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GPs urged to refer elderly for talking therapies

GPs have been urged to refer older patients with anxiety and depression for psychological therapies, after an audit of patients accessing these treatments found the elderly are still under-represented as a group.

The National Audit of Psychological Therapies, the second such audit carried out by the Royal College of Psychiatrists (RCP) and based on data from 2012, found only 6% of service users were over 65 - despite this group making up an estimated 21% of the total population with such common mental health problems.

The findings suggest little has changed in this respect since the RCP’s first audit of psychological therapies from 2010.

The latest report recommended: ‘With immediate effect, referrers, particularly GPs, should take active steps to reduce any inequalities in referrals and ensure that people with anxiety and depression have equal access to psychological therapy whatever their age.’

However, the RCP also found 17% of services are still excluding elderly people, ‘despite new legislation aimed at eradicating this practice’.

By contrast, there was no evidence to suggest under-representation of particular genders or ethnic groups.

In other findings the audit showed some improvements in waiting times with 92% of patients assessed within 13 weeks, compared with 85% in the first report, while 91% started treatment within 18 weeks, again compared with 85% previously. 

But some patients still faced ‘unacceptably’ long waits and only two-thirds felt they had a reasonable wait for treatment.

And less than a third of patients referred for high-intensity therapy received the minimum number of sessions recommended by NICE. Of those who did not receive the recommended number of sessions, 43% recovered – slightly lower than the 46% recovery rate of service users as a whole.

The report also raised concerns about training - although most therapists had completed formal training, over a third said they were delivering therapies they had no formal training in, including family therapy, interpersonal therapy, couples therapy, cognitive analytic therapy, dialectical behavioural therapy and arts psychotherapy.

The findings were presented at a conference on psychological therapies in London on Thursday, which was addressed by NHS England clinical director for mental health Dr Geraldine Strathdee and health minister Norman Lamb.

Quizzed about whether CCGs would be advised to prevent services being delivered by unqualified therapists, Dr Strathdee said it was imperative services were not ‘dumbed down’.

She said: ‘We do not want to dumb down the need to be properly trained to deliver things – therein lies the path to cheap, rubbishy mental health treatment.’

Dr Strathdee added that primary care had not been supported enough in delivering mental health services and NHS England wanted to learn from examples in other countries where primary care services had achieved greater reductions in suicide rates.

Mr Lamb said the high rate of unqualified therapists for some forms of therapy was ‘extremely disturbing’.

He said: ‘We must absolutely resist any “dumbing down” of these services – we are completely committed to ensuring that this is a properly trained service’.

But he added: ‘You can’t get every area working optimally, you can’t achieve it overnight.’

Royal College of Psychiatrists - National Audit of Psychological Therapies


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