The problem with IAPT

I’ve just been referred to IAPT when i really shouldn’t have been, i will explain..

A bit of background: most of you know that i have struggled with various mental health issues for the majority of my life. I’ve also used mental health services on and off for the past decade to try and move towards that elusive “recovery” we hear so much about. I’m also a very well-informed service user with 5 years of  experience working with organisations like YoungMinds-basically i know what i’m talking about when it comes to mental health and in particular what is best for me.

I recently went back to my GP in a very distressed state. My anxiety recently has been through the roof and it’s had a crippling knock on effect on my mood and several other conditions which in turn has lead to a sharp deterioration in both my mental and physical health. Basically i was not in a good way-another bad downspike in what for me is a severe and enduring problem.

This one GP in particular is one i try to avoid as we have had several clashes over my treatment in the past. After refusing to prescribe me more medication she offered to refer me back for CBT (which i have had previously & has been relatively effective). I agreed but pointed out it would probably be at least a year until i was seen and that i would need to continue medication in the meantime (which she was not happy about). She told me that several of her patients had only waited a month or two.

This struck me as odd-i look back and want to kick myself; i should have known why.

She was not referring me back to the adult CMHT who have seen me before and know me. She was referring me to IAPT.

I have since been back to the surgery to see a different clinician who confirmed exactly what i already knew: i should never have been referred to IAPT and my local IAPT service won’t take me-i am too severe a case with far more than mild-moderate Depression/Anxiety.

It’s very frustrating to continually have to educate clinicians myself about things they should know about-mental health and services in particular. I often have to explain mental health conditions to GPs (who do not need to have any training on mental health to qualify by the way) or tell them about third sector services in the area that they could refer people to.

I am exhausted from having to constantly and almost aggressively self advocate in order to get any treatment at all.

Oh the irony..

For me this is actually almost painfully ironic.

You see while i was a VIK at YoungMinds i was part of several consultations on IAPT before it was up and running and i even facilitated group workshops for other young people on the subject. I liked the idea in principle, after all it would offer therapy to so many people who usually wouldn’t be considered “ill enough” or would have ended up of the bottom of the average 18 month waiting list of adult mental health services. It would also bring in a self referral element often lacking from statutory mental health services and the waiting lists they suggested were much better too.

But i did argue one point very strongly:

My concern was that the implementation of IAPT might lead to cuts in other psychological therapies on offer and that we ran the risk of IAPT becoming the be-all and end-all. This is because IAPT is quicker and also therefore cheaper than more traditional talking therapies making it more attractive to commissioners and cash-strapped trusts.

I said repeatedly that there must be safeguards put in place and that clinicians and patients needed to be fully aware that IAPT is not appropriate for everyone, especially not those with more severe issues. Especially as IAPT often offers just 6-12 CBT sessions which are not appropriate for every condition and often not enough (i’ve had about 30 sessions over the years so far and i’m still painfully ill).

Sadly it seems my fears have been realised.

From January-March 2012/2013 259,016 people were referred to IAPT but only 154,722 entered treatment which suggests to me that i am not alone in being wrongly referred to the service. (Source: Health & Social Care Information Centre IAPT data set).

I have also spoken to a large number of people, especially in the 18-25 age range who have been referred to IAPT when they should not have been.

I would be very interested to hear of anyone else’s experiences of being wrongly referred and will be voicing my concerns on this matter to the NHS and YoungMinds.

What is IAPT?

IAPT stands for “Improving Access to Psychological Therapies” and is an NHS program to extend access to talking therapies for over 18s in England (there is also CYPIAPT for children and young people). It is usually offered to people with mild-moderate Depression, Anxiety or Stress.

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6 Comments

  1. I strongly agree with you: IAPT is an excellent initiative, but it has to be used with some intelligence. I was also referred to IAPT inappropriately and told that there was no alternative. In my case I was struggling to handle the impact of my daughter’s sudden and severe illness – I asked for counselling but could only be offered IAPT, which was of little use to me. I was horrified to realise that it was being offered in all situations, including bereavement, and am sure this was not what was intended by the original architects.

