The three-and-a-half year wait for psychological therapy

July 26, 2007
by Chris George

People with mental health problems are having to wait up to three-and-a-half years for psychological therapy.

Latest figures from Derbyshire Mental Health Trust show there are 428 patients waiting up to 186 weeks for counselling in Derby and south Derbyshire.

The revelation comes at a time when the government is promising to increase access to psychological therapies in England and Wales for people diagnosed with depression and anxiety

The Derbyshire Telegraph newspaper reported that the waiting times have grown because of an increase in demand.

See also:
May 16, 2007: Hewitt promises 10 more psychological therapy centres in England
March 29, 2007: Cognitive behavioural therapy via computer to be available from next month to depressed - critics, however, say computerised therapy is dehumanising

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Three years wait? Some don't even get to wait at all

Comment from: Fenella Lemonsky, Expert by Experience, North London Hub, Mental Health Research Network, Imperial College London,
Date: August 2, 2007

The problem with the whole Layard review is to offer more quick-fix CBT, especially to people with mild to moderate depression in primary care. The reality is this - CBT is not a cheap quick fix but requires staff with a mental health background, extensive experience and decent training to deliver. This is not happening across the board.

Graduate psychologists, and other newly qualified staff are offered short courses, often in house, in CBT and told get on with it. A skilled therapist would have done a full structured course - either a short course for non-complex work or an extended course for complex work and have lots of experience behind them in managing mental health distress.

The other issue is many people need more than 6 to 10 sessions of CBT. Locally, you are lucky to get 6 in primary care. You can get 10 sessions in secondary care/psychological therapy service, but long waits to see a psychologist/skilled CBT therapist.

Many need psychological work such as psychodynamic psychotherapy, cognitive analytic therapy, trauma-focused CBT for complex trauma, dialectical behavioural therapy for destructive and impulsive behaviour difficulties, schema therapy or family therapy. Skilled CBT for schizophrenia is also not widely available as it requires extra training that many staff cannot get.

Most psychological therapy services in the UK are stretched . You can have an assessment, then go and sit on a lengthy waiting list for a short course of treatment.

There is a huge gap between what Layard recommends, and those set down by the British Psychological Society for various difficulties such as personality disorder or the Nice guidelines.

Mental health is the cinderella of health priorities, yet they find the money for the latest costly atypical antipsychotics (£300 a month for treatment plus monitoring).

Additionally in the UK we have a gross national shortage of consultant psychiatrists who specialise in psychotherapy. These consultant posts are super specialist and considered a luxury for mental health trusts that have such a post.

However, if every locality had one it would mean that the assessment process would be more thorough and speedier for those with complex difficulties, and junior doctors would then meet the requirements of their training in psychotherapy when training as psychiatrists at a better level.

It would also encourage a more holistic approach away from a medical model and back-up psychological therapy services, with better liaison between psychiatry and clinical psychology.

Some people may be fortunate in that after three years they get something - as many people never even get on a waiting list as there simply is no resource to offer what they need at clinical effective levels.

The disparity and inequity is also complex and postcode lottery is another factor.

I have known people to move home in order to get a better service. My advice is write to Gordon Brown - and keep the letters coming in. It may not make a difference but at least we tried.

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No work for enthusiastic psychology graduates...

Comment from: Mariette Henning-Pugh, psychology graduate
Date: November 4, 2007

It is a disgrace that people with mental health problems are having to wait up to three-and-a-half years for psychological therapy and yet psychology graduates with excellent psychology degrees find it almost impossible to find suitable employment, or opportunities to join clinical psychology or similar training programmes to allow them to practice.

With often as many as 200 applicants for each assistant psychologist position, and many more applicants for each clinical psychologist placement, it is no wonder the bottleneck exists.

There are large numbers of very well educated and enthusiastic psychology graduates desperately wanting to provide psychological assistance to the general community, but very few are afforded the opportunity. Surely there must be a better way to address the situation and for these skills to be put to effective use in the community? Currently many psychologist graduates, who would really prefer to work in the field of psychology, revert to employment in other non-related fields. This is such a wasteful use of valuable resources so desperately needed in this country at this time.

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