NHS Talking Therapies – Wasting Access to Psychological Therapy

by reliance on two screening instruments. Coupled with a failure to conduct an interview that would reliably confirm or reject the impression given by the tests. The effect is that  many are treated needlessly, as most score above the designated cut-offs on the tests [IAPT Manual 2018)]. Further, diagnostic possibilities are constricted by the scope of the 2 instruments, depression (PHQ-9) and generalised anxiety disorder (GAD-7). The message from this Government service is:


Usage of the 2 screening tests would not rule out that a person had say an adjustment disorder triggered by job loss, marriage breakdown, serious illness, bereavement or an accident.  But such difficulties are not the domain of the disorders that are the focus of the randomised controlled trials of cbt for depression and the anxiety disorders. Yet such difficulties are the common currency of primary care. Thus the application of the cbt protocols for these disorders to those with these difficulties is not evidence-based and is a waste of resources. It is likely a matter of pathologising normality.


One third of those attending NHS Talking therapies have a low intensity intervention alone, i.e they are not treated by a psychological therapist, but by a Psychological Wellbeing Practitioner (PWP) [IAPT Manual (2018)].  But the PWPs do not know the diagnosis of any patient, as they, like all NHS Talking Therapies clinicians are not trained to diagnose. The allegation is that they deliver CBT, but for what?

The evidence-base for low intensity interventions is weak, in that, there is an absence of attention control conditions and independent blind assessment. The evidence that PWPs implement the low intensity interventions from the weak trials is weaker still. There have been no fidelity checks on PWPs ministrations i.e independent assessments of treatment targets and matching treatment strategies. 

Almost half of those entering NHS Talking therapies never progress to treatment defined by the Service as attending 2 or more treatment sessions. This is likely a ‘thanks, but no thanks’ response on behalf of patients. There is a monumental waste of scarce resources. Unsurprisingly I found that only the tip of the iceberg recover.  

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 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). The much vaunted ‘50% recovery rate’ that this Governmental service boasts about, refers to the significant minority who cross IAPT’s finishing line. Thus even using IAPT’s own yardstick  the true recovery rate is much less than 50%.

With regards to those who cross IAPT’s finishing line, there is no indication that their ‘success’ is lasting. It is not known what proportion of them ever ‘race’ again. 

The NHS Talking Therapies is an exemplar of what happens when there is an unaccountable Service. In which a therapist’s unfettered judgement, on how to treat a patient, is allowed to rule. Opinion-based treatment withers on the vine.


Dr Mike Scott