It is, as if NHS Talking Therapies is housed in a Georgian townhouse. It is not fit for those with a ‘mental disability’. Following a telephone conversation, with a receptionist, you may arrive at the address at the appointed time, only to find your path is barred by a series of steps. Given your lack of ‘mobility’ you may elect to go home. A third of people (33.1%) did that in the year ending March 2025. NHS Talking Therapies Annual Report.
Once inside, you are greeted by a receptionist who clerks you in, takes your biographic details and gives you two questionnaires to complete. The PHQ-9, a measure of the severity of depression and the GAD-7, a measure of the severity of anxiety. The receptionist might decide that you are not suitable for the service because of your drinking or alternatively that because you are suffering from PTSD/social anxiety disorder/body dysmorphic disorder, you should go straight to the 1st floor where the High Intensity Therapists are housed. Low intensity CBT therapists occupy the ground floor, offering usually up to 6 sessions.
Almost half of those who enter the building (43.8%) do not complete treatment (defined by the Service as attending 2 or more sessions) according to the latest NHS Talking Therapies for anxiety and depression Annual Report (September 2025).
Arbitrary Signposting and Treatment
But there is no transparency about the receptionist’s directions, no specification as to how much drinking is acceptable nor the criteria used to decide on PTSD, body dysmorphic disorder or social anxiety disorder. The receptionist’s lanyard may tell you that he/she is a Psychological Wellbeing Practitioner (PWP) or en route to be a PWP. A brief search on Google reveals that PWP’s are not trained therapists. The PWP has power but lacks credentials.
The NHS Talking Therapies clinicians are not trained in diagnosis, but the doors on both floors each bear the label of a disorder. The myth is that behind each door a therapist is compliant with delivering the designated disorder. But no fidelity checks have ever been conducted.
If initial ministrations are deemed unsuccessful (PHQ-9 or GAD-7 scores above the thresholds of 10 and 8 at the end of treatment) they are sent upstairs to the Hi-intensity therapists. About 10% of clients climb the stairs to the 1st floor but this climb typically takes weeks.
Thanks, But No Thanks
In 2022-2023, for the most common disorders depression and GAD almost as many people attended just one session 235,701 as attended two or more sessions 442,792. Scott (2024).
The one session attenders appear no different to those who attend two or more sessions, based on psychometric test scores. Yet the former are half as numerous as the latter, but have been ignored by the Services researchers. I had to get details on them from a Freedom of Information request Scott (2024).
The building is not fit for purpose. But the rent costs about £1 billion a year, with similar expenditure for the nearby Child and Adolescent Mental Health building. A radical re-think is necessary, but the NHS Talking Therapies juggernaut shows no signs of pausing, might this change when it becomes part of the Department of Health?
Dr Mike Scott