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Fair criticism also needs to be based on evidence

Published online by Cambridge University Press:  02 January 2018

Catherine J. Swaile*
Affiliation:
Haringey, UK, email: cathyswaile@hotmail.com
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Abstract

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Creative Common License - CCCreative Common License - BY
This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2015

This entire article Reference Timimi1 is more focused on cobbling together a damning indictment of the two Improving Access to Psychological Therapies (IAPT) programmes than approaching the facts and evaluating them fairly. In terms of adult IAPT many areas did not have the range of services described by the author, such as pre-IAPT primary care counselling services. Giving a broad section of people suffering from mild to moderate mental ill health access to cognitive-behavioural therapy (CBT) did exactly what it said on the tin: it improved access to psychological therapies. For those of us who do actually ‘believe that psychological therapies help people’, this is a good thing, regardless of the limitations placed by the use of limited modalities. In my area waiting lists for psychological therapies exceeded 30 weeks and were only available via secondary care, so to completely disregard the huge impact of this programme is equivalent to moaning about the limitations of a set menu when being fed for the first time in a week.

The article cites references that are twisted to purpose, for example ‘Research has found that 40–60% of youth who begin treatment drop out against advice’. This research pre-dates the introduction of Children and Young People's (CYP) IAPT, so I fail to see the relevance. In fact, this stark statistic is probably one of the reasons why CYP-IAPT places such a huge emphasis on participation – an element of CYP-IAPT that is completely disregarded in this article.

Admittedly, the implementation of outcome data collection has been problematic, but this is a huge development on a massive scale. This is not about monitoring data in one service, this is about setting up a national system for monitoring and comparing outcomes. Anyone can set up a spreadsheet for a few patients, but linking multiple electronic patient record systems into a central reporting mechanism is a bit more of an undertaking.

References

1 Timimi, S. Children and Young People's Improving Access to Psychological Therapies: inspiring innovation or more of the same? BJPsych Bull 2015; 39: 5760.Google Scholar
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