Month: September 2024

Categories
l

NHS Talking Therapies – Where Therapeutic Outcome is Designed for Income

Clients attend psychological therapy with a perceived problem/s to be solved. The resolution of the problem/s has therefore to be an integral part of outcome. Is a psychometric test score result, a reasonable surrogate for a resolution of a problem/s? NHS Talking Therapies claims it is. The received mantra is that 50% of the Service’s clients score below the cut-off for a ‘case’ at their last contact with the Service, an alleged 50% recovery rate. 

By the Services own metric, it has a very marketable product, attracting Government funding of £2 billion a year for adult and child services. There is no wish on the part of politicians,  Healthcare professionals or the media to scrutinise the Service’s claim, they understandably want to believe that they are making a difference. But it behoves all concerned to consider alternative explanations for the apparent ‘success’, however this does require effort and it is easy for the professionals to claim competing demands on their time. It is comforting to think that 1 in 2 of those attending for psychological treatment are permanently recovered. But there is no evidence of the permanence of any positive change as clients traverse NHS Talking Therapies. Fluctuations in the severity of any disorder is the norm, seizing on a ‘flash in the pan, dip’ is at best, disingenuous and at worst *******.  

Dr Mike Scott

 

 

Categories
l

If You Contact NHS Talking Therapies Can You Tell If You Are Interacting With A Human Being?

A just published paper in The International Journal of Social Psychiatry, by Arundell et al (2024) reports the experience of 12 clients:

  1. A long wait was often the first thing participants reported when asked about challenges with accessing NHSTT treatment:

. . .there was a huge delay from the time the referral was done back in May till I got my first session in November. . .So the GP referred, and I didn’t hear back until November. [P.12]

Another challenge was the limited support offered whilst waiting to begin therapy. While people did reference offers of self-help information or group sessions, this was either seen as insufficient:

. . .if you’re struggling, there’s like these videos online. . . on their website or something, they were useless. . . it was too general. . . so the information I can find from anywhere. . .. [P.5]

The amount of time given per session was often seen as insufficient and as such, this posed a challenge for service users:
. . .only having like half an hour session. . .I think with the treatment that I had because it was half an hour, she had to follow a very rigid structure. . .And that just felt like it took up a lot of time [P.3]
 
It was often the case that service users felt they needed more sessions or that they had not managed to work through everything they had wanted to:
. . .I guess it’s not, you know, a longer process. . .it’s not a program that’s meant to continue along with you. So, I guess there’s very much like goals that you intend to complete throughout the- the end of the program, but you know, obviously mental health issues like, continue. [P.10]

Service users appreciated when they were given the option of longer or additional sessions

We were supposed to stop at six [sessions], but I wasn’t feeling very mentally well, so we extended to seven. . . [P.8]

Disquiet at forced revisiting of painful memories
Some of the most common challenges expressed by service users related to their own personal challenges of therapy, such as the fact that talking about their mental health problems was difficult in itself:
In terms of the help for me it’s been OK, the only thing I would say that could be negative is just that the actual program itself like there are some parts that become difficult because of the nature of what is being spoken about. . . I think it’s more like revisiting memories I didn’t really want to revisit. That was the hardest part of it. [P.4]
 
Arundell et al (2024) concluded ‘Service users should be made to feel comfortable and confident in requesting additional support where they feel it is needed so that this can be considered as part of their treatment package’. 
 
At each session two psychometric tests are administered, the results determine the nature of treatment. Arguably NHS Talking Therapies has become de facto an Artificial Intelligence operative but the Arundell et al (2024) paper also cited the comments of some clients about the warmth of some therapists. The clients were all female and from ethnic minorities but felt no cultural adaptations to their treatment had been  necessary. But no data is provided on outcome.

Dr Mike Scott

Categories
l

NHS Talking Therapies Glaring Failures, Are Highlighted By A Focus On One of The Long-Term Conditions It Targets

CBT is hailed as effective treatment for long-term conditions (LTCs) such as Irritable Bowel Syndrome (IBS). The latter is posited as being maintained by excessively negative cognitions. NHS Talking Therapies, purportedly, provides access to effective treatment for this condition. But this is yet another NHS Talking Therapies myth.

Minimal Access

The prevalence of IBS is between 5 and 20%, and given an adult population of 30 million in England, one would expect (at 10%) 30 X 105 sufferers annually. Thus 3 million is the potential pool of IBS sufferers that could present at NHS Talking Therapies. The service receives approximately 1 million referrals a year and therefore one could expect 100,000 sufferers from IBS to present to NHS Talking Therapies a year, But the latest data from NHS Digital and a response to a Freedom of Information Request (FOI) that I received in June 2024. suggest that approx. 200 present each year, so that it is seeing just 1 in 500 of IBS sufferers. Thus, it cannot be said to be meaningfully provide access to IBS sufferers.

Disengagement

Further, for every 2 people having one assessment/treatment session, only 1 person has 2 or more treatment sessions. The Service is having a serious engagement problem with IBS sufferers.

No Evidence of Recovery

Yet for those who have 2 or more sessions it claims a 50% recovery rate, but this is based on using the PHQ-9, a self-report depression questionnaire as an outcome measure. It can scarcely be taken to measure the severity of IBS. 

Dubious Non-Friendly Model

CBT treatment for long-term conditions (LTCs) is predicated on the assumption that difficulties are maintained by excessively negative cognitions. Little wonder that IBS sufferers have a ‘thanks, but no thanks’ response to engaging with NHS Talking Therapies.

Dr Mike Scott