Search the hub

The NHS is setting up dozens of mental health hubs to help staff who have been left traumatised by treating Covid patients during the pandemic. There is mounting concern that large numbers of frontline workers have experienced mental health problems such as anxiety, depression and post-traumatic stress disorder over the last year. NHS personnel will be able to ring one of the 40 new hubs in England, receive advice and be referred for support from psychologists, mental health nurses, therapists and recovery workers. Frontline workers who are struggling with their mental health will be encouraged to use the service, and hub staff will call workers deemed at highest risk directly to offer their help. Higher-risk groups are likely to include those who work in intensive care, on Covid wards and in A&E units. Almost half of doctors, nurses and other ICU staff have reported symptoms of PTSD, severe depression or anxiety, according to research published last month. Of these, about 40% had probable PTSD – far higher than the rates seen among military veterans. Sir Simon Stevens, NHS England’s chief executive, announced the hubs in an interview with the House magazine. They are being set up at locations across England including Bedfordshire, Lancashire and north-east London. A handful are already in operation. Read full story Source: The Guardian, 22 February 2021

Availability of inpatient child and adolescent mental health services beds — particularly for eating disorders — has reached ‘crisis point’, with young people left waiting on a standard paediatric ward or at home as demand surged during the covid pandemic. A report to Surrey Heartlands Clinical Commissioning Group (CCG) in January read: “Availability of tier four beds [inpatient mental health beds for children and adolescents, commissioned centrally by NHS England] in the South East and across the country is at crisis point and providers have to compete for the small pool of beds." “Waits for beds or being placed far from home is a distressing and unacceptable experience for children and young people and families and places an additional burden on other parts of the system such as paediatric wards.” The report noted a “demand upsurge to the highest levels in the last three years” since the pandemic. It stated, in mid-January, the CCG had two patients awaiting eating disorder beds being managed on paediatric wards as they had become “physically too unwell to be managed at home”. Four others also waiting for a CAMHS bed were being managed at home. Read full story Source: 16 February 2021

One in three Covid patients put on a ventilator experience extensive symptoms of post-traumatic stress disorder (PTSD), according to research, which adds to mounting evidence of the virus’s impact on mental health. The study of 13,049 patients with confirmed or suspected coronavirus, by Imperial College London and the University of Southampton, found that one in five who were admitted to hospital but did not require a ventilator also experienced extensive symptoms of PTSD. The most common PTSD symptom experienced by COVID-19 patients was intrusive images, sometimes known as flashbacks. Examples of these could be images of the intensive care unit (ICU) environment, ICU doctors wearing full personal protective equipment or other patients in the ICU. The study, published in the Royal College of Psychiatrists’ BJPsych Open, on Tuesday, found lower levels of extensive symptoms of PTSD for patients given medical help at home (approximately one in six) and patients who required no help at home but experienced breathing problems (one in ten). Dr Adam Hampshire, from Imperial College London, said: “We can see that the pandemic is likely to be having an acute and lasting impact, including for a significant proportion of patients who remained at home with respiratory problems and received no medical help. This evidence could be important for informing future therapy and reducing the long-term health burden of this disease.” Read full story Source: The Guardian, 9 February 2021

Toronto, Canada, will launch a pilot programme that will see civilians, not police officers, dispatched to 911 calls involving mental health crises — as long as violence is not being threatened. Council also approved a motion by Mayor John Tory to fast-track parts of the plan and review 911 call services in 2021 to determine how best to dispatch help through the proposed new service. The plan calls for four crisis support teams in different parts of the city, to respond to some of the roughly 30,000 calls for people in crisis that go through 911 each year. Pilot programmes are to be launched in early 2022, and were scheduled to be fully implemented in 2026 if proven successful. Tory’s motion called for full implementation by 2025. “Putting something else in place is not a simple task. It is necessary that we do it properly,” said Tory, in bringing forward the motion. Nonetheless, the mayor said, he believes it can be done more quickly. Asante Haughton, a mental health advocate and co-founder of the Reach Out Response Network, focused on transformational change in mental-health crisis response, said the move is another rung on the ladder to a more equitable society. “I really see this as an opportunity to transform the way that we think about mental health and transform the way that we think about social service and community building in general,” he said. Read full story Source: Toronto Star, 2 February 2021

