People trying to access NHS treatment for depression and anxiety in the North of England are facing an “injustice”, with waits of over three months between first and second appointments commonplace, NationalWorld can reveal.
One think tank has warned that the disparities faced by northern communities could have an economic impact too, with mental ill health a “key driver” of the record numbers of people out of work due to illness across the country.
During Mental Health Awareness Week (15 - 21 May), NationalWorld analysed NHS Digital data about adult patients receiving talking therapies for depression and anxiety through the Improving Access to Psychological Therapies (IAPT) programme (now renamed NHS Talking Therapies).
We found that patients across England continue to face “hidden” mental health waiting lists, with those in the North – and the North West in particular – facing the most pronounced delays in the delivery of their care.
Official waiting time targets for NHS talking therapies only look at the time spent between referral and a first treatment appointment, with the target for 75% of patients to wait less than six weeks. This target is being comfortably exceeded, with the latest data showing 90% are being seen within this window.
But NHS guidance also warns that treatment providers must guard against “hidden waits”, which occur when patients face “excessive” delays between first and second appointments, even if they have had the first within the target window.
Of 686,000 patients who had a second session of treatment in the year to February, 396,000 (58%) had to wait over 30 days between their first and second appointments, our analysis reveals, while almost one in four (23%) had to wait over 90 days. That means almost 158,000 patients were left waiting over three months.
But in the North of England, 26% of patients waited over three months compared to only 22% in the Midlands and in the South (20%, if London is excluded from the South’s figures). Performance was worst in the North West, at 28%, and best in the South East, at 17%.
Mental health charities have previously told us how these hidden waits can cause patients to become much more seriously unwell, and can even lead to an increased risk of self-harm and suicide.
In Greater Manchester a massive 84% of patients waited over three months in the latest month (February), while 95% waited over one month.
The Institute for Public Policy Research (IPPR) think tank described the long waits for follow up appointments in the North as “an injustice”, adding: “National World’s findings should be a wake-up call to government.”
IPPR researcher Efua Poku-Amanfo also emphasised the impact that lack of access to mental health care could have on employment in the North, and said our analysis was “further evidence” of the big health inequalities between the North and South of England.
''The effects of the mental health crisis aren’t felt evenly – some of the most vulnerable people in society are disproportionately impacted by it,” she said. “Already, regional divides in waiting times are at a record high, and children and adolescent service backlogs are having unacceptable impacts on young people.
“Beyond the impact that poor access to mental health services has on peoples’ health, it also undermines their economic lives – with IPPR analysis showing that mental illness is a key driver of the record numbers of people unable to work owing to illness. Getting both peoples’ health and the whole country’s economy back on track requires investing in health and care”.
NHS England told NationalWorld it recognised regional variation does exist in access to talking therapies, and that it will continue to work to reduce this. But it also stressed that in the 2021/22 financial year, the service had seen record numbers of people being referred, accessing treatment, and completing courses of treatment, and that data showed a good success rate for patients, seeing demonstrable improvements in their mental health or making complete recoveries.
As well as anxiety and depression, the talking therapy programme also helps people with other common mental health conditions including social anxiety, agoraphobia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and body dysmorphia.
Speaking in October last year, the mental health charity SANE told NationalWorld that a combination of tightening budgets and increasing demand was leaving people without the help they needed. It also warned that long waits can cause patients to give up on treatment, or for their health to deteriorate.
Responding to IPPR’s comments, a Department for Health and Social Care spokesperson said the government is investing £2.3 billion of extra funding each year to expand and transform England’s mental health provision by March 2023 – including for NHS Talking Therapies – so that an extra 2 million people can be treated.
"We're also investing around £200 million from this year to modernise and digitise mental health services across England – including piloting cutting edge digital therapies and digitising the NHS talking therapies programme,” they added.
An NHS spokesperson said: “The NHS remains committed to increasing support through its world-leading talking therapy services and has helped record numbers of people struggling with their mental health, with more than 1.2 million people accessing treatment in 2021/22, an increase of 20% on the previous year.
“NHS Talking Therapies was the first part of the national mental health programme to implement a referral to treatment waiting time standard, and the routine collection of clinical outcome measures is a key characteristic of the programme – national data standards and the collection of high-quality data are essential to help identify areas for improvement and reduce inequalities, and we will continue to work with systems to ensure we provide the best access and treatment for people who need mental health support.”