South West Yorkshire Partnership NHS Foundation Trust

5. Mr A complains the Trust did not refer him to secondary psychological treatment as an alternative to CBT (cognitive behavioural therapy, a type of talking therapy) until 25 April 2019, despite him asking for it since 2014.

6. He also complains the three-year wait time to start psychological treatment was too long and it was unfair given he asked for the treatment in 2014.

7. He says that, as a result, he has suffered extended anxiety, depression and repeated periods of suicidal thoughts, and attempted to commit suicide in 2015. He says the impact on his mental health has also affected his relationships with his former partner and family.

8. Mr A would like the Trust to recognise its failings, tell patients about other services available to them sooner and implement service improvements to cater for people who are on the autistic spectrum and are depressed. Specifically, he would like the Trust to better risk assess the mental state of patients and for the service to accommodate autistic patients with an adapted service within a reasonable timeframe to people with less severe presentation. He would like a better response to be given to patients who feel suicidal.

9. Mr A attended many appointments, assessments, interventions and other interactions with the Trust between July 2014 and July 2022.

10. Mr A had been receiving support from an early-intervention-in-psychosis service the Trust provides since 2010.

11. In July 2014, Mr A was referred to psychology for assessment. The Trust did not take him in for treatment and instead referred him to an NHS clinic that provides a base for the Trust’s ASD service (the clinic) for an ASD assessment. This was to understand his psychological needs and determine whether psychological therapy was suitable.

12. In December, he was accepted onto a waiting list for an ASD assessment at the clinic.

13. In November 2015, Mr A took an overdose and was admitted to the Trust. He was discharged the following month with planned follow-up.

14. In January 2016, his treatment was transferred to the community team.

15. The following month, he attended his ASD assessment and his GP received a letter outlining differential diagnosis of specific personality disorders and atypical autism.

16. In April, a further assessment at the clinic concluded he did not have ASD. Mr A sought a second opinion following advice from his autism support group.

17. In February 2017, an adult autism and neurodevelopment service diagnosed Mr A with Asperger’s syndrome.

18. On 31 March, the Trust received a referral from the early-intervention-in-psychosis service Mr A had been seeing since 2010 for ‘long-term support with psychology’ and Mr A was placed in the care of an anxiety and depression programme (the programme).

19. The programme wrote to Mr A on 31 May. He did not respond so in June the Trust discharged him from the programme’s care because of a lack of contact from him. The programme team then sought to make another referral for a psychological assessment at that point but did not as Mr A was still in receipt of support from the community team at the time.

20. In January 2018, the programme team again opened a referral and in February the Trust scheduled a CBT assessment. The vocational team then saw Mr A.

21. In June, Mr A had the CBT assessment and was placed on a waiting list for the second time for support with anxiety.

22. Later that year, Mr A was due to start his individualised CBT, but the Trust chose to send him back into secondary care with the community team. This was because of increasing concerns at the Trust around rising levels of risk and his suicidal thoughts at the time. He was then discharged from the programme.

23. Following the programme’s discharge, on 28 November the Trust made a referral to secondary care for a review to include psychology if thought appropriate at the time.

24. In January 2019, the psychology team accepted Mr A for an initial screening assessment.

25. Mr A underwent a psychology assessment in April and was later placed on a waiting list for individualised psychotherapy. Then the waiting time was two years.

26. In February 2022, Mr A was reviewed on the waiting list. He started his individualised psychology therapy in July.

CBT alternative

29. Mr A complains the Trust did not refer him for psychological treatment between 2014 to 2019. The Trust says its normal process when service users express suicidal thoughts includes sending them to other Trust services or areas where they can receive support.

30. We understand through our correspondence with Mr A and his advocate, and our review of the relevant records, that this has been an incredibly difficult time for him. We appreciate he believes the Trust mishandled his care and he should have received a referral for secondary psychological treatment sooner than April 2019.

31. Having seen the available evidence, we do not hold the same position as Mr A. We can see a referral for secondary psychological treatment was made sooner than 2019 – the records show the Trust made this referral in July 2014. However, this referral did not lead to an appointment as he was instead referred to the clinic for an ASD assessment.

32. Once he had completed that process and received a diagnosis (following a second opinion), the Trust again made a referral for psychological treatment in March 2017. In May, he was put in the care of the programme for treatment but was discharged in June because of a lack of contact.

33. Based on the evidence we have seen, we are satisfied the Trust referred Mr A for psychological treatment twice before his assessment in April 2019. We therefore cannot agree with his position that the Trust failed to do so.

