# therapy on NHS-in the news



## shychick2 (Oct 20, 2008)

http://news.bbc.co.uk/1/hi/health/8578099.stm
I like this report as highlighting all the right issues of the problems getting treated for depression/anxiety on the NHS.
Apparently it is recommended that you get therapy within 2 months on the NHS for depression and anxiety. I actually laughed as got signed off work then remained unemployed/depressed for 2 months. I saw someone while they got me computer CBT but more to check up on me. I am now at the screening stage for CBT with a real person 8 months later and she has been off sick for at least 4 weeks with no replacement!


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## odd_one_out (Aug 22, 2006)

Usually, when they start trying to enforce targets like this proposed 1-2 month one, they end up creating more problems because there are not sufficient resources to reach them. They consequently end up having to put more effort into covering up shoddy service provision just to prove to the authorities they are making the targets. They might do this in any number of ways, at patients' expense; for example, they might cut back on the number of sessions delivered or medicate unnecessarily.

The problems in NHS mental health services are wider than described here, but the excessive waiting time is a very apparent one. I had to wait over 4 months for therapy in primary services, despite my case complexity. For secondary services, the wait was almost a year. 

Once in the system, the expertise tends to be subpar, the majority of therapists I have seen have been inadequate, and there is not the funding to provide enough sessions for more complex cases. In my region, secondary services cannot even offer CBT (or refer you anywhere for it), and you get lumbered with a bunch of Freudians.


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## odd_one_out (Aug 22, 2006)

*Case Study*: Young adult with anxiety disorders and Asperger's syndrome.

- Patient presents to new GP with SAD (and a history of seeking treatment), and is provided CBT by primary services.

- Primary services deemed insufficient considering case complexity. Referral made by therapist and GP to secondary mental health services.

- 9-month wait for patient to be assessed by secondary services. The gap is to be filled by weekly/fortnightly GP appointments, but the patient's anxiety prevents this.

- Assessment by secondary services is rushed due to the assessor forgetting the appointment and having to rush from out of town at the end of the day. The wait to begin treatment is several more weeks.

- Psychodynamic therapy provided for several months with no option of CBT. Patient deteriorates under this approach and abusive therapist.

- Patient leaves secondary services for sake of health and is told to go to GP from now on when there are problems.

- Patient under GP's care for months, unable to obtain referral for tertiary services out of area, which GP and psychiatrist deem the only suitable option.

- Patient experiences marked deterioration in functioning due to lack of treatment and severe outside stressors. After several months' wait, patient undergoes therapy with primary care services again, but sessions are too short and therapist cannot handle case and wishes to refer to tertiary services. GP gets social services involved.

- GP and patient spend months writing official complaint letters to Primary Care Trust but keep being refused referral. GP writes: "I do not believe there is sufficient expertise locally to provide adequate assessment and ongoing treatment [...]" and mentions the psychiatrist concurring.

He continues: "[My name] has been left without appropriate support or treatments since no clear plan has been agreed or pursued. [My name] remains significantly disabled and distressed. I would be grateful if you could reconsider the PCT's decision not to fund [my name's] further assessment and treatment."

- RESPONSE: None.

- GP describes how much the PCT causes him problems in general, describing it as a giant machine of bureaucracy run by people who are no good at their jobs. He is certain they are unable to understand the letters of complaint-- particularly the details concerning the patient's conditions--and that they have no intention of trying.

- GP next writes to single patient treatment panel:

"[My name] remains significantly disabled by Asperger's syndrome, which [my name] has on the severe end of the spectrum and is complicated also by other psychological problems including anxiety. There have been several attempts to manage these problems within primary and secondary care, which have not addressed [my name's] needs and not resulted in any significant improvements. Whilst clearly very intelligent, [my name] finds it extremely difficult to engage in any interpersonal interactions even at a superficial and brief level and this has interfered significantly with functioning."

"Given that there has been a failure to provide adequate care both in primary and secondary care and that the services available do not have the expertise to deal with [my name's] complex problems, I would be grateful if you could arrange for a single patient panel to assess the case for funding."

- RESPONSE: Funding agreed for assessment in tertiary sevices; further funding for treatment dependent on outcome.

- Patient attends tertiary services for assessment. Patient informed at end of assessment that parents are required to confirm diagnosis, contrary to what was said before the appointment. Patient's diagnoses are therefore inconclusive and assessors are insistent on referring back to services in patient's local area for treatment, despite them already having been exhausted.

- Patient informs GP the following day, who expresses anger. Over 3 months later, patient still has not received assessment report or a referral. Left without services, patient further deteriorates. Patient does some research and discovers others experienced the same at their assessment and whose access to benefits and support have been jeopardised in addition.


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