"Healthy minds" initial telephone assessment

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After a bad year I eventually saw my GP regarding depression and anxiety in late September. I was given sertraline which was awful and recently changed to mertazapine. I also self refered to healthy minds. My GP's been great.

just now I finally had my initial assessment, over the phone, with healthy minds. it was awful. I was having a good day but now I just feel like getting some junk food and going to bed.

She was firing all sorts of questions at me and it was like I was giving the wrong answers. kept asking me to be specific and give more examples and even when I was she's asking what else, and why and how. she just seemed so abrupt, I started crying a little after the beginning of the call and told her some really personal stuff (because she kept pushing me for it) and she doesn't even react just keeps asking for more.

at the end of the call she just said they will get back to me saying if they can help or not, but I feel like it's all an attack, like she thinks i couldn't tell her enough to deserve mental health help but I think if I was any more ill than I am now I wouldn't have even been able to complete the phone call.

what's gone wrong?

Gosh you poor thing.

I am sure she was just 'doing her job^ but that sounds stressful. I am so sorry for you.

If it comes back that they say they can't help/won't help, then I would go back to your GP and complain.....

(((HUGS)))

Over the phone can never replace face to face .
If it has been too much for you today just rest , have the junk food , and sleep .

When you wake , sit still and just breathe and listen for 5 to 10 minutes .

Hope it gets better .

It never fails to amaze me how the people who need to be showing the most compassion can sometimes be so lacking in bedside manner. She sounds like one, as do a few doctors and midwives I've met.

It wasn't an attack, though it's understandable you'd feel that way when you're feeling so low. The IAPT service is usually based around CBT, which is why she was asking for examples and whys and hows.

Unfortunately because of all the funding cuts therapy provision on the NHS is very basic. Tories don't give a fuck about people struggling with their mental health, or physical for that matter. Can you afford to see someone privately? If you're on a limited income you may be able to find a charity that offers free or low cost support.

Over the phone can never replace face to face

I agree, but NHS provision is often phone and even internet based now, where you don't deal with a human being at all. It's terrible that we've reached this point.

So sorry to hear this OP! I used to work for a similar service elsewhere in the country and I really recommend you ring them back and ask to speak to the service manager to pass on this feedback when you feel up to it. Or ring and ask for the manager’s email and then write to them and say what you’ve explained here.

The clinicians who do these initial phone assessments are stretched to the max and often doing ten or more half hour calls each day, but that’s absolutely no excuse. To work in mental health and be in a position where you’re speaking to people who are having a hard time and might have had to work really hard to pluck up the courage to call, you need some empathy and ability to convey you care and are listening, it’s not okay for them to have barked questions at you without any reflection, to not have recognised how difficult it might have been for you. You deserve better, and in the place I worked at if we received feedback like that we’d have been so thankful the person was able to share it, taken it further with the clinician to find out what happened and make sure they learned from it. Problem is if you don’t speak up their manager has no way of knowing this is how they are with people. What we’d have done is to have offered another assessment with someone to try and ensure you were listened to and supported properly, instead of being left feeling this way.

If you are offered some help then it might be with this person or it might not, if you are and it’s with them I hope you feel able to request someone different rather than just not go ahead with treatment. I think you’ll be listened to. Well done for getting through it. The format of the assessment can feel like being grilled as there are certain questions they have to ask and get through but it’s entirely doable to do it in a caring sensitive way that feels more like a conversation than being barked at and that’s what someone in that role should be more than capable of doing.

Don’t lay back and accept this, please speak up. For your own sake and the sake of the next person they assess who might not have the assertiveness or confidence to do something about it. They need to get this stuff right, it’s important!

It wasn't an attack, though it's understandable you'd feel that way when you're feeling so low. The IAPT service is usually based around CBT, which is why she was asking for examples and whys and hows.

I don’t think OP is claiming it WAS an attack, she said that’s how it felt. And I can see why based on how she has described it. A skilled practitioner can elicit examples without leaving the person feeling like they’re being grilled and ‘not reacting’ to what has been said. Sounds really awful for OP.

That's an awful thing to happen. It sounds like the person you spoke with wasn't very skilful and was having a real empathy vacuum.

