Wednesday, August 02, 2017

Why fetishise outcome measurement in IAPT?

Jay Watts has a chapter 'IAPT and the ideal image' in The future of psychological therapy in which she describes the chasm between the image and actuality of Improving Access to Psychological Therapies (IAPT). She concludes that "IAPT operates in a virtuality focussing on performativity and surveillance rather than real encounters between clinician and patient".

In particular, she describes the "pernicious pressure on IAPT workers to gain outcome measures for each session". I've mentioned before talks given by David Clark (eg. see previous post) in which he makes much of the fact that IAPT is collecting this data. As Jay says, "During training, workers are sold into the excitement of producing the largest database on wellbeing in history". It would be nice to know what those promoting IAPT think all this effort has achieved, because I can't see much gain. Data accumulates on a monthly basis without much being done to it (see Reports from IAPT). In fact, this process may well be hindering IAPT from really helping people.

I've mentioned before (see previous post), the perversion of care, as Rosemary Rizq called it, of turning away from the realities of managing distressed people. As Rizq says, society has traditionally allocated to mental health practitioners an "unconscious anxiety-containing function". Mental health practitioners experience enormous emotional difficulties in working with mentally distressed and disordered patients. Focusing on outcomes, as Jay says, "stops pain being listened to and the meaning of symptoms heard".

1 comment:

cobweb said...

For perhaps the most odious example of degrading categorisation and labelling of people in distress is 'The Psychodynamic Diagnostic Manual PDM-2' - which apes the Psychiatric Diagnostic Manual but with ever refined splitting of diagnoses to define individual personality characteristics. Check lists and sub lists of each 'diagnosis' can be in-putted onto a computer to carry out the 'assessment'. There are warnings on the front page to effect this should only be used by qualified mental health workers..wonder where they exist in UK Health service anyway? There is nothing to state whether or how permission to use this manual has been gained in the UK but The UK contributing editors include Peter Fonagay of IAPT fame and public funding. Enough can be read on the net and the book can be bought on Amazon so readers can decide what they make of such a dehumanising manual. How has one set of human beings ended up thinking this is a way of treating others? The sheer arrogance is appalling. At a time when service users and many mental health workers are rejecting this way of pinning people down it has gone further than ever to dehumanise complex individuals. It would be useful if they could describe, as people have rights of access to files and to have diagnoses and treatments explained clearly and honestly, how they will be recording this information and making that available to clients. Incredibly they have received praise for producing this book as they are giving royalties to further research...this furthers their interests not the needs of clients who cannot access any mental health services never mind the shameful project this book is promoting.