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BABCP Response - NICE Consultation January 2022

NHS Talking Therapies – A Black Hole For Psychological Wellbeing Practitioners?

On January 23rd 2023 NHS mental health director, Claire Murdoch, announced that:

‘Despite the disruption caused by the pandemic the NHS is on track to deliver its Long Term Plan commitment to boost mental health spending by £2.3 billion a year, enabling around 4.5 million adults and over 700,000 young people to access mental health services’.

All this without independent evidence of effectiveness. The best evidence available Scott (2018) suggests that for adults only the tip of the iceberg recover.

Australia [Allison et al (2023)] has just completed an inspection of its similar service and concluded:

‘In conclusion, this most recent Better Access evaluation reminds policymakers that psychotherapies are generally developed for clinical cohorts with more severe conditions. The mass rollout of brief psychotherapies for milder conditions does not appear to reduce population distress or suicide rates, and a considerable proportion of these patients experience deterioration [20-40%] Offering treatment for milder symptoms might undermine personal coping abilities and social support networks.Deterioration was less likely for patients with severe symptoms, and they also experienced more improvement.Based on these findings, severity could be used as a criterion for priority setting and resource allocation. Instead of the mass rollout of brief psychotherapies for milder conditions, prioritising longer courses of psychotherapy for more severe conditions may minimise risk and maximise the potential benefits of the Better Access initiative’.

The Better Access initiative was introduced into Australia in 2006 and by 2021 1 in 20 Australians had one or more sessions of psychotherapy at a cost 1.2 billion AUD.  But with no improvement in population mental health.

Alisson et al (2023) comment further:

In translating psychotherapies to the real world, CBT may have re- duced effectiveness unless treatment is carefully targeted, expertly delivered, and of adequate duration. In 2021, the average number of psychotherapy sessions per patient in Better Access (5.4) was lower than most research trials of CBT’

If the Australian findings were taken seriously, it should surely mean the end of low intensity NHS Talking Therapies. But about 70% of their clients are recipients of this dosage of therapy. Psychological Wellbeing Practitioners are threatened with extinction, in the unlikely event of the  UK Government becoming more concerned about wasting money than appearing to be politically correct.

But in neither Australia or the UK has there been publicly funded independent assessors of routine outcome, using a metric of lasting recovery from a disorder. This radical apathy, suggests a real-world indifference to the plight of those with mental health problems, despite political overtures.

Dr Mike Scott