The NHS Talking Therapies Pathway – ridden with potholes


The latest data from the Service shows that in 2022-23, of those at the start of the pathway, 1.76 million, a third (31%) decided that this route was not for them and they did not move beyond an initial contact. Of the 1.22 million who had an assessment, half (44.9%) did not go beyond this one session. Thus, the first two potholes are of a comparable size (i.e the proportion defaulting).

Treatment (defined by the Service as people attending two or more sessions), follows a stepped care model, so that after the 1st two potholes you come to a fork, with 3 possible paths, shown in  Table 1 below, whichever one is taken the majority do not finish treatment

Table 1 Casualties in Stepped Care


Referrals finishing treatment

Percentage  referrals finishing

Mean number of sessions

Low intensity only




Both low and Hi intensity




Hi intensity therapy only





The potholes following the fork (i.e the proportion of people who default) are thus deeper than those before.

The pathway needs to be closed for repair and a diversion e.g attendance at a Citizens Advice Bureaux or local Charity,  needs to be put in place. There is no evidence travellers would be worse off. It would certainly cost a lot less than the £1 billion a year spent on Adult Mental Health Services in Primary Care.


Dr Mike Scott