Issued: 25th September 2014 by BABCP Board
'BULLYING CULTURE' IN NHS MENTAL HEALTH SERVICES PUTTING VULNERABLE PATIENTS AT RISK
Vulnerable patients are increasingly at risk from a growing 'bullying' culture in
the NHS that is ignoring Government-backed minimum guidelines for effective mental
health treatment. This is the claim made by an increasing number of members of the
British Association for Behavioural & Cognitive Psychotherapies (BABCP) working
in the NHS.
Now in its fifth decade, BABCP is the lead organisation and national charity for
the promotion of Cognitive Behaviour Therapy (CBT) in the UK.
CBT is an evidence-based form of psychotherapy used in treating a wide range of
mental and physical health conditions. From the alleviation of low mood and excessive
worry, to cancer care and chronic pain, from soldiers returning from conflict zones
to survivors of terrorist bombings, CBT has been shown to be effective in enabling
people to reclaim and sustain their quality of life. The National Institute for
Health & Clinical Excellence (NICE) recommends CBT in the treatment of depression,
anxiety disorders and other conditions.
For CBT to be most effective, it is critical that the patient receives the appropriate
number of sessions based on sound clinical judgement as well as evidence based protocols.
Concerned BABCP members working at all levels within NHS mental health services
increasingly report that service managers are being forced or are choosing to ignore
NICE guidelines in order to meet unrealistic service contracts and funding or misrepresent
reductions in waiting lists and mask the impact of draconian cuts in services. With
vulnerable patients left unseen or with an incomplete service, this could have serious
consequences for their ability to recover.
These members also describe a NHS management culture of bullying and intimidation,
preventing them from openly raising their concerns and undermining their clinical
judgement. pull-rightened to speak out on the matter in their workplace, they have
been contacting BABCP in increasing numbers pleading for advocacy on their behalf.
BABCP President Professor Rob Newell says: 'Across NHS Trusts and services delivered
in the private and third sectors the variation in mental health service delivery
is considerable. In some areas the service provided is excellent and surveys report
high levels of satisfaction, while in others low levels of successful outcomes have
prompted politicians to get involved and voice their concerns about the level and
competence of service delivery.
'BABCP is alarmed by increasing reports that managers involved in the delivery
of psychological therapies are limiting the number of sessions available to vulnerable
patients, despite clear evidence of the numbers of sessions required for a successful
clinical outcome. Concern is also raised that large group therapy programmes are
being used as a substitute for individual therapy and less intensive forms of therapy
as a substitute for CBT and other evidence based therapies as recommended by the
NICE Guidelines. Judgements about the form and amount of therapeutic input should
be made by clinicians based on assessment of need, rather than by managers concerned
with arbitrary throughput targets.
'BABCP also deplores the bullying and coercive environment that our members are
describing to us. This kind of management culture was heavily criticised in the
Francis Report. Based on what our members are telling us, the conclusions of this
report are being significantly ignored in mental health services.
'BABCP demands that that these concerns are examined at a high level, with clearer
guidance provided to service managers who remove choice, use coercive tactics and
undermine clinical judgement. We need to remind them of the consequences of such
activities for the public whom they are supposed to serve, the service they represent
and the clinicians they employ.'
Notes to editors
BABCP has been the lead organisation and national charity for the promotion of
CBT in the UK since 1972. It has grown from 195 members originally to now in excess
of 10,000 members, most of whom work in the NHS, social care, education and universities.
BABCP is the only UK organisation providing accreditation to those who practise
CBT in the NHS and privately. It is widely recognised by health and social care
employers, training institutions and health insurance companies. BABCP believes
that accreditation is important in protecting the public and raising the quality
of CBT. In addition BABCP produces internationally regarded journals, organises
world class conferences and provides research grants.
CBT is a talking therapy. It has been proved to help treat a wide range of emotional
and physical health conditions in adults, young people and children. CBT looks at
how we think about a situation and how this affects the way we act. In turn our
actions can affect how we think and feel. The therapist and client work together
in changing the client’s behaviours, or their thinking patterns, or both of these
NICE provides independent, evidence-based guidance for the NHS on the most effective
ways to treat mental and physical conditions. It recommends CBT in the treatment
of anxiety disorders (including panic attacks and post-traumatic stress disorder),
depression, obsessive compulsive disorder, schizophrenia, psychosis and bipolar
The Francis Report was the result of a public inquiry into the role of commissioning,
supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation
NHS Trust between January 2005 and March 2009. It followed on from two previous
inquiries into events at the Trust which uncovered a lack of basic care in many
of its wards and departments.