IAPT – the free psychotherapy network

Mental health activists, workfare campaigners and therapists protest against work cure therapy for benefit claimants with mental health disabilities

It’s time for the psy professional bodies to stop colluding with the DWP

Join the protest against the professional bodies supporting work cure therapy for benefit claimants with mental health disabilities

Tuesday 5th July at 9 am at the New Savoy Conference

Hallam Conference Centre, 44 Hallam Street, London W1W 6JJ

Central London @ Great Portland Street tube (Map here)

For a decade or more, the Government has been deploying psychotherapy to get people with mental health difficulties off benefits, back to work and mapped into the neoliberal labour market. Since 2010, austerity policies of welfare reform – punitive Work Capability Assessments, benefit cuts, workfare, sanctioning – have intensified government strategies of psycho-compulsion and work cure for welfare claimants. IAPT therapists are being co-located in Jobcentres, DWP mental health advisers and employment coaches in GP surgeries, food banks, schools and libraries.

The big five national organisations representing the professions of counselling, psychotherapy and clinical psychology* have welcomed these policies and the state funding of back-to-work therapy.

As members of the New Savoy Partnership, they have been major players in The New Savoy Conference, an annual jamboree and market stall for state therapies in the NHS. The NSC frequently stages opening addresses by DWP and Health ministers to assert the close relationship between the professional bodies, MH charities and Government mental health and work-cure policies and funding. Hundreds of mental health workers accredited by the psy professional bodies have been hired by the DWP to provide “support into work”. These are jobs that are experienced as deeply unethical by many of the professionals being steered into this kind of work.

In March this year, the Mental Wealth Foundation (see below) wrote to the five professional organisations challenging their support of the government’s use of psychological therapies to put pressure on people with mental health disabilities to get into work. You can read the exchange of letters between us and the professional bodies here.

So far, all but one of these organisations are refusing to speak to us and continue to argue that they have had private reassurances from the DWP that “work cure” therapy will not be mandatory for claimants, and will not involve setting entry into employment as a therapeutic outcome. This claim defies the reality of the DWP’s record of punitive and coercive policies of workfare, Work Capability Assessment and sanctioning and its growing determination through its Work and Health initiatives to prioritise work as the therapy of choice for long-term mental health disability.

* British Association for Behavioural and Cognitive Psychotherapies; British Association for Counselling and Psychotherapy; British Psychoanalytic Council; British Psychological Society; United Kingdom Council for Psychotherapy

Come and join the protest against work cure therapy for benefit claimants with mental health disabilities. All welcome. Gather at 9am on Tuesday 5th July outside the Hallam Conference Centre, 44 Hallam Street, London W1W 6JJ. For more info contact eventsatfpn@yahoo.com

The Mental Wealth Foundation (MWF) is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.

Currently, seventeen organisations are gathered under the MWF umbrella: Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Critical Mental Health Nurses’ Network; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; National Health Action Party

Happiness and the capture of subjectivity

The Happiness Movement and the capture of subjectivity

I am a kind of paranoiac in reverse. I suspect people of plotting to make me happy.

~ J.D. Salinger  

In November last year (2014), I went to an Action for Happiness event in central London. It was organised to mark the publication of Thrive: the Power of Evidence-Based Psychological Therapies by Richard Layard (a founder of Action for Happiness) and David Clark[1]. Conway Hall was full. The authors spoke for twenty minutes each and took questions from the floor. The occasion was a celebration of the marriage of Layard’s campaign for government action to promote psychological well-being, Clark’s championship of CBT and the resulting roll-out of the IAPT programme. Having failed to get a question or comment into the Q & A session, I wrote to the event organiser with my thoughts on the happiness movement, CBT and IAPT in the context of neoliberal capitalist society. This is a version of the thoughts I put together on the idea of happiness as a campaign slogan for social change, in response to the event and the email exchange that followed.

I want to say first that despite my misgivings about the happiness movement[2] (a term I am using to cover a number of political and cultural initiatives campaigning for the promotion of happiness over economic growth on government policy agendas, here and worldwide), I recognise that it does have a life-giving intention and a commitment to social change.