The pandemic has had a deep impact on children, who are arriving in A&E in greater numbers and at younger ages after self-harming or taking overdoses, writes Dr John Wright of Bradford Royal Infirmary. Children are a lost tribe in the pandemic. While they remain (for the most part) perplexingly immune to the health consequences of COVID-19, their lives and daily routines have been turned upside down. From surveys and interviews carried out for the Born in Bradford study, we know that they are anxious, isolated and bored, and we see the tip of this iceberg of mental ill health in the hospital. Children in mental health crisis used to be brought to A&E about twice a week. Since the summer it's been more like once or twice a day. Some as young as 10 have cut themselves, taken overdoses, or tried to asphyxiate themselves. There was even one child aged eight. Lockdown "massively exacerbates any pre-existing mental health issues - fears, anxieties, feelings of disconnection and isolation," says A&E consultant Dave Greenhorn. Read full story Source: BBC News, 2 February 2021

Hospital trusts in England have been told to stop using virtual assessments to section people under the Mental Health Act after a judge ruled them unlawful. An NHS trust sought a court judgment on remote assessments after the Department of Health and Social Care issued guidance in November indicating that this method could be used as part of an evaluation during the pandemic. Experts said that a “small but significant” number of people may have been sectioned this way. Following the judgment, an email was sent to mental health professionals from NHS England saying “immediate action required”. It added that anyone detained via remote assessment would need to be notified. The message read: “Stop using remote methods for any new or ongoing assessments for detention or section renewals under Part II of the Act.” “All mental health providers should identify and reassess individuals who are currently detained under Part II of the MHA following a remote assessment as soon as possible if ongoing detention is deemed necessary.” The government had originally advised that it believed remote assessment could be used but said only the courts could provide a definitive interpretation of the law, setting out the circumstances under which such assessments could take place. Read full story Source: The Guardian, 30 January 2021

Mental health services in England do not have the capacity to cope with the impact of the coronavirus pandemic on children, Anne Longfield, the children’s commissioner for England, has warned. Despite an expansion in the four years before the pandemic, the supply of treatment for child mental health problems was already falling well short of demand, with referrals rising 35%, but treatments only increasing by 4%, the watchdog said as she called for a “rocket boost” in funding. Longfield cited an NHS study before the latest national lockdown, which found one in six children had a probable mental health condition and said it is highly likely that the level of underlying mental health problems will remain significantly higher as a result of the pandemic, with an increase in referrals to NHS services already observed last autumn. “Even before the Covid pandemic, we faced an epidemic of children’s mental health problems in England and a children’s mental health service that, though improving significantly, was still unable to provide the help hundreds of thousands of children required,” Longfield said. “It is widely accepted that lockdown and school closures have had a detrimental effect on the mental health of many children.” Read full story Source: The Guardian, 28 January 2021

Guidance from NHS England that doctors may lawfully use video assessments during the pandemic to decide whether patients should be detained in hospital under the Mental Health Act was wrong, two High Court judges have ruled. The act makes it a legal requirement that doctors must “personally examine” a patient before recommending detention. A code of practice requires “direct personal examination of the patient and their mental state.” But guidance from NHS England just after the start of the first lockdown last March said that “temporary departures from the code of practice may be justified in the interests of minimising risk to patients, staff, and the public.” Revised guidance in May 2020 included a section drafted jointly by NHS England and the Department of Health and Social Care for England (DHSC) “for use in the pandemic only.” This stated, “It is the opinion of NHS England and NHS Improvement and the DHSC that developments in digital technology are now such that staff may be satisfied, on the basis of video assessments, that they have personally seen or examined a person ‘in a suitable manner.’ ” The guidance added, “While NHS England and NHS Improvement and the DHSC are satisfied that the provisions of the Mental Health Act do allow for video assessments to occur, providers should be aware that only courts can provide a definitive interpretation of the law.” It went on, “Even during the COVID-19 pandemic it is always preferable to carry out a Mental Health Act assessment in person. Decisions should be made on a case-by-case basis and processes must ensure that a high quality assessment occurs.” Read full story Source: BMJ, 25 January 2021

