The provision of psychological treatment on the NHS has undergone an ‘Uberisation’, in which therapists are pressured to exaggerate their success, a conference on work heard.
Dr Elizabeth Cotton said that 41% of therapists working for the NHS’s Improving Access to Psychological Therapies (IAPT) had been asked to manipulate data about patients’ progress.
This included therapists being encouraged by their managers to coach patients to give positive answers to questionnaires asking their views on the service, and to repeat the questionnaires until a positive response was obtained, she told the British Sociological Association conference on work today [Thursday 26 August 2021].
Where patients discharged themselves without notifying the NHS, the therapist was encouraged to fill in data sheets on their behalf to reflect a positive outcome, said Dr Cotton, a psychotherapist and researcher at Cardiff Metropolitan University.
The IAPT programme provides psychotherapy for depression and anxiety to over a million people each year, often through short courses in cognitive behavioural therapy. These courses were now online because of the pandemic.
Dr Cotton carried out four surveys between 2016 and 2020. One, of 1,500 therapists working for the NHS or privately, found that 38% of therapists had raised concerns about patient care, a figure rising to 58% among the 223 currently employed by IAPT.
In another survey of 650 IAPT workers, carried out in 2019, 41% said they had been asked to manipulate data. One therapist told her they had been advised by their manager that “I could complete forms on behalf of clients to get the best results”.
Another said that “I’ve been told not to upload additional questionnaires showing the patients is suffering a specific anxiety disorder not measured by regular data, so we can discharge them and have it count as recovery – I’ve felt under such pressure to manipulate and change data that people often come back within weeks of discharge.”
One said: “Actual human experience was secondary to creating data which would shore up the evidence base for the model in order to justify the economic argument and guarantee further investment. The whole system represents a big self-reinforcing loop relating to success in terms that had been self-defined by the system.”
Dr Cotton said: “People working within IAPT have been asked to manipulate performance data. That can be things like recovery rates, it can be in terms of people turning up, or it can be redoing assessments to get a more positive response.
“What has become known is the gamification of the evidence, particularly around claims of 50% recovery rates using these very light CBT techniques – most people would argue that they don’t really constitute therapy in many cases, particularly when it is carried out online.
“This downgrading of therapy into a standardised, manualised, and now digital model, has opened up the doors for the ending of highly experienced clinical work in the public sector.”
The surveys also found that 68% of IAPT therapists had experienced depression or anxiety, and 70% burnout, as a result of the system of performance management used within the IAPT model.
• More details of the survey can be seen at: www.thefutureoftherapy.org