Nevertheless, I feel very uncomfortable with ‘happiness’ as a goal and/or a campaign banner slogan, and especially with the way it is being linked with ‘mental health’. I will say a bit more about that in a moment. I am also unconvinced that either Action for Happiness or the authors of Thrive are really interested in the social and economic causes of psychological distress. The focus of Thrive is clearly on the subjective, despite its notional critique of some aspects of capitalist society and culture.

On the marriage of happiness and the evidence-base of CBT and IAPT – the issue closest to my heart and experience as a psychotherapist – I am afraid I am disgusted and dismayed. Here, I am focussing on idea of ‘happiness’. Its linkage with CBT and IAPT deserves a separate discussion, especially given the peculiarly disingenuous nature of Layard and Clark’s book in its celebration of the success of “evidence-based” therapy.

Is happiness a valid common good?

As an organising banner for social change, happiness is a simplistic concept. It is labile.

A huge range of things and experiences make me feel happy at one level or another. My iPad, my new VW Polo, losing half a stone, my relationship with my wife and children, a pint of cider, women I fancy on the street, many moments in my consulting room, the cormorant fishing the canal, a decent pair of nail clippers, a new gadget for my bike, my friendships, having a few thousands in a savings account, not being 18 again, etc, etc make me happy.

Happiness needs ground to have substance and value – a context in space, time and relationship. Being happily married is not in the same cosmos as being happy with my chocolate bar. Being happy looking at pornography is something very different from being happy that death has come to me at last! Happy to have survived that awful accident is not related to happy I caught that bus. The Skidelskys talk about all this in “How much is Enough?”[3]. So do many of the academic critiques of the happiness and well-being movement.

Capitalism of course sells us happiness all the time, and is adept at recognising changing social mores and fashion as opportunities to make profit selling back to us our quest for happiness.

Coca-Cola is probably the best-selling source of happiness throughout the world – perhaps because it is the ‘real thing’. Bisto gravy sells the happy family to the UK. Apparently, Christmas advertising on TV in 2013 generated ten times more happiness then anger.[4]

Happiness is modern capitalism’s most important sales pitch. It makes money by attaching its products and services to our desire to be HAPPY. It markets a version of society in which happiness is the primary – in fact, the only – goal in life that matters. In its neoliberal incarnation, it excels at selling us the promise of happiness, as it immiserates a significant proportion of the population.

So when Action for Happiness and Lord Layard assert self-reported happiness to be a primary social good to be prioritised by political policy-makers, I want to ask what is it that distinguishes their happiness from the happiness that sells us goods and services, and can make us feel good about our lived experience? Why is their version of happiness not simply a sales pitch for CBT, physical exercise, buying Thrive, positive thinking, meditation, group facilitation, mindfulness, life coaching, spiritual training, advice on nutrition, etc, etc?

Is happiness actually a valid common good, taken out of the complex contextual debate of what gives meaning to our lives?

Happiness and mental health

What kind of context does the connection with mental health give to happiness? If mental health is thought of as states of mind that can be negative or positive, and happiness is defined as having a positive state of mind, then the link Richard Layard and others have been making between unhappiness and untreated mental illness has a very obvious popular appeal. If we focus on helping people develop more positive states of mind, more people will feel happier and suffer less mental illness. Focus on helping people feel happier, and they will have more positive states of mind and less mental illness.

No-one, of course, thinks that mental health is just a state of mind. We all know that what gets called mental health is in fact a complexity of lived experience involving subjective and objective conditions, personal history and circumstances, as well as social, economic and political history, and circumstances, personal opportunities and socio-economic opportunities. Mental health is, by definition, in terms of lived experience, a misnomer in all sorts of ways – for example, it involves a mind/body split which more and more people see as unhelpful; it associates psychological life with the mind and thinking – a sort of Cartesian fantasy of who we are as human beings; in other words, it tends to separate subjective states from lived experience and circumstances; it also tends to treat the psychological and the subjective as symptoms of the individual rather than the collective.

Meanwhile, the ‘health’ in mental health tends to think of the psychological realm in the same categories as physical health and medicine. We think of medicine as a science. We assume an objective norm of the healthy body, in relation to which sickness is a deviation to be cured. Medicine has an evidence-base close to the natural sciences – anatomy, bio-chemistry, x-rays and scans, lab-work, microscopes etc, etc. Illnesses are diagnosed and treated on the basis of scientifically evidenced efficacy.

