeonessa »

Interesting article in the Observer today:

http://www.guardian.co.uk/society/2009/ ... psychiatry

Any thoughts?
psyt
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Post by psyt »

IAPT: a good idea that does need further implementation and some good decisions by the politicians, I think...
plarsson
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Post by plarsson »

Well it's no surprise really when considering the completely unrealistic expectations the IAPT initiative had. The whole scheme was much too political, and assumed an idiotic cognitive-behavioural fallacy that all distress is located within the individual, when in reality the problems many people face are within the society the IAPT initiative is attempting to socialise them into.

Another attempt by psychology to try to convince everyone, including itself, of its scientific status, and embarrassing itself in the process.
"They called me mad, and I called them mad, and damn them, they outvoted me"
Nathaniel Lee
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baa
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Post by baa »

plarsson wrote: when in reality the problems many people face are within the society the IAPT initiative is attempting to socialise them into.
which we acknowledge, which explains our many links with other organisations who are far better placed to help with those problems. Signposting appropriately and being aware of the limits of the techniques and methods used in an IAPT service is actually rather high up on our list!

Our staff have been cut in a sneaky way, actually, not that sneaky because it was raaather obvious.

As for untrained staff, it's not surprising that only 400 staff can be classed as trained. I was in the first cohort for training, and technically have not passed my course yet, as the essays etc have still to go to external examiners and the such like, so even though I've been in post for 14 months, handed all coursework in in July, and working as a qualified, fulltime LIW, I'd still be classed as untrained.
Nomi
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Post by Nomi »

Just read the article - it's a real shame because I think the IAPT scheme has a lot of positives, but the way it was immediately jumped on as this miracuolous cure-all solution which would work for everyone and instantly save the government tons of money - it was just set up to fail. And now any good it has done will be discounted, and the whole of psychological therapies (not just CBT) will suffer from lack of funding as this will be used as proof of the claim that it's all a waste of money.

Typical instance of an obsession with targets and immediate results, plus trying to make everyone fit into one system, instead of investing more in treatments which cater to individual needs and are maybe more long-term.
plarsson
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Post by plarsson »

I agree baa, all initiatives have teething problems of course. I just think, like Nomi, that it's a shame that because of IAPT's disappointing results there may be a backlash against all psychological therapies and future funding. I firmly believe that therapy should be available to all if needed (as I'm a trainee myself), but this scheme just seems like its ambitions are too tied up in some pipe dream that people can be quantified and somehow cognitively manipulated into being more productive citizens.

Then again, as soon as there are cutbacks mental health is unfortunately always the first to go. It shows that when it comes down to it mental health matters actually aren't taken particularly seriously, and that whichever ear Layard managed to bend to get this all rolling has now left him high and dry. That's politics.
"They called me mad, and I called them mad, and damn them, they outvoted me"
Nathaniel Lee
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baa
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Post by baa »

I think our service have actually met our targets so far, though I don't actually know what they are :D

I think it's too early to be drawing any conclusions, given that we're only just in our second year, and some IAPT teams have literally only just been set up. I think if people wait until the services are actually up and running with qualified staff, then they'll be able to draw some proper conclusions. Our lot had a fit in the first quarter as we hadn't got enough people back to work, but that was after only months, and given that we can be seeing people for longer than that, and then there's a three month follow up, the panic was all a bit pointless!
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baa
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Post by baa »

Reply to the Observer from IAPT

http://www.iapt.nhs.uk/2009/10/07/respo ... ober-2009/

Sounds like they were jumping the gun a bit
plarsson
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Post by plarsson »

Well there you have it. Hope it goes well for all involved. All the best.
"They called me mad, and I called them mad, and damn them, they outvoted me"
Nathaniel Lee
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Post by CBTer »

It is so stupid that IAPT are basing client recovery as off benefits and with a PHQ score lower than 11. Recovery for one person may be different to recovery for another person. Outcome data tells you very little. Also, IAPT in some areas seems to be "see as many people in one day as you can" - what about ethics, what about practitioner stress levels. Surely quantity over quality is detrimental to client recovery? we will see what the future holds
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jane doe
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Post by jane doe »

