NICE under scrutiny
the impact of the NICE guidelines on the provision of psychotherapy in the UK
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Executive summary
This paper examines the negative consequences for patients of their inability to access the full range of psychotherapies due to a combination of NICE's approach to mental health and the implementation of its guidance through Improving Access to Psychological Therapies (IAPT).
NICE's methodology has been inappropriately applied to psychotherapy in that:
- It adheres to an overly medicalised perspective on emotional distress
- It has not consulted with the full range of relevant professional psychotherapy groups and psychotherapy research experts in the field
- It treats psychotherapy as if it were a drug for research purposes when a more appropriate metaphor might be therapy as a dialogue
- It uses an inflexible hierarchy of evidence which its own Chairman has criticised.
The relevance of the assumptions which underpin NICE's preferred research method for all psychological therapies, randomised control trials (RCTS), is questioned.
The case is made for NICE to adopt a pluralist approach to research methodologies in order that research using methodologies better suited to psychotherapy can be admitted for consideration in creating guidelines.
While NICE recognises many of the issues raised concerning its methodology, it is acting as though they don't exist by only recommending those therapies which can provide a very narrow type of evidence.
The current process works in favour of some therapies (e.g. CBT) and puts others at an unreasonable disadvantage, with the result that the choice of therapies available on the NHS is diminishing at a time when the government has stated it is committed to increasing choice. Researchers tend to favour the psychotherapy they themselves practice.
The Department of Health is called on to intervene as a matter of urgency prior to NICE's Guidance Development Group review in December 2011 so that the matters raised in this paper might be considered in the review.
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