The second wave of COVID-19 has put doctors under huge pressure, the Royal College of Physicians has warned, as two thirds of physicians report feeling tired or exhausted. A survey of 25 500 members of the college from across the UK, conducted on 2 November, received 1890 responses. It found that two thirds (64%, 931) felt tired or exhausted, 48% (687) felt worried, and just under a third (29%, 424) felt demoralised. Almost a fifth (19%, 280) said they have sought informal mental health support, such as speaking to colleagues or friends, during the pandemic. Just 10% (155) said they had sought formal mental health support from either their employer, GP, or external services. College president Andrew Goddard said he was concerned about the mental health of doctors, “There is no way to dress it up—it is pretty awful at the moment in the world of medicine. Hospital admissions are at the highest ever level, staff are exhausted, and although there is light at the end of the tunnel, it seems a long way away.” He said that before the pandemic, few physicians would have expected to need formal mental health support during their career. After the pandemic, staff will be in desperate need of a break, Goddard said, and will need specific time away if they’re to be at their best. “Doctors have demonstrated remarkable resilience throughout the pandemic, working under the most challenging conditions the NHS has ever faced, but they can’t continue working this way forever,” he said. Read full story Source: The BMJ, 21 January 2021

The UK’s main gender identity development service for children is leaving thousands of vulnerable young people at risk of self-harm as they wait years for their first appointment, according to a highly critical report. The Care Quality Commission (CQC) took immediate enforcement action against the Tavistock and Portman NHS foundation trust when it completed the inspection in November, which rated the service overall “inadequate” and highlighted overwhelming caseloads, deficient record-keeping and poor leadership. The commission, which heard from young people using the service, parents, carers and staff in the course of its inspection, told the trust that services and waiting times in the Gender Identity Development Services (GIDS) in both their London and Leeds clinics “must improve significantly”, demanding monthly updates on numbers on waiting lists and actions to reduce them. The service has faced major scrutiny in recent years, with some former staff and campaigners raising concerns about the “overdiagnosing” of gender dysphoria, the consequences of early medical interventions and the significant increase in referrals of girls questioning their gender identity. Read full story Source: The Guardian, 20 January 2021

Many hospital staff treating the sickest patients during the first wave of the pandemic were left traumatised by the experience, a study suggests. Researchers at King's College London asked 709 workers at nine intensive care units in England about how they were coping as the first wave eased. Nearly half reported symptoms of severe anxiety, depression, post-traumatic stress disorder or problem drinking. One in seven had thoughts of self-harming or being "better off dead". Nursing staff were more likely to report feelings of distress than doctors or other clinical staff in the anonymous web-based survey, which was carried out in June and July last year. Just over half reported good well-being. Victoria Sullivan, an intensive care nurse at Queen's Hospital in Romford, said she often can't sleep because she's thinking about what is happening at the hospital. Her worst moment was breaking the news of a death on the phone, she said, adding that the screams from the patient's relatives "will honestly stay with me forever". "Telling someone over the phone and all you can say is 'I'm really sorry', whilst they're crying their heart out, is quite traumatising," she said. "Although you're saying how sorry you are, in the back of your mind, you're also thinking: 'I've got three other patients I've got to go and see, the infusions need drawing up, and meds need to be given and a nurse needs support'. "The guilt is just too much." Lead researcher Prof Neil Greenberg said the findings should be a "wake-up call" for NHS managers. He said: "The severity of symptoms we identified are highly likely to impair some ICU staff's ability to provide high-quality care as well as negatively impacting on their quality of life." Read full story Source: BBC News, 13 January 2021

The World Health Organization’s (WHO) new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support. The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs. Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems. It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan. “It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.” Read full story Source: WHO, 8 October 2021

One in 10 posts for consultant psychiatrists in England are vacant with growing waiting times for people needing mental health treatment, experts have warned. A census of the current situations across England by the Royal College of Psychiatrists has found there is just one psychiatrist for every 12,567 people in England. Health service bosses at NHS England have acknowledged there are an estimated 1.5 million people who are waiting for mental health support amid fears the situation will worsen as the effects of the Covid pandemic become clear. This is on top of the 5.6 million patients waiting for routine operations and treatments for physical illness. The Royal College said there was a shortage of 568 empty consultant posts in the NHS out of a total of 5,367 which it said meant patients would have to wait longer for treatment. In total there are 4,500 full time consultants working in the NHS. The highest rates of unfilled positions are in the fields of addiction, eating disorders and child and adolescent psychiatry. Read full story Source: The Independent, 6 October 2021

