Clinical psychologists employed by NHS Greater Glasgow and Clyde say the welfare and recovery of people with complex mental health conditions will be jeopardized if plans go ahead to limit the number of treatment sessions any patient can receive.

Current practice is for people with complex mental health conditions, such as post traumatic stress disorder triggered by events in their lives, to receive as many sessions with a psychologist as they require before a decision is taken to discharge them.

Amid continuing pressure on services, community-based psychologists who have contacted healthandcare.scot say they are being told they must now discharge every patient after a total of 20 sessions, those sessions including all the time taken assessing the person and developing and agreeing a treatment plan with them.

The professional organisation for clinical psychologists says that, while it realises services across Scotland are under significant pressure, these pressures won’t be resolved by imposing ‘blanket rules that remove clinical discretion’.

NHS Greater Glasgow and Clyde says their teams deliver psychological therapies within national guidance and, while staff are advised to treat people within 20 sessions, the board insists more sessions can be delivered when necessary.

“Horribly arbitrary”

One psychologist who spoke to healthandcare.scot said the cap on the number of treatment sessions is unfair to patients and potentially damaging:

“The cap being proposed seems horribly arbitrary and risks, for many people, cutting off an evidence-based clinical process before it has had a chance to make a permanent, sustainable difference to that person’s ability to cope with their condition.

“The 20 session cap is not being presented to us as an option but an edict.

“Our understanding is that we will be held to account personally on any occasion where more than 20 sessions are delivered for a patient.

“It seems to be about fixing a problem which is already being fixed. We are told that this is about us seeing more patients sooner, but the waiting time for our service has halved and is continuing to reduce despite us not being fully staffed.”

The psychologist, who spoke to us on condition of anonymity, questioned whether monitoring will be stepped up to establish if there is an impact from imposing a cap on sessions, given that they have never once been to provide a patient's outcome scores.

The psychologist added:

“The proposal will be bad for many patients with complex conditions. But it will also be bad for the service.

“Clinicians who are already under pressure from the sheer number of people who need their help, will now have to cope, as professionals, with the knowledge that some of the people who put their faith in them to make their lives better have not received all the help they should have.

“Some of us will find it difficult to work in a service where our clinical judgement is going to be routinely undermined.”

A spokesperson for NHS Greater Glasgow and Clyde told healthandcare.scot that the board delivers psychological therapies in line with national guidance from Public Service Delivery Scotland and the Scottish government, stating:

“Evidence shows that most adults receiving specialist psychological therapy within secondary care successfully complete treatment within around 20 sessions. Staff are advised to aim to keep treatment within this number while ensuring flexibility to provide more sessions when necessary.

“The quality and effectiveness of these services are monitored through robust clinical governance arrangements, including regular reviews of patient progress and treatment outcomes by therapists and their clinical supervisors, alongside routine feedback from service users.

“As part of these governance arrangements, staff discuss their cases with senior clinicians, including those expected to complete treatment within 20 sessions and those likely to require a longer course of therapy.”

Trusting clinicians

Clinical psychologist, Dr Jake Easto, who is Director for Scotland of the Association of Clinical Psychologists UK, the professional organisation for clinical psychologists, told healthandcare.scot that addressing pressures on services – and achieving the best outcomes for patients – are best done by allowing clinicians to use their judgement:

“ACP-UK has been in contact with senior colleagues and clinicians working in community mental health teams to understand the concerns being raised.

“Clinical psychologists are highly trained practitioners. That training includes the clinical judgement to determine, in partnership with the people they treat, the minimum intervention needed to bring about meaningful and lasting change. It also includes the ability to weigh the effectiveness of ongoing therapeutic work.

“These decisions should be grounded in the evidence base, made collaboratively between the treating clinical psychologist and their clinical supervisor, and reviewed against the needs of the individual patient.

“We recognise the tension. Services across Scotland are under significant pressure, but service pressures are not resolved by blanket rules that remove clinical discretion.

“A longer-term preventative perspective is needed to manage capacity and sustainability.

“Fixed caps that stop effective treatment before it has achieved a lasting benefit do not meet service needs any more than sessions continuing well past the point of clinical usefulness. Crucially, neither serves patients.

“ACP-UK would encourage services under pressure to base session numbers on service specifications developed from the evidence base. The Matrix, Scotland's guide to psychological therapies, sets out the evidence base clinicians draw on when determining treatment approach and duration.”

 

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