Shortages in NHS ‘talking therapies’ services, The Times, 1 August 2011

From The Times, 1 August 2011 (story by Sam Lister and Madeline Davies)

Cuts leave patients waiting months for mental health help

A growing number of patients suffering from depression and other mental health problems are waiting more than three months for counselling in the latest sign of the impact of financial pressures on NHS services.

A drive to improve access to “talking therapies” — the first line of treatment recommended by the NHS clinical watchdog for conditions such as depression — appears to have had little impact on access or waiting times, research shows.

Findings suggest that many patients are either suffering unattended, or still being put on anti-depressant medications despite Government efforts to reduce doctors’ reliance on such prescriptions. They lend weight to fears that mental health, often referred to as a neglected “Cinderella” service, is being hit badly by efforts to save money throughout NHS, even after a recent £170 million investment to improve access.

Data collected from 120 Primary Care Trusts (PCTs) in England under the Freedom of Information Act shows that in those trusts that provide access to trained counsellors, more than 40 per cent leave patients waiting three months. A year earlier, in 2009, 29 per cent of 90 PCTs polled required a three-month wait for sessions with a counsellor. At least 10 trusts last year could only provide such a service if patients waited six months.

Figures for Cognitive Behavioural Therapy (CBT), which is provided by all 120 PCTs, have remained unchanged, with 28 per cent reporting waiting of more than three months and a third offering access within a month. At least eight PCTs demand a six-month wait for this frontline talking therapy.

Further concerns about the provision of depression care were raised yesterday by mental health charities and professional groups. It followed the publication of recommendations which have removed three indicators for depression from the system which rewards GPs for the quality of care they provide.

Mental health specialists said that the latest PCT data, to be published next week in the magazine Health Insurance, raised concerns about the deterioration in people’s conditions while they waited and the long term impact this could have on recovery. Anecdotal evidence suggests that many are opting to take up private care if they can afford it.

Last year The Times revealed that a growing number of PCTs were issuing service restriction documents for hospital care, grading hospital procedures by priority. Some patients refused procedures such as IVF and hip and knee operations were opting for private care instead.

The concerns were backed up last week by a report from the Co-operation and Competition Panel which warned that some trusts are increasing waiting times to encourage some patients to go private or die before they are seen.

The new figures show that striking variations in waiting times persist for mental health, with patients waiting up to 54 weeks for counselling in Central and Eastern Cheshire and up to 67 weeks for CBT in the Wirral. Both are available with no wait, or in a matter of days, in other areas.

The Improving Access to Psychological Therapies (IAPT) programme, which was launched in 2008 to grow the NHS mental health workforce, currently covers around 60 per cent of the population.

In February the Government announced a further £400m investment over the next four years to complete the roll-out and ensure that every adult has access to psychological therapies for anxiety disorders and depression. It suggests the programme to deliver £700m of savings in healthcare, tax and welfare gains, chiefly by returning people with mental health problems to work.

Research carried out by Mind, the mental health charity, shows that people who wait three months or less are five times more likely to report that it helped them get back to work than those waiting for a year or more.

“Waiting times for treatment can make the difference between someone making a swift recovery, to someone having every area of their life fall apart,” said Vicki Nash, head of policy and campaigns at the charity. “It seems so wrong that the outcome all depends on where in the country you live.”

Kevin Healy, of the Royal College of Psychiatrists, added that patients who had waited months for talking therapies could prove more difficult to help. “People usually seek out such therapy when they are in a crisis situation and need to find a way of dealing effectively with the crisis at that particular time. If they don’t have the help of a therapist they will seek whatever solution makes their situation more manageable.

“It is more likely that they will find ways to cover over their problems and may then find it difficult to address their difficulties when a therapist becomes available many months later.”

The survey also shows that the range of talking therapies set out by National Institute for health and Clinical Excellence for mild to moderate depression is unavailable in many parts of the country. The recommendation, which supports the Government’s pledge for patietn choice, is because CBT is not appropriate for all diagnoses.

Interpersonal therapy — a treatment designed to address relationship problems — is not provided by 45 PCTs while 61 do not offer behavioural couples therapy. Psychodynamic therapy, which focuses on causes of depression rooted in childhood, is unavailable in 56 PCTs.

Phillip Hodson, of the British Association for Counselling and Psychotherapy, said the NHS needed “a whole family of therapies” to serve people with depression.

According to Mind, less than a third of people suffering from anxiety and depression are offered a choice of therapy. Those that receive a choice have higher levels of satisfaction with their treatment and are more likely to report that it helped them to return to work.

The Department of Health said it recognized that positive mental health was key to good overall health, and that swift access to high quality services was important. A spokesperson said that since the IAPT programme began in 2008 over 600,000 people with mild to moderate depression have entered treatment.

Case Study: Laura Murphy

Laura Murphy had battled with depression and anxiety attacks since she was 17. For many years she used anti-depressants, which she felt never helped her get to the root of the problem.

It was only at 27 that Ms Murphy, an artist from Kent, met a GP keen to get her into counselling. But, she recalled: “My GP said, ‘You’re welcome to go on the list, but it’s about six months long’. When you are at rock bottom and you are told you must wait six months … it’s not good enough for anyone.”

Her GP suggested instead a counselling centre. It was not part of the NHS, but accepted mean-tested payments, allowing Ms Murphy, now 32, to pay £10 a session.