As part of the UK Government’s efforts to tackle health problems, including mental health, earlier in the cycle, the newly-created Office for Health Improvement and Disparities (OHID) has launched the latest Better Health – Every Mind Matters campaign to improve the general public’s mental wellbeing. The new campaign aims to empower members of the general public to look after their mental health through tips and practical advice, helping to find what works for them in reducing stress and anxiety, boosting their mood, sleeping better, and feeling in greater control of their lives. New research commissioned by OHID revealed nearly half of adults (49%) in England said the Covid-19 pandemic had a negative impact on their mental wellbeing. In the same research, more than a third of all adults in England (34%) said they did not know what to do to improve their mental wellbeing. That equated to 15.1 million people. Younger adults were the most significantly affected group with their mental health, with 57% of 18-34 year olds suggesting the pandemic had negatively impacted their mental health. Just under half (44%) reported not knowing what to do to help improve it. This is the first campaign delivered by OHID since being officially launched on October 1, 2021. They have been set up with the aim of tackling health inequalities across the country. Minister for Care and Mental Health, Gillian Keegan, said: “The public showed great resilience throughout the pandemic, but it has served as a stark reminder that we all need to look after ourselves not only physically, but mentally. “There are simple steps we can all be taking to improve our mental wellbeing and reduce feelings of stress and anxiety. For anyone who is unsure what they can do, I urge you to visit Every Mind Matters and take advantage of the expert advice and practical tips available to you.” Claire Murdoch, NHS National Director for Mental Health, added: “The last year has taken its toll on people’s mental health but NHS staff have responded rapidly to treat more people with mental health issues than ever before – rolling out 24/7 crisis lines across the country and mental health support teams in schools during the pandemic. “The NHS is here for you, so if you’re struggling with anxiety and depression our rapidly expanding talking therapy services are available, while anyone who needs urgent help can access our 24/7 NHS crisis lines – available to people of all ages. “I would encourage everyone to look after their mental health, and by answering 5 simple questions, get a tailored ‘mind plan’ which will give you tips to help boost your mood, sleep better and deal with stress and anxiety.” Over 3.4 million individual Mind Plans have already been created since the campaign was first launched in October 2019. Original source: National Health Executive

There is a mental health crisis in England, with rates of depression doubling since the COVID pandemic began. Strategies of “speaking up”, mindfulness sessions at work, and national “happiness” campaigns have been touted as an effective approach to tackling mental health at work, but therapists are unconvinced. But what of mental health services offered by the state? This has been equally unconvincing. Over the past decade or so, mental health services in England have been undergoing a process of “Uberisation”. This refers to how services are effectively treated as commodities marketed through online platforms, changing the way they are delivered as well as making the jobs of the people delivering them more precarious – similar to the effect of ride-hailing apps on taxi drivers. Specifically, this has happened through the introduction of a standardised and digitalised model of therapy called Increased Access to Psychological Therapies (IAPT). This Uberisation appears to be contributing to a mental health crisis within the therapy profession itself. IAPT, which was introduced in 2008, provides psychotherapy for depression and anxiety to over a million people each year – the largest NHS programme in England. It uses a model of cognitive behavioural therapy – made up of short-term interventions of four to 12 sessions – that use techniques, such as relaxation exercises, to encourage positive mood and behaviour. With extremely high levels of depression and anxiety among therapists, there is a genuine question about patient safety that is being overlooked. If the mental health model itself is broken, are services deepening the mental health crisis, rather than solving it? Read the full article here Source: The Conversation

