Referral and 1:1 therapy not accepted
13. In July 2024, Mr H’s GP referred him to the Trust’s community mental health services for support in managing his anxiety. A second referral for talking therapies (treatment where you talk to a trained professional counsellor/therapist) was made in September 2024. Mr H told us he feels the Trust should have accepted this referral and offered him treatment, rather than him waiting nearly seven months to access care to manage his GAD and BPD.
14. The NHS mental health clinically led review of standards explain adults and presenting to community-based mental health services should start to receive help within four weeks from request for referral. The care can involve immediate advice, support or a brief intervention, help to access another more appropriate service, or the start of a specialist assessment that may take longer.
15. NICE CG113 and NHS talking therapies manual set out a stepped-care model for patients with GAD to provide the least intrusive, most effective intervention first. Patients should be stepped up to more intensive treatments only if they do not benefit from the initial intervention.
16. The NHS talking therapies manual and NICE clinical guidance CG113 recommend interventions include individual self-help, guided self-help, drug treatment, cognitive behavioural therapy (CBT – goal orientated talk therapy) and psychoeducational groups (materials to teach people about mental health, learning and emotional well-being to improve understanding, coping and outcomes). The Trust used a stepped care model approach with Mr H. It started him on the least intensive treatment (CBT treatment) and when this did not work, it moved him up the intensive/specialist service (for example medication change, binge eating course).
17. The GP sent the referral on 4 July 2024, and the Trust offered Mr H an initial assessment on 5 August, within the NHS mental health service standards timeframe. During this assessment Mr H complained of fluctuating low mood and anxiety, poor sleep, that his current medication was no longer working and his existing CBT and DBT techniques were not working for him. The multi-disciplinary team (MDT) discussed Mr H’s case on 7 August.
18. The Trust told Mr H the outcome of the MDT on 9 August. It adjusted his medication to address his poor sleep. It discharged Mr H back to his GP’s care, having determined that the binge eating course would address the issues raised in the GP’s referral without requiring a separate new treatment. The Trust considered the second referral on 1 October and decided to not offer 1:1 talking therapy.
19. Our adviser said the Trust’s decisions on the two referrals were appropriate. Mr H was already attending a binge eating disorder course which incorporated support for his emotional regulation and BPD symptoms. Providing two concurrent therapies with different models is not considered advisable because of the different therapy models that could be used. Our adviser said once Mr H completed the binge eating course, he would need a period of consolidation to put the tools he learned into practice. The decisions were in line with the guidance to try the least intrusive, most effective intervention first.
20. The Trust applied the NICE recommended stepped-care model by adjusting Mr H’s medication to address his poor sleep, a clinically recognised barrier to recovery, and concluded that his existing care pathway effectively met the needs identified in the GP’s September 2024 referral.
21. We know Mr H has found the treatment he had in 2025 more helpful and he would have like this sooner. When we weigh up the available evidence, there is no indication Mr H had to wait for seven months for appropriate treatment. Care for the issues set out in his GP’s referrals was integrated through his existing treatment plan following the August MDT. It was therefore justified for the Trust to discharge Mr H back to his GP’s care with relevant advice.
22. There is no indication of a failing in the Trust’s handling of the referral or its decision on 1:1 therapy.
Psychiatric support
23. Mr H complains that he was told by the Trust that once he completed his binge eating course, he would be directly referred for psychiatric support. This did not happen and in January 2025, Mr H’s GP sent a further referral to the Trust. The Trust assessed him, arranged treatment and a plan of care.
24. In the complaint response, the Trust said staff need to be mindful that they are clear and realistic in relation to the treatment options they offer to patients. It set out his care pathway.
25. There is no indication in Mr H’s medical records that the Trust told him he would be referred directly for psychiatric support after the binge eating course finished. They do say Mr H could be referred back to the service, which his GP did in January 2025. Our adviser said referral for psychiatry support would be considered based on several factors including a risk assessment and if all other treatment was not working, in line with the NICE and NHS talking therapies guidance. The final decision lies with the clinical team. So there is no indication the Trust should have automatically referred Mr H for psychiatric support.
26. We recognise that Mr H told us the Trust gave him information that led him to believe this would be the case. The available evidence does not allow us to verify if someone gave him incorrect information. Even if they had, this would not have changed that he needed referring back into the service. His GP did this, so there was no significant disadvantage to him. When we weigh up the evidence, we do not it was wrong that the Trust did not just arrange psychiatric support for Mr H.
27. We acknowledge Mr H has gone through a difficult time and we are sorry to learn of the impact this had on him. We hope our decision provides some reassurance to Mr H about the care and treatment he received.