One Size Does Not Fit All: Independent Review for NHS Talking Therapies Needed Now
(NHS TT – formerly known as Improving Access to Psychological Therapies, or IAPT)
Letter to MP
Please copy the letter below and add your MP’s name at the start and your name at the end. It’s a good idea to edit the text to fit your own voice. Then send it to your MP via post or email.
I am writing to express my concern about the provision of NHS Talking Therapies.
While mental health distress is increasing NHS Talking Therapies are becoming more limited and difficult to access. There is an urgent need for a thorough review and audit of NHS Talking Therapies. This should include looking at the diversity of available therapies including relational therapies, staff pay and conditions and how to respond more appropriately to community needs.
Much of the NHS TT data is presented in a misleading way. For example, NHS TT claims a 50% recovery rate. However, this is misleading because in fact 50% of those who complete treatment recover, not 50% of all of those who are referred.” The recovery rate of all those referred is therefore nearer to 18%. Similarly, there is a claim that 90% of people referred are seen within 6 weeks, whereas the wait between first and second appointment can often be over a year.
There is an exceptionally high drop-out rate in NHS Talking Therapies. One third of people referred do not start treatment and a further third do not finish. There is very little follow up on anyone, so we do not know the reason. We also do not know if treatment is effective over time.
There is an increasingly restricted range of therapy options available in spite of the emphasis on ‘choice’. When therapies were provided by GPs many types of therapies were available. Now the range is frequently limited to CBT, web based self- help therapy or non-relational therapies using scripts. While CBT can be helpful to some people, one size does not fit all and many people are in need of a different approach.
I am also concerned about the employment practice of the private companies providing the services. Many therapists work for low pay, with long hours, in gig-economy contracts. Stress and burn out in therapists are common along with other mental health problems. In addition, there are thousands of well-trained psychotherapists and counsellors available but not employed in NHS Talking Therapies.
I do not believe that the NHS Talking Therapies is cost-effective. Although the cost of NHS TT is not made public, an estimate made in NE London was £240 per session. Many counsellors and psychotherapists in private practice charge £40-60 per session.
In addition, NHS Talking Therapies fail to address inequalities of mental health care. Their own data shows that fewer people from socially deprived and ethnic minority communities either finish treatment or recover.
NHS Talking Therapies has consistently relied on its own data to claim to be a successful, evidence-based service. Many critical reviews of its data suggest a different picture. There is no evidence that the prevalence of common mental health problems in the UK population has declined in the decade since the service was rolled out – on the contrary.
It is time for the reality of the failings of this service to be examined. Please support this call for an independent review and audit of this service.