34. Also, Mr A’s clinical records show numerous examples of the interventions the Trust provided for Mr A over this period of time. Though we accept this was not the psychological treatment he may have been seeking, we can see he received a large number of home visits, which were replaced with video calls when COVID-19 restrictions meant they could not happen, and phone calls.

35. Though it did take until April 2019 for Mr A to get onto the psychological treatment waiting list and until July 2022 to actually start that treatment, the evidence shows the Trust did offer various forms of support to Mr A throughout this period.

Three-year wait time

36. Mr A complains the three-year wait time to start psychological treatment was too long and it was unfair given he had first asked for the treatment in 2014.

37. The Trust recognises waiting times for treatment can be lengthy but explains it can only prioritise appointments where there is a clear clinical need to do so. When someone contacts the Trust with a similar experience to someone else who has been waiting longer, it would be unfair to prioritise the newer referral over the older one.

38. The waiting time guidelines state a ‘waiting time clock’ begins once a public health organisation such as an NHS trust makes a referral. There are several reasons to stop that clock, including when treatment begins or if the patient fails to attend their first appointment. A new clock is needed when a patient is re-referred into a service under a new referral.

39. Our Principles state public bodies should treat people equally and fairly and should understand and respect the diversity of their customers to make sure there is equal access to services and treatment regardless of background or situation. They state, when taking decisions, public bodies should behave reasonably and make sure the measures taken are equal to the goals being aimed for, appropriate in the circumstances and fair to the people concerned.

40. As set out earlier, Mr A’s initial referral for individualised psychological treatment happened in July 2014. This referral was rerouted to the clinic so he could undergo an assessment for ASD. This was because it was felt the treatment he had been referred for would not be right for him unless he had a diagnosis of ASD. After seeking a second opinion, Mr A received an ASD diagnosis in February 2017. The following month, the early-intervention-in-psychosis service made the second referral to the Trust for psychology treatment.

41. On 31 May, the programme wrote to Mr A regarding psychology treatment and asked him to get in touch to make arrangements. As the programme received no contact from him, on 15 June it discharged him from its care and back into the care of the community team.

42. When the Trust made a third referral for psychological treatment in January 2019, it arranged an initial assessment which took place in April. Given the time since the earlier referral in 2017, the Trust treated this as a new referral. Based on the waiting time guidelines, a new ‘clock’ should be started for each new referral, which is what happened.

43. Following the initial assessment, the Trust placed Mr A on the waiting list for treatment. He ultimately began his individualised psychological treatment in July 2022.

44. Though we understand Mr A’s position, as clearly the whole process took an extremely long time, it would not have been fair to fast-track his third referral solely because a referral had been made some years earlier. This third and final referral did not act as an update or amendment to the previous two – they were treated as a new referral each time.

45. It would not have been fair to other people ahead of him on the waiting list had Mr A been placed at or near the top of the waiting list following the third referral. We believe the Trust’s actions were appropriate based on the situation and were the fairest way to handle the matter for everyone concerned – including the other people who would have been on the waiting list. We consider these actions to have been in line with our Principles and the waiting list guidelines.

46. We can, however, absolutely appreciate Mr A’s frustration at what he feels to be further (and unnecessary) delays in the process.

1. The Parliamentary and Health Service Ombudsman has identified no failings in South West Yorkshire Partnership NHS Foundation Trust’s (the Trust) handling of Mr A’s treatment referrals. The Trust made referrals for psychological treatment in July 2014, March 2017 and January 2019. The first referral ended because the Trust referred Mr A for an autism spectrum disorder (ASD) assessment. The second referral was refused because of Mr A’s lack of contact. After the third and final referral, the Trust placed Mr A on a waiting list for treatment. We therefore did not conclude the Trust failed to refer Mr A for secondary psychological treatment during this period.

2. We identified no failings in the Trust’s handling of Mr A’s psychological referral in 2019. We appreciate he had been referred for treatment earlier and these referrals did not go ahead. However, the ‘clock’ on a referral does not continue to run until one is successful – each referral is dealt with and either accepted or refused on its own merit. When a new referral is made, it is not appropriate or fair to other people who may be in a similar situation to consider how long it has been since the last one. Each referral is considered on the evidence at the time, which is what the Trust did.

3. We therefore do not uphold this complaint.

4. Through our correspondence and from reviewing the available evidence, we recognise the difficulties Mr A has experienced during this period. The obstacles he has faced will have been immensely challenging for him and his unhappiness with the situation is entirely understandable. Our decision is in no way intended to lessen the importance of that.