The alternative to IAPT

The improved access to psychological therapies scheme was based on a health economics. Its probably more complicated but essentially keeping people in work is a cost saving which offsets the cost of a short course of CBT.

The health economics argument is what won over the government and they commissioned the landmark scheme. There are strong compassionate and patient choice reasons for the scheme but those wouldn't have been as persuasive.

In current times there's a better option. I've been very lazy and based my argument on a single systematic review. It's one I've promoted often. It's the one which shows very large effect sizes for physical and mental health for job satisfaction. The review covers a total of about 250,000 subjects.

The review itself is poor quality. The trials are probably heterogenous. The trials aren't proper experiments of the quality of a psychiatric trial. It doesn't only include double blind RCTs with good design and follow up not attempt to be careful in its use of meta-analysis. It also doesn't include a funnel plot. However when all this is taken into account for CBT it doesn't fair favourably either.

That's a weak argument of course and the best thing would be for this sort of high quality review of evidence to be done to establish truly if helping people into satisfying jobs would work.

From the review the evidence is strong. In fact what's surprising is how infrequent negative results are. There's a graph which maps confidence intervals. I don't quite understand them but the results are uniequivocal in that the studies rarely show negative results for subjects whereas CBT can have negative results.

The amazing thing isn't just the massive effect sizes in this one systematic review. Its that it works for physical and mental health. Its a double whammy.

The economics is pretty good too. There is a move to force ill people into work. It would make sense to offer help and if the work offered healthcare benefits then there is a cost saving in care. There is a long term cost saving because of the benefits for physical health too because people will be less ill over a longer period.

There's an argument for a job creation scheme which creates satisfying jobs because we're in a recession. The ill would have jobs they're happy with and be able to contribute as well as have their contributions recognised. Many ill people volunteer.

There's also the sort of obvious thing. Rather than offer people thought and behavioural modifciation to put up with the shit jobs many people have to endure this alternative seeks to address the root cause: the shit jobs.

There's more work to be done of course were this idea to be realised. For example what does job satisfaction really mean? Are the measues representative? How the hell to put this idea in to practice too?

However given that iapt is rolling up to 400 million pounds a year of funding in seems daft to not consider an alternative especially given the current climate of unemployment and the government forcing people into work who are ill when there's few jobs.