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Labour Promise 20% Increase In Funding For NHS Talking Therapies, Despite Less Than The Tip Of The Iceberg Engaging In Treatment!

The Labour Party, in its election Manifesto, has made a commitment to 8,550 new mental health staff, in its 1st term in Office.  At an average cost of £30K (salary plus national insurance) a year, the total is £255 million. Adding in overheads rent, heating etc this probably approaches £0.5 billion a year, about 20% of the £2 billion a year spent on Adult and Child mental health in NHS Talking Therapies.

On June 5th 2024 following my Freedom of Information Request (FOI) NHS England, sent me the data in the 2nd column of the table below, showing the number of people attending just one assessment/treatment session by diagnosis, for the 10 most frequently specified disorders. The 3rd column shows the number of people attending treatment (defined as attending two or more sessions) from the NHS Talking Therapy report for 202223 and the 4th column, the proportion of people who engage in treatment.

Thus, whatever the diagnosis, less than 10% of those attending NHS Talking Therapies are engaged in treatment. With only 1 in 50 of those with PTSD or panic disorder engaging in treatment and 1 in 100 of those with Agoraphobia engaging.

Diagnosis Number attending 1 session Number attending 2 or more sessions Proportion engaging in treatment
1. Depression 160,509 4,879 2.9%
2. Generalised anxiety disorder 75,182 5,694 7.0%
3. PTSD 23,069 491 2.1%
4. Mixed anxiety and depressive disorder 13,411 832 5.8%
5. Social phobias 7,746 185 2.3%
6. Panic disorder  5,664 130 2.2%
7. Obsessive compulsive disorder 5,084 223 4.3%
8.Hypochondriacal disorder 2,929 88 2.9%
9. Agoraphobia 2,030 22 1.1%
10. Specific phobias 1,560 60 3.7%

The FOI data state that the diagnostic status of 126,1923 people attending one session was unknown, i.e the diagnostic status of 29.8% was unknown. Given that the diagnostic status of nearly a third of those entering NHS Talking Therapies is unknown, their claim to be NICE compliant, treatment based on diagnosis, is preposterous.

NHS Talking Therapies in its’ Annual reports has always focussed entirely on those who ‘complete treatment’, small wonder! The politicians need to be wary of the slick marketing of NHS Talking Therapies and the National Audit Office needs to wake up.  The Liberal Democrats have promised the introduction of a Mental Health Commissioner, but this would be to no avail if she/he is ‘minded’ by NHS Talking Therapies.

This looks decidedly like, ‘The Great NHS Talking Therapies Scandal’.  

 

Dr Mike Scott

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NHS Talking Therapies Totally Fails The Traumatised – But There Is A New Way of Moving On

On June 5th, 2024 under a Freedom of Information Request (FOI),  NHS Talking Therapies informed me that in the year 2022-2023, 23,069  people with post-traumatic stress disorder had just one assessment/ treatment session with the Service. But according to NHS Talking Therapies data for the year (psych-ther-2223-out-ther-data-tables.xisx), just 491 clients completed treatment (defined as attending two or more sessions) i.e of the total number of PTSD clients presenting, 23,560, only 2.1% completed treatment. Thus the Service failed to engage 98% of those it described as having PTSD! Further for those who completed treatment the recovery rate was 17.1%! It is always possible that I have misunderstood the Official data, certainly my initial reaction was one of shock, and I invite NHS Talking Therapies to correct me if I have got it wrong .

 

The FOI data reveal that for those attending just one session, those with PTSD have higher mean scores on both the PHQ-9 (17.9) and GAD-7 (15.6)  than any other diagnostic group. Further these mean scores are higher than those who start treatment  mean PHQ-9  of  15.5 and GAD-7 14.1. It thus appears that those who have only one session are likely more traumatised than those who go on to have treatment. 

It appears that there is something radically wrong with the traditional trauma-focussed approach to trauma adopted by NHS Talking Therapies. My new self-help book, Moving On After Trauma (2nd edition) published by London: Routledge on June 13th 2024, takes a radically different, more user-friendly approach. Instead of positing that the primary difficulty lies with arrested information processing at the time of the trauma and the consequent need to re-live it therapeutically, I suggest that what is pivotal is the centrality accorded to the trauma for today and that there is no need for a re-traumatisation of the client. My clinical handbook ‘Personalising Trauma Treatment: Reframing and Reimagining’ published in 2022 by Routledge, spells out the specifics of this approach for clinicians.

Accordingly I am adding a ‘Moving On After Trauma’ page to this website for clinicians, those who have been traumatised and those travelling the road with them. Here are my 12 rules for Moving On:

  1. Begin building a bridge between yourself now and the person you were before the trauma. Start by doing a little of what you did before. Constucting gradually as wide a ranging an investment portfolio as you can manage.
  2. Expected that building the bridge, like all forms of construction, will be steps forward and one backwards. It will need daily commitment.
  3. Don’t block the memories of the trauma, the harder you push them away the more they spring back.
  4. Put the traumatic memories in their place by questioning their relevance to today’s plans.
  5. Don’t get hooked by what could have happened. That is just a horror video which spoils today, with dark imaginings.
  6. Expect that the traumatic memory will knock at the door of your mind daily. But it is only asking about its’ relevance to today. Calmly answer this visitor.
  7. Go by what you would bet £5 on happening today, not by how vivid the traumatic memory is and how upsetting you find it.
  8. Remember that guilt is about deliberately doing something wrong. Trauma related guilt is bogus, it arises from either believing you should have looked into your crystal ball before the trauma or that you actually had the time to have done something differently. Feeling guilty and being guilty are not the same.
  9. Refuse to see flashbacks/nightmares as credible forecasts of what is going to happen today. Being constantly on the edge of your seat is about the past not the future.
  10. Give people the time of day. Expect to feel disconnected from others as you are looking at your world through war-zone glasses. Try on the pre-trauma glasses, they are more reliable. The view through them is based on a lifetimes experience rather than on a single drama.
  11. Refuse to take your alarm going off as evidence of danger- it’s just a ‘dodgy alarm’. Tripped easily by anything not exactly as you would want it, reminders or any unusual but not abnormal bodily sensation/s.
  12. Refuse to look at yourself and your personal world through the window of the trauma. Don’t make the trauma, pain or disability central.

 

 

Dr Mike Scott

 

 

 

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Minimalist Approach To Depression Doesn’t Deliver

A just published study in Lancet Psychiatry shows that just screening people for depression  using a PHQ-9 score of 10 or more, doesn’t help the patient, whether or not they and/or their GP are informed. A month after baseline, PHQ9 scores in all groups reduced by 4 points  and remained at this level in follow-up. 

Based on a diagnostic interview only a third of the sample met DSM diagnostic criteria at follow up. But in NHS Talking Therapies, a PHQ-9  score of 10 or more would usher people along a depression treatment pathway. This study indicates that two out of three people would have been directed along the wrong path. Watchful waiting is called for, oftentimes there is just a passing crisis in a person’s life.   Clients need comprehensive assessment, monitoring and treatment. NHS Talking Therapies’ simple dichotomy of low and high intensity interventions is not fit for purpose.

A screen by itself is simply a ‘scream’

Interestingly in the feedback to GPs ( the study took place in Germany) they were told  that ‘a diagnosis cannot be made on the basis of the screening score alone’ and there was a ‘recommendation for further assessment and treatment for any depressive disorders that might be present’. NHS Talking Therapies clinicians are not informed of the need for a thorough going assessment.  There is no diagnosis-informed care. The Service expects clinicians to  continue to work in the dark. Only a quarter of the sample received psychotherapy or an antidepressant.

Dr Mike Scott