Mental Health and The Montgomery Judgement


Informed decision making is obligatory not only with regards to physical but also with regards to mental health. But NHS Talking Therapies clients are never informed that they would likely fare just as well attending the Citizen’s Advice Bureaux or a Charity such as Anxiety UK, Scott(2018). The client has a right to know, at the outset, that the service haemorrhages clients. 

The trajectory of patients in NHS Talking Therapies is rather like that of horses entering the Grand National. There were 1.69 million referrals to IAPT ( the predecessor of NHS Talking Therapies) in 2019-2020, 1.17 million left the starting gate, 30.77% (almost 1 in 3) were non-starters. Further only 1 in 3 (36.8%) got around the course (defined curiously by IAPT as attending 2 or more treatment sessions).

In the UK since the Montgomery Judgement of 2013 it is the patient who is choosing  from the treatment/non-treatment options and it is obligatory on the professionals to present all the options the ‘patient’ might consider important and not those the professional considers salient. The Judgement arose from a case in which a mother was not informed of the dangers of a vaginal delivery and had she been fully informed, would almost certainly have opted for an elective Caesarean.

If a person attends the Citizen’s Advice Bureaux with mental health problems they likely have a fair idea of the limits of expertise of the CABx worker. But in attending NHS Talking Therapies a member of the public is likely to have an inflated view of the level of expertise of the personnel they first encounter. The Service takes no steps to address the client’s likely misjudgement, for example they do not state upfront that they are not qualified therapists. It is likely that NHS Talking Therapies violates the principle of informed consent.The Montgomery judgement has yet to percolate down to mental health.

It is only a question of time before NHS Talking Therapies is brought to task on this matter in the Courts.



Dr Mike Scott