In March 2025 the government announced the end of NHS England within 2 years, with a move of staff and function to the Department of Health and Social Care. Integrated Care Boards, who oversee much of mental health provision, are being asked to achieve a 50% reduction in costs. Jobs are likely on the line. The pressure will be to avoid any ‘talking’ in favour of digital ‘solutions’ such as Silver Cloud. A recent exchange on Twitter highlights the extreme dissatisfaction with NHS Talking Therapies attempt to do things on the cheap! The paradox will be ‘talking therapies, don’t talk’.
Psychological treatment is following an ‘entropy trajectory’, where energy becomes progressively available in a less useful form. The process starts off reasonably well, with randomised controlled trials showing CBT treatments are better than active control conditions, but a paucity of evidence on how long gains last. Further it is not clear what this means in the real-world.I have found it impossible to discover what proportion of those given CBT would say that they recovered in the sense of being back to their normal selves for what they would see as a meaningful period. When the rcts have been evaluated in routine practice , there has usually not been independent assessment. Thus whilst a case can be made that ‘efficacy’ is proven, not so for ‘effectiveness studies’. When it comes to routine practice the energy is further degraded, it is only the Service providers who claim a 50% recovery rate. My own independent analysis as an Expert Witness to the Court suggests a tip-of-the iceberg rate of recovery. Most likely explained by giving people simply time and attention rather than anything to do with CBT.
Unfortunately, Service providers and lead organisations for CBT are likely to push as far as possible f or the retention of the status quo. But in w hose interest?
Dr Mike Scott