.........
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baa
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Post by baa »

CBTer wrote:It is so stupid that IAPT are basing client recovery as off benefits and with a PHQ score lower than 11. Recovery for one person may be different to recovery for another person. Outcome data tells you very little. Also, IAPT in some areas seems to be "see as many people in one day as you can" - what about ethics, what about practitioner stress levels. Surely quantity over quality is detrimental to client recovery? we will see what the future holds
The getting people off benefits target is actually quite small, plus, we're pushing for the bigwigs to acknowledge a change in benefits as a goal as well - incapacity to JSA etc. Mind you, employment (inc voluntary) is actually important to a massive number of people - independance, identity, earning their own wage, meeting people - it ticks a lot of boxes :wink: After all, we're all on this forum because of our employment - current or desired!

As for those "see as many people as you can" - we're getting that a bit here, but quite frankly, they can go jump. It's partly up to LIW/HIWs to shout when they're feeling stressed, to not work outside their own limits and to keeping feeding this back to the bigwigs. There's no point putting all of us on the sick too!
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jane doe
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Post by jane doe »

and of course if someone moved from long-term incapacity benefit (c. £85 a week) to JSA (c. £65 a week) then they'll cost the government less regardless of their employment status... or am I just being cynical?
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baa
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Post by baa »

But they might also be closer to their own long term goal of getting back to employment. Getting people off benefits really isn't just the Govt's goal, a lot of my patients would quite like it too.
axiomatic
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Re: Observer article re threats of cutbacks

Post by axiomatic »

LaLeonessa wrote: Interesting article in the Observer today:

Better Access (probably), but better Quality (definately not).

http://www.guardian.co.uk/society/2009/ ... psychiatry

Any thoughts?
I was employed 3 yrs ago as a GPCMHW, but in Sept last year our trust adopted the new IAPT model of working, and my job is now LI worker, band 5.

I have seen the service change from one where the graduate role was well valued and repected, to one which is becoming increasingly de-skilled, formula and process led, in fact (as others have pointed out) reduced to that of a call centre receptionist - it took me a total of six years to gain the A Levels and University degree I needed to gain access to the Graduate role.

Whilst our waiting lists have gone down (explained by the large cohorts of LI and HI trainees into the service) 'Access' to therapies has improved. However, one has to ask what kind of a service are clients getting better access to. We are being pressured into offering more and more 'short' telephone contacts, so we can 'process' more clients in a day. My experience is that when offering telephone contact to clients, they will always choose face to face contact. I believe that how well a client responds to a LI intervention, relies to a great extent on the time given to let clients tell their story, and to show empathy and gain a good therapeutic relationship. We are finding that there is no time to reflect on formulations, research good practice, develop ourselves professionally, with the end point of helping our clients to feel better. The pressure of high volume caseload, telephone contact, much increased admin work, delivering measures etc, is demoralising us as workers, and certainly not giving clients what they want, or what is good for them.

Also, management have done little to inform GP's about these huge changes to the service, and GP's are not fully aware of what a client gets when they come for a LI intervention. The tendency is for GP's to generically refer for 'counselling' and to tell clients this, so clients expectations are often not met by guided self-help delivered through telephone contacts. As somebody else in the forum pointed out, this can make you feel like a 'fake' therapist, a poor substitute for a cbt therapist, and second rate.

However, our service are not beyond putting pressure on us to work with clients we often feel are outside the remit of our training and the LI role, and this is one of the biggest problems LI workers face in our service. When waiting lists are growing for a HI intervention, it is not uncommon and is becoming more and more the practice for management to put inappropriate referrals onto the caseload of LI workers. This is also happening with trainees who came into the service in September 2009, who have barely learned the basics about the five systems model. Again, we have to ask what the quality of the intervention is that clients are having improved access to.

I hope this will become apparent before too long, and we can all return to working with clients to their benefit, not fulfilling targets, and jumping through hoops for the sake of complying with funding criteria.
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