To answer your question: the person you spoke to was not being good at their job. Maybe they're normally brilliant, maybe they're always bad at it. Either way, it is not your fault. Be kind to yourself.

It may (it may not, depending on how you feel) be worth taking a few minutes to jot down what happened in the call and any other details. If you decide that you want to take it further (e.g. PALS) it may be helpful to have your notes then. I would hope that the organisation have some kind of feedback facility, whether it's an online form or something else. If you feel you want/are able to, let them know what's happened.

You mentioned about "what she thinks" - if she needs to call back to let you know what's happening next, it's because she isn't the one making the decision, so what she thinks doesn't matter.

Finally, if it were to turn out that she will be the person working with you, and you don't want that (why would you?), tell them you want someone else. It is absolutely fine to request a different therapist.

Thank you for all your responses. I will feed back and ask for someone else IF they say they can help me. I'm seeing GP on Friday about my meds so I'll let them know about the phone call also!

A lot of people here are assuming that NHS Healthy Minds personnel are trained therapists. They’re not. Maybe in some parts of the country (although I doubt it), but in many areas the people who do the phone assessments and run some of the CBT courses are Psychological Wellbeing Practitioners.

PWPs do just one year of training, so they’re slightly more qualified mental health support workers. They’re not psychologists, or therapists, or CPNs, or counsellors. They have minimal training yet they're expected to deal with a variety of mental health conditions and severities in 30 minutes, and unfortunately in cases like yours OP, it shows. I’m so sorry you had to go through that. You’re not the first person I’ve heard from who felt a lot worse after a Healthy Minds assessment.

Your best bet if you can afford it is private therapy, unfortunately. That’s what we had to do. NHS mental health services aren’t fit for purpose due mainly to a chronic lack of funding, and the people working within them are run ragged .

NitrousOxide

Just to clarify, to qualify as a PWP it’s a year-long postgraduate training course on top of a relevant degree or core profession. To be accepted into the PWP training you need either a core profession such as MH nursing or social work, or a degree in psychology. So yes, it’s one year of specialised PWP training but on top of several years at university training in a relevant profession or a psychology degree. Just wanted to make that clear lest people believe you can rock up with a few GCSEs and do the PWP training!

I’d always encourage anyone accessing services to feel confident in asking their clinician what their training/qualifications are. You’re right in that it is usually PWPs carrying out initial assessments, that’s the IAPT model stepped care approach where everyone is funnelled initially through a generic assessment and then based on what’s said they are directed to the most appropriate treatment (whether that’s guided self help with a PWP, CBT, counselling or group work).

I have heard however of some services recruiting ‘PWP assistants’ at band 3 to carry out initial assessments which is shocking, and those people do not have the aforementioned training/backgrounds. Sadly unless services are properly funded service managers are caught between a rock and a hard place trying to provide an adequate service that meets the demands of the commissioners with less and less money to do so, and patient care of course suffers.

I'm so sorry.
I had the same experience and felt very stupid for asking for help.
Thankfully the actual therapists have normally been better so don't write it all off as a bad idea.
I hope they get back to you soon.

PWP assistants’ at band 3 to carry out initial assessments which is shocking

That really is shocking. JFC. Totally inappropriate on so many levels - for the patients, obvs, whose first contact with services is quite likely to be off-putting if the assessor appears (as in this case) to be unskilled/unempathetic. It could put them off any further contact with services. And it's not fair on the staff either, who are being asked to do with they are unequipped for.

OP, your priority must be your own well-being. If you don't feel like you want to revisit yesterday's appointment, then absolutely don't. If you are able to feed back that would be helpful.

Hope your GP is helpful on Friday.

*work they are unequipped for

The people that do these assessments are not medical trained, just admin staff. I have also been through one of these assessments. The person you speak to scores you on various criteria, a therapist then looks at them and decides. None of these people are medical doctors. You can qualify to be a CBT therapist through a college course. You do not have to be a psychologist, phyciatrist or any other sort of doctor.

I know Tableclothing. It’d be a scandal if GP surgeries and hospitals employed people with no training to diagnose and treat physical health conditions. Yet if it’s mental health apparently that’s acceptable.