We know that, to an important but under-acknowledged degree, evidence-based medical science has its limitations. Any doctor will tell you that much of medicine is trial and error, diagnosis is often a process of elimination, cure achieved by the placebo of a pill or an empathic ear. But most of us will accept that to a very significant degree the evidence-base of medical science works for us as far as the body is concerned.

This just is not the case for working with psyche – emotions and emotion-laden thinking, negative fantasies, repetitive cycles of anxiety and fear, emotional conflict in relationships, lack of self-esteem, martyrdom, harsh self-judgement, depression, self-loathing etc. Much of what might be diagnosed as mental illness is not something comparable with symptoms of physical illness. The “norm” for every human being, if there is one, is to have experience and symptoms of all psychological disorders in some shape and degree. We all get anxious, depressed, obsessive, paranoid, addicted, aggressive, cut off, manic, psychotic to some degree or other, at some time or another.

The diagnosis of mental illness is a hugely contentious business among psychologists, psychotherapists and counsellors, and psychiatrists. Many of us are very concerned at the growing industry of diagnosing psychological suffering and distress as mental illness – across the spectrum of severity of symptoms. Critical psychiatrists all over the world have protested at the mushrooming and distortions of diagnostic categories in the DSM5.^{^[5]}

Psychiatrists and psychotherapists with a social perspective on psychological distress are increasingly wary of the diagnosis of depression and anxiety as mental illness rather than either the sickness of society or a reasonable response to social and economic deprivation and exploitation.^{^[6]}

For many counsellors and psychotherapists, depression and anxiety are part of the human condition, as much to do with the existential struggles of identity and emotional/ethical conflict as any diagnostic category of mental ill-health.

But whatever we think about the term mental illness, what exactly is the connection between that and happiness?

Is happiness a natural binary of depression or anxiety? “I used to be depressed/anxious, now I’m happy”? What about “I used to be depressed, but now my life feels more meaningful”. Or “less empty”. Or perhaps “looking back, I can see that getting depressed has made me more appreciative of the other people in my life”. Or “I see now that this stuff I call depression is a mixture of a number of things – rage, loss, fear. I feel more alive recognising these feelings, though I wouldn’t call it ‘feeling happy’”. If I feel less anxious or depressed, frightened or violent, cut off or manic does that mean I must feel happier? Maybe, but unless I give you some context, it would be very simplistic of you or anyone else to assume so. Happiness is not the primary goal of life. And suffering is certainly one of its everyday ingredients.

None of this is to deny that there is an awful lot of psychic pain in the world that people need help with. Nor that much of this suffering is unrecognised and stigmatised, and that help is often in short supply.

Psychological and material well-being

But if, for the moment, we allow that having more happiness than unhappiness in your life is a rather good thing – for you, those around you and society in general; if, therefore, we would like to influence society to attend more to what it is that helps us feel happier with life; if we also allow, for the moment, that psychological suffering is a major indicator of unhappiness, that it is more widespread than is normally acknowledged, and therefore society and government need to attend to it; then we need to know something about what psychological suffering is and what causes it, in order to develop policies for change.

One of the most common themes of mental ill-health is the familiar dichotomy of nature and nurture. Does mental illness originate from within, or from without? Is it more to do with genes, or more to do with environment? Is it located more in the individual/subjective/personality/inner world, or more in the collective/objective/inter-personal/external world?

The link between psychological well-being and socio-economic well-being is complex. The autonomy of the individual and the collective realms needs to be respected while at the same time recognising their interdependence. In terms of national policy, it matters how we understand this relationship, where we put the emphasis, and therefore how we pitch campaigns to improve psychological well-being.

On the Action for Happiness website^{^[7]} and in Thrive, the interwovenness of the psychological, social and material are acknowledged, but the emphasis is distinctly on the genetic and the subjective. This for me distorts and undermines the integrity and value of the use of words like happiness, well-being, mental health and therapy. If the focus of people’s sense of well-being is pulled too far away from social, economic and political reality, it begins to lose touch with real lives and moves towards the realm of ideology, marketing, and public relations.

On the website, the emphasis is on the individual, his/her genes, personality and subjectivity as something quite independent of material circumstances, social class, ethnic background and so on.

