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Bullying Culture in NHS Mental Health Services Putting Vulnerable Patients at Risk

Issued: 25th September 2014 by BABCP Board


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. Frightened 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.'

3 Replies

Hi ya! It is good that this matter is finally brought to light. However, as to what they will do about it is another :-( Patients are scared and not quite sure who to trust and fear the backlash of speaking out.. After all they have to live with it on a daily basis :-(


Thank you for your response. Have you had such an experience and if so, would you like to talk about this here or more privately?

Be well!


1 like

Will consider this and get back to you. Thanks