Waiting list eradication in secondary care psychology: Addressing a National Health Service blind spot

Abstract

Objectives Waiting times for secondary care psychological therapy remain a ‘blind spot’ in serious mental illness (SMI) provision, and their reduction is a priority within the National Health Service (NHS) Five Year Forward View. The paper describes the eradication of waiting times within a community‐based NHS service and the effectiveness of strategies whilst examining help‐seeking behaviour, compliance and therapeutic need. Methods Analyses are reported for treatment compliance and therapeutic outcomes for 208 waiting‐list cohort individuals seen by the SMI psychology service over an 18‐month period between October 2014 and March 2016. Results No significant clinical or demographic differentiation between individuals who successfully completed therapy compared to those who disengaged was observed. Despite an average 2.20‐year waiting time, this alone did not significantly impact engagement with psychological treatment and all psychological therapies provided led to a significant clinical improvement and no individuals who completed therapy required re‐referral at 12‐month follow‐up. Conclusions If imposed appropriately over a suitable time frame evidence‐based practice coupled with effective operationalization can result in efficient needs‐led psychological provision within SMI and secondary care. Potentially debilitating waiting times for service users and other referring professionals can be avoided, whilst psychology provision retains a flexible, formulation‐based and person‐centred approach.

Conceptual and practical challenges associated with understanding patient safety within community‐based mental health services

“…Access issues are of greater significance to safety in community care, where waiting times often extend over several months for specialist psychological therapy, or to receive any care upon referral to secondary care community services. 61 , 62 , 63 Rather than a direct relationship between care delivery failures and immediate safety consequences, safety problems in community settings may less resemble an ‘incident’. Risks may build over time where care is delivered across multiple, dispersed community settings, with patients and their carers playing a bigger role in patient safety, alongside involvement from several providers (e.g., GP practice, community mental health team, social care, community pharmacy).…”

“…Accordingly, the pace of care may be much slower, often with little to no community team involvement between appointments. Access issues are of greater significance to safety in community care, where waiting times often extend over several months for specialist psychological therapy, or to receive any care upon referral to secondary care community services (C. Baker, 2021;Iqbal et al, 2021;Royal College of Psychiatrists, 2020). Rather than a direct relationship between care delivery failures and immediate safety consequences, safety problems in community settings may less resemble an 'incident'.…”

Socio-economic inequalities in adolescent mental health in the UK: Multiple socio-economic indicators and reporter effects

“…two-thirds of patients experience a year-long wait for NHS provided mental health services (Iqbal et al, 2021). Alternatively, the Family Stress Model (FSM) posits that a reduction in, or low income constitutes a risk for child mental health, through economic pressure (e.g., difficulty paying rent and shopping habits in food and clothing), and negative changes in parental mental health, marital interaction and therefore parental quality (Conger et al, 1994).…”

Socio-economic inequalities in adolescent mental health in the UK: multiple socio-economic indicators and reporter effects

“…Parents with a high income are able to access appropriate medical care and modify their child's environment to reduce the severity of their symptoms, which is likely more difficult for families with a lower income (45). The former is especially notable in the UK, where two-thirds of patients experience a year-long wait for NHS provided mental health services (46). Alternatively, the Family Stress Model (FSM) posits that a reduction in, or low income constitutes a risk for child mental health, through economic pressure (e.g., difficulty paying rent and shopping habits in food and clothing), and negative changes in parental mental health, marital interaction and therefore parental quality (47).…”