By Shavel Gordon
It is a must to wait for many things in life; sometimes, the waiting process can be worthwhile. However, the growing waiting list for mental health support within the National Health Service (NHS) is concerning. And for millions across England, waiting for appropriate support can be catastrophic and a bridge between life and death.
Waiting times have increased since the pandemic, leading to increased mental health distress in service users. Photo credit: Canva
The Consequences of Long Waiting Times
Desperation, as experienced by some, is understandable after experiencing a severe mental health crisis. In an interview for the British Medical Association, Nicola Mattocks recalls experiencing mental health difficulties at 14 years old (Cooper, 2018). Told by a local hospital her symptoms were just “not severe enough”, Mattocks waited painstakingly long for therapy, even after self-harming and battling suicidal ideations. As a result of feeling rejected by mental health services, Mattocks’s mental health deteriorated further, with her surviving a severe overdose, yet receiving little significant mental health support. She was eventually offered dialectical behavioural therapy (DBT) after more than a year. Still, she believes her mental health difficulties may not have intensifid if her pleas were taken seriously and if the waiting time was not so long.
Statistics on this crisis are concerning. According to the Royal College of Psychiatrists (2022), around 23% of service users wait approximately 12 weeks for treatment to start. After waiting, many experience increased mental health challenges. Up to 78% have had to seek help elsewhere. Therefore, longer waiting times have affected much support available for those with mental health difficulties.
However, this is not always the reality for many people. Since the pandemic, there has been increased pressure on NHS mental health services, when many people struggled with mental health concerns threatening to pull them under. Many more have adjusted to new lives confined within their homes, many with abusive partners. There may have also been issues with cyberbullying or parental abuse, with many reaching their breaking point and seeking support. Therefore, it is no surprise that this contributes to long waiting times in the NHS. Thus, affecting the level of access afforded to those from lower-income backgrounds, who are unlikely to have access to private therapy.
Findings From A Study By East London NHS Foundation Trust
Even more concerning is the gripping reality that little has changed since the pandemic. Moreover, statistics show that waiting times have increased. A quality assurance report conducted by the East London NHS Foundation Trust found that from referral to assessment, service users in Adult Community Mental Health teams waited 8 – 16 weeks before an initial appointment (Ali & Nicholas, 2022). A backlog of service users meant that it could take between 8 – 48 weeks to start assessment and treatment, following an initial appointment.
No waiting times existed from referral to assessment in Improving Access to Psychological Therapies (IAPT). There is, however, a 4 – 9 week waiting time between assessment and the beginning of treatment, depending on service location. Although, a large backlog of service users is still present (around 778 – 2234) across each site.
Within Specialist Psychotherapy Services, minor improvements can be noted. The waiting time from referral to assessment ranged from 7 – 19 weeks in places such as Newham and Bedfordshire, with a backlog of up to 200 patients at each site (NHS, 2022; Pybis et al., 2017).
A personal story
It took a very long time getting to the treatment stage. I was eventually referred to an online service offering free CBT treatments. But therapy was ineffective since I lost sight of my original goal. CBT could only address my current thinking patterns and behaviour, not how I felt in the past. I then gained interest in psychodynamic therapy, which would consider all aspects of my life. But I later decided against this; it is a costly endeavour when going outside the NHS. For many, this is a significant barrier to accessing treatment.
What can be done?
Many solutions can be suggested for these issues. The government could:
- Increase funding to primary and secondary mental health services with longer waiting times. This can reduce instances of postcode lottery, making it easier for patients to access equal levels of support (Stacey, 2022).
- Adjust how services report the type of therapies offered and the length of time for each treatment. Improving specificity will make it easier to see what can be changed and provide solutions where services fall short (Stacey, 2022).
- Develop a more enhanced form of IAPT, allowing for more prolonged treatment and setting realistic targets for patients with more complex mental health conditions. (Burningham, 2018, as cited in Cooper, 2018).
- Aside from CBT, funding should be increased for psychological therapies, and the workforce should significantly increase.
In closing
Long waiting times have negatively impacted access to psychological therapies. Many solutions are suggested, but time will tell whether these will be effective in the long run. Still, changes need to be implemented for the good of those with longstanding mental health conditions, especially those with lower incomes.
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Shavel Gordon
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References
Ali, A., & Nicholas, T. (2022). Report on waiting times. In Impact of Covid on ELFT Services (p. 7). East London NHS Foundation Trust. https://www.elft.nhs.uk/sites/default/files/2022-01/11b._tbd-2022-01-27_waiting_times_report_-_jan_2022_final.pdf
Cooper, K. (2018). The devastating cost of treatment delays. British Medical Association. https://www.bma.org.uk/news-and-opinion/the-devastating-cost-of-treatment-delays
Mind. (2021). What is cognitive behavioural therapy (CBT)? Www.mind.org.uk; Mind. https://www.mind.org.uk/information-support/drugs-and-treatments/talking-therapy-and-counselling/cognitive-behavioural-therapy-cbt/#:~:text=work for me%3F-
NHS Digital. (2021). Psychological therapies: Reports on the use of IAPT services, England March 2021 final including a report on the IAPT employment advisors pilot and quarter 4 2020-21 data (pp. 1–12). NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services/march-2021-final-including-a-report-on-the-iapt-employment-advisors-pilot-and-quarter-4-2020-21-data
NHS. (2022). What happens during CBT sessions. NHS. UK; NHS England. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/#:~:text=The course of treatment usually
Pybis, J., Saxon, D., Hill, A., & Barkham, M. (2017). The comparative effectiveness and efficiency of cognitive behaviour therapy and generic counselling in the treatment of depression: Evidence from the 2nd UK national audit of psychological therapies. BMC Psychiatry, 17(1), 1. https://doi.org/10.1186/s12888-017-1370-7
Royal College of Psychiatrists. (2022). Hidden waits force more than three quarters of mental health patients to seek help from emergency services. Www.rcpsych.ac.uk; Royal College of Psychiatrists. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2022/10/10/hidden-waits-force-more-than-three-quarters-of-mental-health-patients-to-seek-help-from-emergency-services
Stacey, B. (2022). Improving wait times for mental health services – money and mental health. Money and Mental Health Policy Institute. https://www.moneyandmentalhealth.org/levelling-up-mental-health-services/