    • Hmm no i think more specialised counselling would have been much more appropriate. There are thankfully some really good charitable organisations that offer counselling and support for families facing illness or bereavement it’s just a shame that so many doctors seem unaware of the non-NHS services available in the area.

      I hope you eventually got the treatment that you needed.

  2. Hi Kat,

    Obviously I have know you for a long time and aware of much more than Joe Bloggs due to my parents previous professions (CMHN).

    This year is the first year I have ever experienced mental health issues personally. Thankfully the GP I saw seemed to have sense and didn’t actually just medicate me and
    be done with it. This may be due to the fact I took my mother with me!

    Anyway, I have been referred to IAPT and was seen fairly quickly and recommended 8 sessions however I currently do not feel this will be enough but then also don’t think I am severe enough to be given much more. It also does not help my CBT has fairly broken English so half the time I come out of the sessions confused as I have had to sub words for her and try and understand what she is trying
    to convey to me. Another factor was initially I was not even going to be referred to IAPT until I pushed for it and actually wrote some notes for the GP to write the referral.

    Once IAPT contacted me they seemed impressed with my language (mostly CMHN jargon thanks to Mum) but now I’m feeling a little let down by the service because I’ve had 2 sessions and am getting no where.

    I know this isn’t exactly what you were looking for in response however as you do have such good knowledge regarding this – can I see a different CBT? Or am I stuck with who has been allocated? My anxiety is still very high and it’s having a knock on physical affect.

    Sorry to hijack your blog. I’m pretty sure my dad was referred incorrect at first as he then was given more sessions.

    x

    • Emma my dear friend you have in no way hijacked my blog, thank you for sharing your experience. I am kind of glad (and yet obviously at the same time unhappy) that i am not the only one who has experienced this.

      It’s interesting that you say that having your mum there, with her experience & jargon helped. I have unfortunately found that if i wear an NHS lanyard i seem to be taken more seriously than if i don’t when meeting new doctors and i constantly feel like i have to argue with them to point out i do actually know what i’m talking about. And yet i still occasionally feel like i’ve been completely walked over and disregarded.

      It seriously concerns me that people like me with all my experience & knowledge and people like you with your experienced mum to help you navigate the system, still can’t get what we need & still have to fight. If we can’t get help how is anyone else expected to be able to?

      I think you should definitely ask if you can see a different therapist if it isn’t working out with the one you are currently seeing. If you don’t click with a therapist & don’t feel she can help you need to see someone else and that is okay. Studies have shown that it actually doesn’t matter so much what kind of therapy you have, the most important factor for success is the therapeutic relationship.

      Let me know if i can help in any way and i would love to see you over xmas.

  3. I was wrongly referred to IAPT after a long journey of being sent from one service to the other, ‘like pass the parcel’ as my long suffering GP put it. I got as far as the IAPT assessment, when it was made clear to me I should never have been referred, and was too ‘complex and high risk’ for the service. She also felt that 12 weeks only would ‘damaging’, when I explained how distressed I become in the run up to appointments knowing I will be asked about my trauma. The IAPT woman said that I needed to see a psychiatrist and I am now with the CMHT who are a more appropriate service. I was referred to IAPT even though professionals were aware of repeated self harm and suicide attempts (one recent), and psychotic symptoms (I have Borderline Personality Disorder). In the months I waited to be referred to the CMHT after the IAPT debacle, I made another attempt. I feel that if I’d got the support I have now but earlier things might have been different. I am lucky that now I’m getting the longer term treatment that I need.

    I noticed you mentioned this as an issue for younger people – I’m 28 and I suspect many people of all ages are inappropriately referred. I too support IAPT, and have a friend with moderate anxiety who found it really helpful. I’m glad it’s there, but it’s got to be made more quickly available for those who are suitable and not used as the cheap option for those who need more support. Doing that benefits no one.

  4. Hi Katy,
    there is a very interesting editorial on depression in the New Scientist dated 27th July 2013. I thought you and others might be interested to read it. The full article is on pages 35 – 37 inclusive of the magazine.
    I’ve scanned the article and will email it to you.

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