Course suitability
11. Mr E complains the talking therapy wellbeing course was not suitable for him as it did not cater to his personal needs.
12. Mr E completed a self-referral form to access support from the Trust on 9 March 2023. The reason for this was because he was suffering from generalised anxiety.
13. The Trust explained the course was suitable for Mr E, as it was in line with the ‘stepped care model’ (a model of treatment providing the most effective, yet least intensive treatment, where the patient only ‘steps up’ to more intensive services if clinically appropriate).
14. Our adviser directed us to ‘NHS Talking Therapies for anxiety and depression manual’. This recommends talking therapy sessions for patients with a number of mental health problems, including depression and anxiety.
15. The stepped care model is in line with the ‘NHS Talking Therapies for anxiety and depression manual’, which states that ‘Services are delivered using a stepped-care model, which works according to the principle that people should be offered the least intrusive intervention appropriate for their needs. Many people with less severe depression or anxiety disorders are likely to benefit from a course of low-intensity treatment delivered by a psychological wellbeing practitioner (PWP).
16. Individuals who do not fully recover at this level should be stepped up to a course of high intensity treatment.
17. In line with the ‘NHS Talking Therapies for anxiety and depression manual’, the Trust offered Mr E a talking therapies wellbeing course. Our adviser also clarified he was in the correct stepped pathway. As a result, we did not find any indications of wrongdoing by the Trust.
Referral to psychologist/other support
18. Mr E believes the Trust should have referred him to a psychologist and discussed other support options with him at the end of the course. In response, the Trust explained that signposting/further referral is only discussed at the end of the therapy. But, in Mr E’s case, he terminated his therapy and did not respond to the Trust’s request when it asked him whether he would like to continue with the therapy. Therefore, the Trust considered Mr E did not allow it an opportunity to discuss further support/referrals with him.
19. The Trust has reasonably explained that because Mr E did not complete the course, it could not refer him for psychological therapy/other support options.
20. Again, our adviser referred us to the stepped-care model outlined in the ‘NHS Talking Therapies for anxiety and depression manual’. This highlights that only individuals who do not fully recover at the low-intensity level treatment should be stepped up to high-intensity treatment (which would be referral to a psychologist/other support options). In line with this, it was not appropriate for the Trust to have referred Mr E without completing the course first.
21. As a result, we did not find any indications of failings regarding this part of Mr E’s complaint.
Course delivery method
22. Mr E complains the Trust failed to deliver all therapy sessions face to face, and said it held some sessions remotely. He says he encountered technical problems accessing the sessions via video link, which did not work on his computer.
23. In response, The Trust said it offers all clients remote therapy initially to allow flexibility. It offered Mr E a remote course, and he accepted at the time. The Trust also outlined that if somebody finds remote therapy difficult, they can discuss this with the therapist or contact the service and can still request face to face therapy.
24. We again referred to ‘NHS Talking Therapies for anxiety and depression manual’. It explains ‘Services should offer a choice of in-person or remotely delivered therapies, as there is evidence to show that these therapies can achieve comparable outcomes to face-to-face therapy when the same therapy content is delivered in an online format’.
25. The Trust offered Mr E remote therapy, which he accepted, and then delivered the courses remotely, in line with the manual and Mr E’s preference. The manual does not instruct organisations to deliver all sessions face to face, rather it encourages flexibility due to technological advancement.
26. We cannot therefore say there are indications of failings by the Trust not holding all sessions face to face. It acted in line with Mr E’s preference at the time, and the manual. We cannot say the Trust was responsible for the technical issues Mr E encountered. We do recognise that these technical difficulties must have been incredibly frustrating for him at that moment in time and recognise the distress they must have caused.
27. We are very sorry Mr E did not find the course helpful and that he has experienced a deterioration in his mental health. We do not underestimate how difficult things have been for him. We hope we have explained our decision clearly.