With a quick scan of the site, I can only find one example (I am sure there may be others) of a more nuanced conception of how material and psychological well-being are intertwined, ^{^[8]} and this is not an Action for Happiness document it seems.

On the AfH site’s front page there is a pie-chart “Our Happiness is not Set in Stone”:

Although our genes influence about 50% of the variation in our personal happiness, our circumstances (like income and environment) affect only about 10%.

As much as 40% is accounted for by our daily activities and the conscious choices we make. So the good news is that our actions really can make a difference.

Though “the pie” says “Genes and Upbringing”, the text reduces this to genes. Confusing! Upbringing, of course, is family background, childhood, family dynamics and its social and economic circumstances. I put these factors in “environment”, not “genes”. Moreover, despite the fashion for genetic and neuroscientific theories of emotional and psychological states of mind, the jury is still way out for many of us on simple equations of genes and psychological states. The assertion of a significant connection between depression and inheritance is still precisely that – an assertion. So for example, the Human Genome Study has produced no evidence so far for a “depression gene/s”.^{^[9]}

In Thrive, Layard and Clark do offer a somewhat more nuanced discussion of the genetic/environment relationship in their chapter 7 – What causes mental illness? But genes still come first, and in the “genetic” section they make the unfounded claim for scientific evidence of a gene/depression connection. Thriving (being happy) is primarily associated with subjective states of mind, located within the individual, rather than a more realistic and holistic picture of a relationship between internal and external worlds. The obstacles to individual thriving are primarily negative states of mind that the individual can remove or moderate through positive thinking and positive actions. The social and economic causes of psychological ill-health are consistently underplayed, to my mind.^{^[10]}

This downplaying of the social, political and material contexts of subjective states involves sidestepping overwhelming evidence over decades that economic and social deprivation is a major cause of psychological ill-health. See, for example:

The WHO 2014 report on the social determinants of mental health worldwide.^{^[11]}

The Institute of Health Equity and Michael Marmot on the impact of the Coalition’s austerity policies in London, published in 2012.^{^[12]}

The American Psychological Association’s Resolution on Poverty and Socioeconomic Status 2000.^{^[13]}

The Royal College of Psychiatrists 2004 paper Poverty, social inequality and mental health.^{^[14]}

The Mental Health Foundation’s working paper of 2013.^{^[15]}

In their chapter on the causes of mental illness, the authors of Thrive devote the first nine pages to talking about genes.^{^[16]} There is one page on childhood, and just over one page on job loss, stressful work environments, physical illness and disability. The two pages on social class and income argue that these are not causal factors in the aetiology of psychological ill-health. The section on what makes mental ill-health persist goes back to genes and innate personality.

The final section, on the nature of society, identifies four factors affecting well-being across a society – the level of corruption, freedom, trust and social support. Financial inequality and poverty are dismissed. Ideologically-led policies of social and economic exploitation, the debasement of democratic processes, and the exploitation of the majority by a political and financial elite are not discussed, nor are the structures of power in society generally.

The neoliberal turn of capitalism

For me, it is this marginalising of the socio-economic in favour of the genetic and individual subjective that puts Action for Happiness in danger of becoming a palliative to neoliberalism rather than a real challenge to it. Without more context in the realities of people’s lived experience, happiness feels like a sort of social soporific. Happiness becomes a rather insipid goal in life, rather like a drug – soma in Huxley’s Brave New World.

Since Margaret Thatcher’s premiership, and revitalised with a vengeance by this Coalition government, neoliberal political policy has propagated a devastating increase in most of the socio-economic, cultural, ethical and political conditions that nurture psychological distress and suffering. Current political policy-making manufactures depression and anxiety, if you like.

It seems perverse to me for happiness campaigns like Action for Happiness to want to influence government policy towards reducing levels of anxiety and depression without coming out very strongly against current government policies that are having a devastating effect on the nation’s ‘mental health’.

So, while Thrive devotes space to the social side of mental ill-health, it is careful to say little about social class, adult and child poverty, waged poverty, the cuts in social security – including disability allowances for the mentally ill, policies like the bedroom tax, the consistent fall in real wages, the growth of zero-hour contracts, the growing shortage of affordable homes, the crazy rise in private rents in London, policies forcing families out of central London, food banks, the cuts in mental health budgets (20% higher than cuts for physical health budgets over the next five years, despite “Parity of Esteem”), the stigmatisation of asylum seekers and more.

