Mental health services are unable to cope with demand for psychological therapies, according to an investigation by the We Need to Talk coalition. The coalition of mental health charities, professional organisations, Royal Colleges and service providers says that huge variations in referral rates and waiting times around the country are unacceptable and are making people more unwell. It is calling on the next government to make access to talking therapies an immediate priority after the election.
The investigation brings together three separate sets of data from Clinical Commissioning Groups (CCGs), therapists and services users that paint a picture of services struggling to cope. An analysis by the coalition of the latest Health and Social Care Information Centre data from CCGs shows enormous variation in both referrals and waiting times across England. In the last quarter of 2013/14, several CCGs report fewer than 100 new referrals for talking treatments, such as CBT, counselling and group therapy, while others report up to 5,400 in the same period.
While some CCGs, such as NHS Oxfordshire, say the majority of people are assessed for treatment within 28 days of referral, others report that more than 90 per cent have to wait longer. The We Need to Talk coalition surveyed over 2,000 people who have tried to access therapy in the last two years. It reveals that one in ten (9.6 per cent) are waiting over a year between referral and assessment, while four in ten (41 per cent) wait more than three months. Once assessed, most people start therapy within three months, yet a third (32 per cent) wait longer.
While waiting, two thirds (67 per cent) feel they have become more mentally unwell. Four in ten (40 per cent) have harmed themselves, two thirds (67 per cent) have experienced suicidal thoughts and one in six (16 per cent) attempted suicide. The survey also revealed the toll on other services; six per cent of people waiting for therapy have been voluntarily admitted to hospital, three per cent admitted compulsorily under the Mental Health Act and seven per cent have come into contact with the police as a result of their mental health.
Psychological therapies are recognised as effective treatments for a wide range of mental health problems. Since 2007 the Government’s Improving Access to Psychological Therapies (IAPT) programme has enabled more people to access National Institute of Health and Care Excellence-approved talking therapies. The current Government has invested in IAPT but progress has been patchy and the coalition says that there is still much to do before people with mental health problems receive the help and support they need. IAPT services are primarily there to help people with depression and anxiety and there is a need for specialist services for people with more complex mental health problems.
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A joint survey of over 650 NHS therapists by the British Psychoanalytic Council (BPC) and the UK Council for Psychotherapy (UKCP) suggests that despite investment in IAPT, the situation in many areas is getting worse as other psychotherapy services are being cut back. More than half (57 per cent) of therapists report an increase in waiting times over the last year and two thirds (62 per cent) report shorter courses of treatment. Almost four out of five (77 per cent) say they are seeing people with more complex needs coming through their doors.
Meanwhile, more and more people are turning to private providers in a bid to get the help they need. The We Need to Talk survey revealed that a quarter (24 per cent) of people who have recently tried to access therapy have paid to go private, compared with just one in ten (11 per cent) in 2013. The UKCP and BPC also surveyed 600 private therapists, 89 per cent of whom say clients have come to them because the NHS could not give them the help they need.
Paul Farmer, Chair of the We Need to Talk coalition and Chief Executive of mental health charity Mind, said: “Our investigation shows that providers, frontline staff and those who use services are all united in the view that mental health services aren’t currently set up to cope with demand. We know that in some parts of the country investment in IAPT and other models has transformed lives as people have been able to access the help they need when they need it. But far too many are facing unacceptably long waits or are struggling to even get a referral. This simply isn’t good enough.
“At the same time as people are waiting for psychological therapies, prescriptions for antidepressants rise and rise and we have seen mental health services struggle to cope with the demand for beds and other crisis services.
“All three main political parties have been in power in the time we have had IAPT, so we know the commitment is there but we have yet to see the ambitions of the programme made a reality on the ground. Whoever forms our next government must redouble their efforts and make this a priority, ensuring fair access and establishing waiting times targets so that no matter where you live, you can get the help you need when you need it. We are calling on them to ensure the NHS in England offers a full range of evidence-based psychological therapies to everyone who needs them within 28 days of requesting a referral.”
Kerry is 29 and lives in Lambeth. She has had depression and anxiety since she was 15. She received 12 sessions of person-centred counselling about two years ago, which she says really helped. This was provided outside of the NHS by a charity and was something that Kerry had to research and ask for herself. She is currently on the waiting list for a specialised psychological therapy to help her cope with the emotional trauma she has experienced after being raped in 2010. Three weeks ago Kerry tried to take her own life.
She says: “I had to push for three months to see a psychiatrist for a referral and then waited another two months before I got the letter confirming I had been referred. I am now on a four-month waiting list, which feels like a long time. I should have had this therapy a long time ago and it’s only because I have pestered them on a daily basis that I have got this far. And it still feels so far away. In the meantime my depression has got worse and I feel like my life is passing me by. I feel like I am running a marathon every day.
“A friend of mine very kindly offered to pay for me to go private, but it’s not right that it should come to that. Even if my friend can afford it there’s no way I could accept that kind of generosity from a friend.”
