What Chance Effective Psychological Treatment?

“If You Have Heart Problems and Depression You Are Four Times More Likely To Die In The Next Year or Two Than Those With Cardiac Problems Minus Depression”

– All In The Mind, Radio 4 May 3rd 2017.

 But scarcely more than the ‘tip of the iceberg’ of those with mental health problems receive psychological help

Iceberg, Water, Blue, Ocean, Ice

Here are two examples of people that I have seen recently who have been drowning in the ‘frozen waters’

‘Sarah’ was made redundant and had a fall 3.5 years ago. She has suffered from depression since and the only help she has been offered is antidepressants by her GP. Psychological therapy which is the NICE approved first line treatment for depression has not been discussed.

‘Ivan’ recently had a serious road traffic accident two years ago, and was referred by his GP to his local IAPT Service. He said that had a few face to face conversations with the staff but they did not offer him a diagnosis and said that they did not have the funding to treat him. Ivan was referred back to his GP with a recommendation he be referred to secondary care. On examination I found that he was suffering from PTSD complicated by the back pain he had suffered in the incident. The Secondary Care Unit provided no diagnosis but suggested a group programme could cater for his needs but he was not keen on this.

Dr Mike Scott


Moving Forward

Perhaps this diagram may help us in how we can move forward from this:-


Ultimately we want to make a socially significant to client’s lives, a real world difference, [See Scott (2017) Towards a Mental Health System that Works: a guide for practitioners. London: Routledge], not just a questionable change on some psychometric test.

Wounded Healers

“Two thirds (68.6%) of workers in low intensity CBT (PWP’s) are suffering from burnout and so are half of workers in high intensity.”

(Journal of Mental Health, published online January 13th 2017 “Predictors of emotional exhaustion, disengagement and burnout among improving access to psychological therapies (IAPT) practitioners” Westwood et al).


The position is no better than a year ago.  On February 3, 2016, The British Psychological Society reported on a 2015 survey of over 1,300 psychological therapists working in the NHS. The survey found that 46% reported depression, with half (49.5%) feeling they are a failure. One quarter considered that they now have a long-term chronic condition, and 70% said that they find their jobs stressful. Reported stress at work was up 12% in 2014: ‘The overall picture is one of burnout, low morale and worrying levels of stress and depression . . . the majority of respondents made negative comments about their work environment, 10% of comments were more positive’,

Should working in IAPT carry a government health warning? One educator said to me recently ‘I wouldn’t work in low intensity for a ‘gold clock’!


This new website is intended to be a safe-harbour for cbt clinicians – many will be the ‘wounded healers’ described below. Hopefully, it will help clinicians chart new directions and empower them to advocate change, not least via the Discussion Forum and the careful monitoring of service provision.

Hospitality’ has to begin with welcoming clients, as we would a friend/relative in difficulty. MP’s and GP’s insist on face to face contact with those whom they serve in the first instance, but curiously those with mental health difficulties are expected to book a telephone assessment with the least qualified mental health clinician, is this a perpetuation of stigma?  Head over to the forum and have your say.

Welcome to the website, invite others

Dr Mike Scott