Mental health patients who were discharged from or admitted to acute mental health services during the first Covid-19 lockdown experienced loneliness and social isolation, according to a new study. Published in the British Journal of Psychiatry Open the 34 patients, carers and clinical staff were interviewed by a team of researchers from The University of Manchester. Mental health service users also reported ‘working harder’ to avoid admission due to fears around environmental safety as a result of COVID-19. “Even before the pandemic, there are lots of safety concerns associated with recent discharge from inpatient mental health services, for example suicide and self-harm,“ said lead author Dr Natasha Tyler, researcher at the GM PSTRC and The University of Manchester. Dr Tyler added: ‘Our patients and carers felt that because of the national need to free-up hospital beds, the quality of discharge and admission planning was compromised at times. “That meant discharging patients from hospitals who were not ready to cope in the community or not admitting patients who needed in-patient care. “The closure of most community support services meant patients had minimal opportunities for accessing care via alternative routes. This worsened their feelings of helplessness and loneliness.” Full article here Source: Greater Manchester Patient Safety Translational Research Centre

A patient died from a serious spinal injury after emergency staff incorrectly attributed his physical condition to his mental health issues, an inquest heard. Robert Walaszkowski, who had been detained at a secure mental health unit run by North East London Foundation Trust in October 2019, suffered a serious injury after running into a door on the unit. Staff from London Ambulance Service did not suspect a spinal injury and he was taken to the emergency department at Queen’s Hospital in Romford with a suspected head injury. An inquest heard he did not receive a spinal examination and imaging of the spine, despite this being required due to the nature of his injury and presentation. He was discharged from A&E the following day, and was then placed on the floor of a private patient transport vehicle, to be transported back to the mental health unit, Goodmayes Hospital. He arrived at the hospital unresponsive. He never recovered consciousness and died of his injuries a month later. An inquest jury has recorded a narrative conclusion and found that neglect contributed to Robert’s death. Read full story (paywalled) Source: HSJ, 24 September 2021

A coroner has raised concerns about how a family was allowed to bring a restricted item that contributed to a man's death into a mental health unit. Joshua Sahota, 25, died as a result of asphyxia and psychosis in Bury St Edmunds, Suffolk, on 9 September 2019. Suffolk coroner Nigel Parsley said Mr Sahota's relatives were not told the item they brought in when visiting was on a restricted list. The NHS trust which runs the unit said it had improved its internal processes. Mr Sahota, from Kennett in Cambridgeshire, was taken to the Wedgewood Unit on the West Suffolk Hospital site three weeks before his death as his mental health had declined. Insufficient staffing levels contributed to his death, an inquest jury at Suffolk Coroner's Court concluded. Other factors included insufficient observations and one-to-one processes, no clear and concise risk assessments, being slow to develop a care plan and the absence of a documented crisis plan. Read full story Source: BBC News, 21 September 2021

Record numbers of children and young people are seeking access to NHS mental health services, figures show, as the devastating toll of the pandemic is revealed in a new analysis. In just three months, nearly 200,000 young people have been referred to mental health services – almost double pre-pandemic levels, according to the report by the Royal College of Psychiatrists. Experts say the figures show the true scale of the impact of the last 18 months on children and young people across the country. “These alarming figures reflect what I and many other frontline psychiatrists are seeing in our clinics on a daily basis,” said Dr Elaine Lockhart, the college’s child and adolescent faculty chair. “The pandemic has had a devastating effect on the nation’s mental health, but it’s becoming increasingly clear that children and young people are suffering terribly.” Read full story Source: The Guardian, 23 September 2021

Leaked results from a national survey of NHS staff has revealed a sharp drop in those who believe their health and wellbeing is being supported by their employer. The People Pulse is a national, monthly survey launched in 2020. It enables provider and commissioner organisations to monitor the NHS workforce’s health and wellbeing. According to a snapshot of the results recorded between May and August seen by HSJ, there was a drop of 9.6 percentage points in “perceptions of wellbeing support”, with “positivity” sitting at 57.3%. Almost a quarter of the survey respondents reported a “negative” experience of health and wellbeing support. The survey results also revealed almost a third of respondents said they wanted to speak up about a specific issue during the pandemic, especially on issues of staff safety, health and wellbeing, but they did not because they feared repercussions or believed nothing would happen. Read full story (paywalled) Source: HSJ, 21 September 2021