When the system works: Case study, TalkingSpace
TalkingSpace is the Oxfordshire Improving Access to Psychological Therapies (IAPT) service, run as a partnership between Oxford Health NHS Trust and Oxfordshire Mind since 2009. The service is offering a high quality but high volume service which copes with 8,000 referrals per year and 6,000 people completing a course of treatment. The recovery rates are at 48 per cent and 92 per cent patient satisfaction. Over 100 people have moved off sick pay and benefits per year and they have trained 56 staff to deliver recommended talking treatments.
The ambition for the service in the coming year is to reach more people, helping more people towards recovery and improving their offer to older adults, BME communities and people with physical health problems.
NHS Oxfordshire CCG reported 1,670 assessments in quarter 4 of 2013/14, which is above the national average. Of these, 91 per cent were assessed within 28 days of referral.
Comments from individual We Need to Talk member organisations
Louise Robinson, Healthcare Development Manager at the British Association for Counselling and Psychotherapy, said: “With increasing demand across the UK and a growing number of trained, qualified and registered workers ready to provide this vital service, effective and timely access is both needed and achievable.”
“BACP has over 40,000 members and the majority meet the Department of Health definition of psychological therapist and yet the majority are also not in full time employment as a therapist. What we need are pragmatic and cost-effective commissioning solutions that mobilize this workforce into services that help address the causes of both psychological distress and physical illness, thus relieving human suffering and saving public money.”
Gary Fereday, Chief Executive of British Psychoanalytic Council, said: “We Need to Talk’s investigation shows that if you happen to be among the millions of people who experience mental illness and need urgent psychological therapy, it is highly likely that you will not receive appropriate or adequate therapy. Moreover, it demonstrates that you have a high chance of waiting for an unacceptably long time for treatment and even that your health may deteriorate further. Although investment in IAPT has changed people’s lives, the state of current provision is unacceptable and would be considered scandalous if we were talking about physical health services. This is why the British Psychoanalytic Council joins with We Need to Talk partners in urgently calling for the NHS to provide the full range of evidence based psychological therapies to anyone who needs them within 28 days of asking for help.”
Professor Jamie Hacker Hughes, President Elect of the British Psychological Society, said: “As a clinical psychologist and psychotherapist, but also as a service user, I know from experience that talking therapies work. However, in order for them to do so, they need to be timely, accessible, evidence-based and tailored to the needs of the client. This is why the British Psychological Society wholeheartedly supports the WNTT campaign, calling on Government to fund and prioritise a range of talking therapy services nationwide ensuring accessibility, equality, equity of access and parity with physical health services.”
Centre for Mental Health deputy chief executive Andy Bell said: “Some 4.6 million people in England have both a long-term health condition and a mental health problem at the same time. This puts them at risk of poorer quality of life and of dying sooner. It also costs the NHS some £10 billion in extra healthcare. Offering evidence-based psychological therapies to people with long-term conditions as part of a better integrated approach to care could help to improve their health and reduce costs. The IAPT programme is finding ways to do this and it is vital that this work is sustained and expanded nationally so that no one misses out on the support they need when they need it.”
Jenny Edwards CBE, Chief Executive of the Mental Health Foundation said: “The effectiveness of evidence based psychological therapies is proven. Despite the clear case for timely access people have to wait far too long, even up to a year before they start to receive help. This is costly to the health of the people waiting and has an impact on many aspects of their lives ”” their work, relationships and ability to cope. People have a right to expect parity in how they are treated whether their ill health is mental or physical.
“Early intervention is common sense and will help people avoid ending up in crisis, with risking harm to themselves and high costs to health services. People from black and minority ethnic communities, people in later life and young people must not be left behind in the drive to provide psychological therapies so we can reduce health inequalities.”
Liz McElligott, Chief Executive, The National Counselling Society, said: “‘We Need to talk’…. but actions speak louder than words and we need Government to act. There are trained professionals waiting to help and there are distressed patients waiting for help but funding is needed to bridge the gap between the two groups.”
Mark Winstanley, CEO of Rethink Mental Illness said: “It’s disgraceful that some people are waiting for over a year to receive talking therapies, and many are missing out altogether. Talking therapies should not be seen as ‘optional extra’, and everyone going through mental illness should be offered this treatment.
“Too often, people are fobbed off with medication alone, when we know that psychological therapies have the potential to transform lives. If you had a serious physical illness like cancer, you’d expect to get the full range of recommended treatments, so why should it be different for people with mental illness?”
Dr Maureen Baker, Chair of Royal College of General Practitioners, said: “We live in a stressful society and GPs are seeing a huge increase in the number of patients presenting with mental health issues.
“Mental health is a clinical priority for the RCGP and we understand how important it is to refer patients to the right place at the right time. It is a travesty that so many people are still falling through the gaps.
“It is crucial that GPs are part of this coalition so that we can take the necessary action to address this.”
David Pink, chief executive of UK Council for Psychotherapy, said: “Demand for therapy is higher than ever but the NHS is not delivering.
“Many NHS psychotherapy posts have been cut, clients are forced into long waits and thousands more are simply turned away. At the same, antidepressant prescriptions continue to rise and rise. This is a national scandal.
“While the NHS flounders, private therapy is the lifeline keeping many afloat. But private therapy is only available to those who can afford to pay.
“The next government must consider how to use this highly trained therapy workforce to ensure the NHS meets its founding commitment: that all can access support based on clinical need and not on the ability to pay.”
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