The National Audit Office’s investigation into the performance data of IAPT services.

by Julia Evans on August 14, 2017

So I got to be so laid-back, I completely mistook the date. Nonetheless, the following has been sent within the National Audit Office. Its receipt has not been acknowledged.

Have a good summer


Dear Sirs,

Apologies for submitting during the report writing period – I mistook the date.  I thought I had until end of August. This is such an important topic I have hastily put the following together:

A definition : IAPT = Improved Access to Psychological Therapies : See here

Access to the NAO investigation appears to have disappeared. Some information appears here and the original site is here. I will update as more information becomes available.

Who I am

Julia Evans

From 1973 to 2002 worked as a Chartered Organisational Psychologist in Manufacturing Industry and the IT sector.

From 1988 to 1995 retrained as a Lacanian Psychoanalyst.

From 1995 to date practice in Earl’s Court as Lacanian, registered with the London Society of the New Lacanian School, see here

See also my web-site : or Lacanian Works

Your consultation

I understand that the National Audit Office is currently carrying out an investigation into the performance data of IAPT services.

My concerns

The Government enshrines all treatments for conditions known as ‘Mental Health’ within the Heath Profession Order 2001 which has as its objective : ’in exercising its functions shall be to safeguard the health and well-being of persons’. This implies that the Government has a standard for ‘normal’ health and well-being from which to measure deviation.  So in promising to safeguard, the Government projects an imaginary of what is acceptable and normal, and measures against it. Evaluation thus becomes an idealised game of numbers where unique individuals are measured against a Government imposed ideal of mental health and well-being, and the amount they deviate from the Government norm is thus established.

An Order goes through the Privy Council and uses its absolute power. It was invented by King Henry VIII so he could have his own way. When he died all the laws he made were rescinded but it was left on the statute book for emergency use. Thus, the form of power involved is absolute and top-down. The Government is absolutely correct and the recipient is inadequate. This goes against any treatment of Mental Health. This ‘Animal Farm’ imposition of Government-defined happiness is then subjected to outcome measures, primarily achieving Lord Layard’s economic happiness, having a job. Each session of IAPT using the Government defined (by a cost-benefit-analysis) treatments, (usually cbt) is also evaluated to a point where recipients will say anything just to get out of the grip of this State sponsored cure.

The evaluation procedures are easily fiddled by those involved in supplying the Government with their defined cures. Suppliers are corralled in a closed shop, so that they keep and control their revenue stream. The closed shop blocks out many practitioners who deviate or ignore the Government’s definition of Good Practice. With over 40 years experience, my training and experience does not register with the Government’s definition of practitioner or treatments so I am considered a charlatan.  When huge profits are at stake, remaining a registered supplier to the Government involves submitting satisfactory evaluation figures, so I suggest that putting pressure on those with mental health issues to fill in meaningless forms is being applied.

The Government have decided that Mental Health issues are a medical condition. This has a number of results. 1) Mental health symptoms are diagnosed by the Government’s NICE in exactly the same manner you look for spots in chicken pox. 2) Symptoms are treated as if they have as much concreteness as a broken leg. Everyone presents in exactly the same manner is assumed. 3) The practitioner is such a superior human being that they can categorise what the individual is saying into the NICE clinical guidelines.  There are no errors – it is as easy as diagnosing a brain tumour. 4) The individual becomes stamped with this classification so announces to the world ‘I am depressed’. This relieves them from taking responsibility for the condition as it is the practitioner’s job, as doctor, to cure them. 5) An end point when you are better, is defined.  So it is possible to reassemble a unique human being psychically in the manner you put a body back together after a car crash.

The Government does not recognise that there are no reliable physical correlates of mental ill-health. Astra-Zeneca stopped researching new drugs for depression in 2010. The reason was that there is no reliable way to evaluate if any change is in place.

From Health: no room for gloom by Clive Cookson and Andrew Jack : Financial Times : 14 June 2010 : Available :

At the heart of the problem is the difficulty in first identifying appropriate patients to take part in clinical trials and then proving that they do better on the new drug candidate than on placebo (dummy pills). “That is the number one reason why we as an industry are moving away from an area that has an incredible burden of disease,” says Frank Yocca, AstraZeneca’s head of discovery for central nervous system drugs. Clinical trials are particularly hard to organise for antidepressants because, for a start, medical definitions of depression and its severity are not as clear-cut as for most other diseases. In addition, reliable “bio markers”, objective measurements of disease progress such as brain scans or blood tests, are unavailable.

Further, as the only tool which has a chance of working is the offer of a relationship of trust, this makes evaluation data even murkier.

Further quote from Cookson & Jack : Then there is the large – and mysteriously growing – placebo effect, which makes it hard to demonstrate statistically that patients taking the active drug are doing better than those on dummy pills. Psychiatrists have long recognised that patients with depression and other mood disorders are susceptible to the suggestion that they will get better. But it is not clear why placebo power should have increased, as analysis of clinical trials over the past 30 years shows it has.

“It would be like invoking magic to suggest that people are becoming more suggestible,” says John Geddes, professor of psychiatry at Oxford University. “The change is more likely to be an artefact of the way patients are recruited to clinical trials.”

Practitioners, as well as sufferers, are unique human beings. Some can offer a relationship of trust and others can’t. Sufferers will also vary with whom they feel comfortable working. They will work better with one practitioner than another one. Evaluation data which does not take into account variance in human relations, is worthless.

: a fuller discussion of this article is available here : Challenges to Government’s principles used to define the care of mental ill-health by Julia Evans on 15th July 2010 or here

I urge you before you get bogged down in studies of evaluation to look at the framework in which Government Agencies and those in charge of awarding these lucrative contracts, hold conditions known as Mental Health issues and their treatment.

Julia Evans

Practicing Lacanian Psychoanalyst, Earl’s Court, London

Further texts

Evaluation and Outcome Measurement here

Responses to Consultations here

Networking & Politics here

From LW working groups : here

Organisational : here

By Julia Evans (See here or )

By Éric Laurent here

By Sigmund Freud here

Notes on texts by Sigmund Freud : here

By Jacques Lacan here

Notes on texts by Jacques Lacan here