A mental health hospital in Suffolk has been closed after inspectors found it was failing to protect patients from harm and abuse. St John's House in Palgrave, near Diss, was previously rated inadequate by the Care Quality Commission (CQC). A further inspection of the 49-bed hospital found the care was "unacceptable" and "insufficient progress had been made regarding patient safety". The company that runs the hospital, Partnerships in Care, part of the Priory Group, has now decided to close the site. Stuart Dunn, CQC head of inspection for mental health and community services, said: "Our latest inspection of St John's House found an unacceptable service where insufficient improvements had been made to protect patients from harm and abuse and the number of safety incidents remained high." "Staff weren't responding appropriately to patients who were self-harming, with one patient not being sent to hospital quickly enough after swallowing a foreign object, despite complaining of abdominal pain. "We reviewed CCTV footage and found staff were sometimes asleep when they should have been observing patients to make sure they were safe. This was all the more concerning as we identified this as a concern during the previous two inspections of this service, demonstrating a lack of improvement to keep patients safe. "Incidents of restraint remained high and not all staff had the right training to carry it out safely. In addition, staff were not following hospital policy when using soft handcuffs with patients during safety incidents." Read full story Source: ITV News, 17 September 2021

NHS leaders are being urged to tackle racist abuse of staff as new figures reveal that a third of black, Asian or minority ethnic workers in mental health trusts in England have experienced harassment, bullying or attacks by patients, relatives or members of the public. One in three (32.7%) BAME staff in mental health settings have experienced abuse, according to analysis by the Royal College of Psychiatrists. For BAME workers across the NHS, the rate is more than one in four (28.9%). One medical director told the Guardian that hot tea had been thrown at them “because of the colour of my skin”. A psychiatrist told how they were left traumatised after they were racially abused – then threatened with a knife. The college is calling on health leaders to take a stand against discrimination by setting up better processes in NHS trusts to record and understand data about bullying and harassment. Dr Adrian James, president of the Royal College of Psychiatrists, said the findings were deeply concerning. He said: “NHS leaders and local health bosses must tackle this head-on.” Read full story Source: The Guardian, 9 September 2021

Shortfalls in mental health services and staffing have been flagged as concerns in dozens of inquests since 2015, the Observer has revealed, with coroners issuing repeated warnings over patients facing long waiting lists or falling through gaps in service provision. The Observer has identified 56 mental health-related deaths in England and Wales from the start of 2015 to the end of 2020 where coroners identified a lack of staffing or service provision as a “matter of concern”, meaning they believed “there is a risk that future deaths could occur unless action is taken”. Coroners issue Reports to Prevent Future Deaths (PFD) when they believe action should be taken to prevent deaths occurring in future, and send them to relevant individuals or organisations, who are expected to respond. In one case, a woman referred to psychotherapy services had still not received any psychotherapy by the time she died 11 months later. In another, someone had endured a seven-month wait for a psychological assessment. Alison Cobb, senior policy and campaigns officer at the mental health charity Mind, said: “It’s shocking that so many should lose their lives because there isn’t enough capacity in mental health services to provide adequate care. These prevention of future deaths notices are meant to inform better ways of working, and it’s especially concerning that similar stories are repeating over and over again.” Read full story Source: The Guardian, 5 September 2021 Coroner's reports on the hub

A new campaign to increase awareness of life-saving treatment that can reverse drug overdoses has been launched in Scotland. The Scottish government and Scottish Drugs Forum (SDF) have joined together to help improve information about naloxone which can prevent deaths in the case of opioids overdoses. Drugs policy minister Angela Constance said: “Firstly, on International Overdose Awareness Day I want to pass on my sincere condolences to all those who have been affected by a drug-related death. That is why I am pleased to launch this joint campaign with Scottish Drugs Forum to encourage the public to get involved in our national mission and equip themselves to save a life." Read full story. Source: The Independent, 31 August 2021

According to Elizabeth Cotton, of Cardiff Metropolitan University, an expert in mental health at work, more than four in 10 – 41 per cent – of therapists working for the NHS’s talking treatments programme had been asked to manipulate data about patients’ progress. This was done in order to to improve the scheme’s apparent achievement rates, although NHS chiefs insist patients’ views are recorded when therapists are not present. Read full story. Source: The Independent, 26 August 2021