And here is a final thought on this particular issue.

According to Jack Carney’s piece in Mad in America (2012)^{^[17]}, before the 1980s, academic studies of the relationship between social deprivation and mental illness concluded that the former was the primary cause of the latter. With the rise of neoliberalism, studies have generally concluded the opposite – that mental illness causes social deprivation. The implications for neoliberal governmental policy are obvious. Define the problem as one of mental illness, treat it as an individual affliction, and carry on creating a society that celebrates inequality, social injustice and environmental devastation, in the interests of the global market.

[1] 2014 Penguin

[2] Not to be confused, of course, with Coca-Cola’s “Happiness is Movement” campaign in 2014 – http://www.coca-colacompany.com/videos/happiness-is-movement-ytbn3bc63pz38

[3] Robert and Edward Skidelsky (2013) How much is enough? Money and the good life Penguin, chap.4

[4] For more, see https://freepsychotherapynetwork.files.wordpress.com/2014/11/blank-9.pdf

^{^[5]} See an NHS review of the issue here http://www.nhs.uk/news/2013/08august/pages/controversy-mental-health-diagnosis-and-treatment-dsm5.aspx

^{^[6]} For example, http://dxsummit.org/archives/2032

^{^[7]} http://www.actionforhappiness.org

^{^[8]} http://b.3cdn.net/nefoundation/bb8366694aa033e578_vvm6bfv3t.pdf

^{^[9]} See for example, http://www.ncbi.nlm.nih.gov/pubmed/23290196

^{^[10]} David Harper argues a similar case regarding Action for Happiness in the Guardian here http://www.theguardian.com/society/2012/feb/21/sad-truth-action-for-happiness-movement

^{^[11]} http://www.instituteofhealthequity.org/projects/social-determinants-of-mental-health/social-determinants-of-mental-health-full-report.pdf

^{^[12]} http://www.instituteofhealthequity.org/projects/demographics-finance-and-policy-london-2011-15-effects-on-housing-employment-and-income-and-strategies-to-reduce-health-inequalities/the-impact-of-the-economic-downturn-and-policy-changes-on-health-inequalities-in-london-full-report

^{^[13]} http://www.apa.org/about/policy/poverty-resolution.aspx

^{^[14]} http://apt.rcpsych.org/content/10/3/216.full

^{^[15]} http://www.mentalhealth.org.uk/content/assets/PDF/publications/starting-today-background-paper-3.pdf.

^{^[16]} Pagination from the Kindle edition.

^{^[17]} http://www.madinamerica.com/2012/03/poverty-mental-illness-you-cant-have-one-without-the-other

Other resources:

William Davies The corruption of happiness 18 May 2015 in OpenDemocracy

A fascinating article. The comments on happiness as a choice put me in mind of the fantastic (and often misrepresented) film ‘No’ by Pablo Larrain (2012). The film documents the overthrow of General Pinochet in Chile by a campaign using the tagline ‘happiness is coming’ (which the film frequently equates with Cola adverts). It offers a fascinating and deeply cynical perspective on the seamless persistence of neoliberal ideology despite the overt change in the head of state.

The sorry state of NHS provision of psychological therapy.

Healthcare Today carried the following headline at the end of January – “Figures from the Health and Social Care Information Centre (HSCIC) show fewer than 6% of referrals made under the Improving Access to Psychological Therapies (IAPT) programme in 2012-13 resulted in ‘reliable recovery’”. Shocking surely? If this were physical health, wouldn’t there be an outcry about wasted money and human resources? Wouldn’t NICE’s confidence in CBT be a little disturbed?

But according to the HSCIC report itself, this is a story of success. “43% of patients completing a course of treatment under IAPT achieved recovery”. In its foreword, Lord Layard writes, “the dataset … supports … the Department of Health’s continuing commitment to parity of care between Mental Health and other Health services”.

So, what is going on? Is it 6% or 43%? The answer lies in the opacity and manipulation of IAPT’s evidence base, and the politics of mental health.

According to the reported statistics, 43% “of those referrals that had completed treatment and were at ‘caseness’ at their first assessment (127,060 referrals)” achieved recovery. However, this group of 127,060 represent only 14% of 883,968 new referrals during the year. 51,900 patients were deemed to have recovered – 6% of the total number of referrals.

