NHS mental health therapists pressurised to exaggerate success rates, expert claims

‘Actual human experience was secondary to creating data that would shore up the evidence base for the model to guarantee further investment,’ says one

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The provision of psychological treatment on the NHS has undergone an “Uberisation”, in which counsellors are pressurised to exaggerate their success in treating patients, a conference has heard.

Elizabeth Cotton, of Cardiff Metropolitan University, an expert in mental health at work, said that more than four in 10 – 41 per cent – of therapists working for the NHS’s talking treatments programme had been asked to manipulate data about patients’ progress.

The action is designed to improve the scheme’s apparent achievement rates, although NHS chiefs insist patients’ views are recorded when therapists are not present.

The NHS describes its Improving Access to Psychological Therapies (IAPT) programme, which was launched in 2008, as “the most ambitious programme of talking therapies in the world”.

The programme, which was designed to make therapy more accessible, has transformed the treatment of adult anxiety disorders and depression in England, providing psychotherapy to more than a million people each year, according to the health service.

IAPT plans should allow the number of people with anxiety disorders or depression who can access talking therapies increase by an extra 380,000 per year to reach 1.9 million by 2023-24, under NHS plans.

But Dr Cotton, an adult psychotherapist who has written a book on working in health and social care, says the pressure on therapists was such that some had been encouraged by their managers to coach patients to give positive answers to questionnaires.

Patients were urged to repeat the questionnaires until a positive response was obtained, she told the British Sociological Association conference on work.

Where patients discharged themselves without notifying the NHS, the therapist was encouraged to fill in data sheets on their behalf to reflect a positive outcome, said Dr Cotton.

The term Uberisation means shaking up traditional services and farming them out to a network of suppliers, putting clients directly in contact with service providers, often leading to faster but less enriching experiences.

The pandemic has led to an explosion in numbers of people seeking treatment for depression and anxiety. Over the past year at least a fifth of people in Britain have experienced depression – more than double the pre-pandemic figure, data from the Office for National Statistics (ONS) suggests.

People desperate for help have turned to the IAPT, which in many cases offers short courses in cognitive behavioural therapy – a technique in which sufferers are taught to change negative thoughts into neutral or positive ones.

The rise in demand has heaped pressure on the service, which has taken its toll on NHS staff themselves.

Health professionals earlier this week warned of a “mass exodus” of workers amid the mental health crisis.

They told how staff were suffering with burnout, extreme tiredness, anxiety and “compassion fatigue”.

Dr Cotton carried out four surveys between 2016 and 2020. One, of 1,500 therapists working for the NHS or privately, found that more than a third - 38 per cent - had raised concerns about patient care, a figure rising to 58 per cent among the 223 currently employed by IAPT.

In another survey of 650 IAPT employees, carried out in 2019, 41 per cent said they had been asked to manipulate data.

One therapist had reportedly been advised by their manager that “I could complete forms on behalf of clients to get the best results”.

Another said: “Actual human experience was secondary to creating data which would shore up the evidence base for the model to justify the economic argument and guarantee further investment.

“The whole system represents a big self-reinforcing loop relating to success in terms that had been self-defined by the system.”

Dr Cotton warned the downgrading of therapy “into a standardised, manualised, and now digital model” had “opened up the doors for the ending of highly experienced clinical work in the public sector”.

Claire Murdoch, NHS national mental health director, said: “The NHS talking therapies programme is a world-leading service that supports more than one million people a year struggling with anxiety and depression, and patients’ views on the service are recorded outside of their treatment sessions, when the therapist is not present.

“During the pandemic, NHS staff have been working round the clock to provide patients with specialist mental health support, and I would like to thank them for their efforts. If any therapist has concerns about data collection, they should formally report them to their professional body.”