Here’s a discussion on it:

www.clinpsy.org.uk/forum/viewtopic.php?t=19659

The people that do these assessments are not medical trained, just admin staff. I have also been through one of these assessments. The person you speak to scores you on various criteria, a therapist then looks at them and decides. None of these people are medical doctors. You can qualify to be a CBT therapist through a college course. You do not have to be a psychologist, phyciatrist or any other sort of doctor.

In the vast majority of cases they are qualified psychological well-being practitioners who’ve undertaken a year’s full time postgraduate training at university on top of a psychology degree or degree in nursing or social work. You are correct they are not medical doctors (I don’t think anyone would expect to be assessed initially by a psychiatrist!).

To qualify as an accredited CBT therapist and be on the BABCP register (which is mandatory to work as a CBT therapist in an NHS service) it’s not a ‘college course’, it’s a year’s postgraduate training full time at university while working, on top of a profession in social work or nursing or, again, a psychology degree (and most have also qualified previously as a PWP).

The vast majority of services use qualified PWPs for assessments, not admin staff! Anyone can ask for the qualifications of the person assessing them.

I felt it was similar to calling 111.
"Are you suicidal? No? Well you only qualify for three sessions of telephone CBT. Bye!"

Definitely report back to your GP.

HRH2020

It really saddens me to hear of experiences with some of the crappier more poorly funded IAPTs elsewhere in the country. In my local one where I used to work it was fantastic, patients had access to a full course of face to face therapy (up to twenty hour-long sessions, for either CBT or counselling), six to eight 45 min sessions with a qualified PWP, or psychoed groups, and people weren’t forced into things like groups or phone work unless that was their choice. Services that can only afford to offer four half hour sessions do so little good and are just pushing the problem down the road, creating a revolving door of clients who need to keep returning as nothing is ever resolved. It takes time to do proper therapy, I wish all services were like the one I’m familiar with (and I worry that reading the valid experiences of people who went to a shitty one will put someone off trying it for themselves when they might actually be in an area with good provision and the ability to have six months of therapy).

"Anyone can ask for the qualifications of the person assessing them."

Exactly that's how I know how it is in the services in my area. In addition I used to work in an allied profession- I can state with 100% certainty there are people working in mental health without postgraduate level qualifications.

But don't take my word for it, the admin signs off with her full title in letters "xyz service admin support officer"

Ah i see. Well yeah, that’s shit. Not aligned with the IAPT model at all but the result of being woefully underfunded I assume. Very glad the IAPTs within my local trust all insist on being properly qualified as a requirement of employment, it’s dangerous otherwise.

Hi @StripeyTopRedLips. It appears that your trust may have been stricter than most, or that things have changed, because I got my information from the NHS website and from someone else who works in the field and is getting frustrated with the damage done to his clients by insufficiency-trained PWPs. This is what I found:

“Entry requirements and experience needed

Training places are open to either:

- people from the local community, with a wide range of life experience who will be trained to a graduate level. An apprenticeship is a great opportunity for people without a degree to undertake the training

- graduates or those who can demonstrate that they can meet the academic requirements of the post graduate level qualification

Experience of working with people with mental health problems is desirable, excellent interpersonal skills are essential.

www.healthcareers.nhs.uk/explore-roles/psychological-therapies/roles/psychological-wellbeing-practitioner

The link says nothing about having to have a relevant degree or core profession, and indeed, it states that experience of working with people with mental health issues is only ‘desirable’ .

It sounds like your trust was doing it as it should be done, but unfortunately that doesn’t appear to be a national requirement, and people are suffering because of it .

When I had a bout of depression, I was referred for talking therapy, as well as medication and the sessions were all face to face. It wasn’t the same person each time, but that was OK.

We moved area and I had another episode. This time the talking therapy was only available on a phone basis. I didn’t find it helpful at all and stopped after a few sessions. I try to go back to the techniques and mindfulness I did originally, because the phone calls and filling in questionnaires without being able to see and discuss with a person, really didn’t work for me.

I feel for you OP.

I’m sorry to hear this. I’m waiting on a telephone consultation with them too, not looking forward to it now