England’s ‘hidden’ mental health crisis: thousands forced to wait months between NHS therapy sessions

Patients with depression and anxiety are being left languishing on “hidden” mental health waiting lists, with tens of thousands facing delays of more than three months between therapy appointments.

Exclusive analysis of NHS data by NationalWorld has uncovered a postcode lottery for adult patients using the Improved Access to Psychological Therapies (IAPT) programme across England, which provides talking therapies to people with common mental health conditions.

At least 75% of IAPT patients should start treatment within six weeks, and 95% within 18 weeks, according to NHS targets. But our investigation found that while these official targets are being met, the vast majority of patients then have to wait at least a month between their first and second treatment sessions. In one part of the country, up to nine in every 10 patients had to wait more than three months to get their second bout of therapy.

Mental health charities say long waits between treatment can be detrimental to patients. SANE says it can cause people to become “far more seriously ill” and even leave them vulnerable to self-harm or suicide. It added it was “worrying” to see the regional variation NationalWorld’s analysis had revealed.

Waits are getting worse

During June, 56,800 patients received a second bout of treatment through the IAPT programme, analysis of NHS Digital data shows. Of those, more than three in five (34,300, or 60.4%) had waited over 28 days since their first appointment, while almost a quarter (13,500, or 23.7%) had waited over 90 days.

The figures only include waits between first and second sessions of treatment, rather than initial assessments of a patient’s condition before they start on a course of treatment.

In the first six months of the year, more than 200,000 people were forced to wait over a month, and almost 80,000 over three months – and the waits are getting worse, with the proportion waiting over 90 days at the highest level since the first Covid lockdown, in April 2020.

Last June, fewer than half of patients (49.5%) had to wait over 28 days, while 13.6% waited over 90. As a rolling three-month average, the proportion waiting over 28 days is at an at-least five-year high.

The figures are broken down to Clinical Commissioning Group (CCG) areas, which until recently were the bodies responsible for planning and buying healthcare in local areas. They were replaced with Integrated Care Board (ICB) areas in July, which tend to cover much larger populations. They commission care from providers, such as NHS trusts.

Out of 106 CCG areas, 82 saw more than half their patients waiting longer than 28 days between appointments in the first six months of this year, while 11 saw more than half waiting over 90 days.

Where in England do people face the longest waits?

Patients living in Merseyside, Tyne and Wear, Northumberland and South Essex are particularly badly affected. Of the 10 local areas where the greatest proportion of people waited over three months in June, eight fell under the jurisdiction of three new ICB areas.

In the since abolished Southport and Formby CCG area (now part of the Cheshire and Merseyside ICB), 90% of patients waited over 28 days and 80% waited over 90 days. Also badly hit in the ICB area was South Sefton CCG (83.8% over 28 days and 68.8% over 90 days) and Warrington CCG (96% over 28 days and 56% over 90 days).

A spokesperson for the ICB said it was working closely with local providers to help tackle a backlog exacerbated by Covid, and was exploring digital options to ensure people can access timely support.

“We are committed to reducing waiting times between first and second appointments,” they added. “In Sefton alone, a record 26 trainee psychological wellbeing practitioners have joined the service in the last year.”

The former North Tyneside CCG, Sunderland CCG, and Northumberland CCG areas (all now part of the North East and North Cumbria ICB) were also badly affected, as were Castle Point and Rochford CCG and Southend CCG (now part of Mid and South Essex ICB).

A spokesperson for Mid and South Essex ICB said it is working with the Essex Partnership University NHS Foundation Trust, which provides services in Castle Point and Rochford, to ensure people can access therapies as quickly as possible.

“We recognise how distressing delays can be and are focused on reducing waiting times,” the spokesperson said. The North East and North Cumbria ICB declined to comment.

You can look up the results for your CCG area in the table below. Can’t see the table? Click here to open it in a new window.

While official targets only exist for the length of time between referral to first treatment, NHS guidance to providers warns they should guard against “hidden waits”, meaning “there should not be an excessive wait between the first and second appointment for a particular therapy”.

It does not define what an excessive wait is. The National Institute of Clinical Excellence (NICE) – whose guidance the IAPT talking therapy programme is based on – also told us it did not have specific recommendations for providers on what would be an appropriate time between appointments.

Marjorie Wallace, chief executive of mental health charity SANE, said it is “deeply concerning that patients still appear to be facing these ‘hidden waits’”. A combination of tightening budgets and increasing demand is leaving people without the help they need, she added.

“Psychological therapies are an important part of treatment, and early intervention is vital,” she said. “Waiting is hard when you are struggling mentally and excessive delays between the first and second appointment for a particular therapy may leave some people more at risk than they were before.

“Patients in desperate need may become far more seriously ill. We know that many simply give up on treatment or deteriorate further while waiting for it to commence. This may trigger a patient into self-harm or increase the risk they become suicidal.”

Healthwatch England, an independent statutory body which champions patient rights, said its local teams across the country often hear from people who are having to wait many months at each stage of the journey through mental health services.

“This leaves them feeling in limbo and struggling to self-manage their condition,” said national director Louise Ansari. “And when they are finally able to access support, it is not always the right sort of help or is time-limited only.

“For some these delays are difficult, for others they can be dangerous. Patients in crisis report to us that services seem oversubscribed, particularly community services, which could have helped prevent circumstances escalating in the first place.”

What is Improved Access to Psychological Services (IAPT)?

IAPT is otherwise known as NHS talking therapies. Patients can self-refer, or be referred by their GP. The programme offers a range of therapies for patients struggling with common mental health conditions such as stress, anxiety or depression. It also helps people with obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), phobias, and body dysmorphia.

The nature of the therapy will vary depending on a patient’s symptoms, and could include counselling for depression, cognitive behavioural therapy, or guided self help from a therapist who coaches them through a course.

NHS England did not respond to a request for comment.

Have you been affected by long waits between IAPT appointments? Contact [email protected] if you would like to share your experience.