The four-year vision for the IAPT programme published in Feb 2011, and repeated with every quarterly progress report, is for a total of 3.2m referrals, 2.6m completed courses of treatment (81% of referrals) and 1.3m ‘recoveries’ (40% of referrals) between 2011 and 2015. Compare this with the actual figures for 2012-13 – 14% of referrals completed treatment and 6% of referrals recover.

Put another way, then, 94% of referrals to IAPT failed to receive a successful course of therapy, and 86% failed to complete any course of therapy at all. What happened to 757,000 referrals who never completed a course of therapy?

The ‘evidence base’ obscures rather than clarifies the picture. We learn that of the 449,000 referrals who do not enter clinical treatment of any kind, 37% were still on a waiting-list at the end of the year and a half of this group (84,000) had been waiting for more than 90 days. The other 283,000 non-starter referrals disappear from the data. Who are they? Where do they go?

From a different starting point, we are told that 60% of new referrals ‘ended’ during the year. This figure includes referrals who completed treatment and those who either never started or failed to complete. A quarter of this 60% dropped out of the process ‘unexpectedly’ and another quarter ‘declined the treatment offered’. Why? What happened to these people?

These are not new questions being asked of the IAPT statistical light show.

In Nov 2013, The We Need to Talk Coalition report on access to talking therapies proposes from the results of its survey that 10% of IAPT referrals have been on a waiting list for over a year, and that 50% have been waiting for 90 days or more.

Tellingly, an article in Pulse Today in November 2013 reports an analysis of IAPT data for the previous year, 2011-12, by researchers from the University of Chester’s Centre for Psychological Therapies in Primary Care (CPTPC), published in two papers in the Journal of Psychological Therapies in Primary Care.

“ In the first paper, an analysis of IAPT data from the NHS Information Centre for 2011-2012, the team reported that the official figure for patients moving to recovery was 44%, based on those patients who were ‘at caseness’ to begin with and were considered to have completed treatment.However, when the researchers considered all patients entering treatment – completing at least one session – the figure fell to just 22%. If the full quota of patients referred for IAPT was considered, the proportion of patients moving to recovery fell even further, to just 12%.”

So, it seems one year later the proportion of patients moving to recovery has fallen even further, to just 6%.

Apart from the raw numbers, the report is full of obscure terminology and statistical caveats which are surely incomprehensible to the uninitiated and intended to hide as much as they reveal. For example, what a course of treatment consisting of two sessions means; what reliable recovery or reliable improvement really mean; how to read the complex flow chart illustrating the relationship between the two; and, even more, the perplexing diagrams of the various types and stages of threshold to recovery – all are beyond me at least.

Nor can I get my mind around this caveat concerning which case may or may not be counted to measure an outcome of ‘recovery’:

Not all referrals that have ended are eligible to be assessed on outcome measures such as recovery. It is possible for patients to exit the service, or be referred elsewhere, before entering treatment, or without having the required number of appointments to determine the impact of IAPT services. As a result of this, in order to be eligible for assessment a referral must end with at least two treatment appointments, allowing any changes between those two (or more) appointments to be calculated. This is known as “completed treatment”, but may not be the same figure as the number of referrals with an end reason of completed treatment, as the method allows all referrals with the requisite amount of treatment appointments to be assessed (even if the end reason is that the patient dropped out or declined treatment).

It does not help my understanding to hear that Professor David Clark, a key proponent of the IAPT programme, criticised the Chester researches by pointing out that it was inappropriate to consider all people referred to the service as many would not end up being treated, while those who did not complete treatment were people who had one session of treatment and advice, ‘in many cases entirely appropriately’.

By comparison, I know where I am when the Department of Health academics who made the economic case for the IAPT programme reject the researchers’ claims as based on ‘flawed analyses’, ‘inappropriate’ calculations and ‘dubious assumptions’. This is what the political game of evidence-base is all about. It makes no differences what the numbers actually say. Statistics are essential to the political lie. In this case, in the pursuit of the familiar policy – contempt for mental health.

The truth revealed by the 2012-13 IAPT annual report is that the IAPT programme is failing – a failure obscured by the smoke and mirrors of its statistical evidence.

Paul Atkinson

March 2014