Mental health care should not be reduced to performance targets, argues Claudia Turbet-Delof, ahead of today’s online conference.

Every patient in the NHS deserves to understand how the Talking Therapies model currently delivers mental health care across the UK.

This model—formerly known as IAPT (Improving Access to Psychological Therapies)—has been rolled out nationally over the past decade to expand access to mental health support. It has undeniably increased the number of people able to access therapy. However, the data also tells a more concerning story.

Across many NHS trusts, drop-out rates from Talking Therapies range between 40% and 70%. This means that while many people are referred for therapy, a large proportion never complete treatment. In many cases, people disengage after only one or two sessions.

Importantly, this information is publicly available. The NHS provides live data dashboards where anyone can explore how Talking Therapies services are performing across the country and in their local area.

These dashboards allow patients, clinicians and the public to see referral numbers, treatment completion and outcomes for each NHS trust. Anyone can zoom in and see how the current model of therapy delivery is working in their local area.

While increased access to therapy is welcome, the scale of disengagement raises urgent questions about whether the current delivery model truly meets the needs of patients.

Our campaign recognises that therapy—of any kind—is deeply needed. However, when a system consistently shows over 50% drop-out rates in many areas, it demands urgent review.

This conversation is particularly important now. The Government’s 10-Year NHS Plan is expected to expand community-based mental health care. As this happens, we must ensure that services offer a diversity of therapeutic models, rather than relying heavily on a single standardised approach focused on measurable ‘progress’ and data metrics.

Mental health care should not be reduced to performance targets. Therapy must allow space for patients to express when they are not feeling improvement and to have that experience recognised as part of their process.

I say this also as someone working within the mental health sector and seeing day in and day out the impact of long waiting lists. I am a Registered Person-Centred Counsellor (BACP); I know first-hand how valuable therapy can be for many people. But I also know that Talking Therapies are not the only pathway to mental health support, healing, and inclusive care. Communities heal in many ways—through relational therapies, long-term counselling, peer support, community-based approaches and culturally grounded practices. If we are serious about improving mental health outcomes, we must recognise that one model cannot meet the needs of everyone.

During my own experience working and training within IAPT services, I encountered practices that raised serious ethical concerns. At one stage it was suggested that if a patient reported they were not feeling improvement in their therapy, I should encourage them to reconsider their rating and mark their progress as “improving”, particularly because services were required to demonstrate a 55% recovery rate in order to maintain their contract.

I have never seen a written policy requiring this. What I describe is based on my personal experience over more than ten years ago as a trainee. At the time I raised concerns because I believed this risked distorting patient feedback and undermining trust. It felt abusive. 

For me, this became a turning point and the Talking Therapies model became something I felt strongly needed deeper scrutiny.

Before my suspension from the Labour Party, I served on the North East London Health Scrutiny Committee, where I secured—after some persuasion—a commitment from NHS England representatives to review aspects of the Talking Therapies model.

Because of my suspension, I was unfortunately removed from that seat in North East London Health Scrutiny, which meant I was unable to follow this work through directly.

However, I have continued to raise this issue wherever possible. I have pressed these concerns in the Health in Hackney Scrutiny Commission, and in my role as a Governor of Homerton Healthcare NHS Foundation Trust.

For several years now, I and many colleagues have consistently raised concerns about the high drop-out rates within Talking Therapies services. This has not only been my concern alone. Comrades and mental health colleagues from the Mental Health Action Group have raised these issues with every Integrated Care Board (ICB) across the country, writing directly to them about the implications of these figures and the urgent need for review.

Despite these consistent warnings, I remain disappointed to see that the Talking Therapies model continues to be prominent within the delivery package for community mental health services.

I hope that proper scrutiny and review of these drop-out rates has taken place. It is also important to ask whether some of the funds currently used to sustain services with persistently high disengagement rates could be redirected towards community organisations that day in and day out provide vital mental health and wellbeing support for our communities.

Across the country, grassroots groups, peer networks, and culturally grounded organisations are already supporting people through crisis, trauma and isolation—often with very limited funding.

At the same time, we continue to hear that the UK faces a major mental health crisis, with growing waiting lists, particularly among young people. We cannot continue to speak about this crisis while maintaining and expanding a model that, in many places, has struggled to deliver meaningful engagement since its inception.

If we are serious about tackling the mental health crisis, we must be willing to review existing models honestly and invest in diverse approaches to care, including those rooted in communities, relationships and long-term support.

Mental health care must be built on trust, empathy and human connection.

If the NHS is to meet the scale of the mental health crisis facing our communities, we must move beyond one-size-fits-all solutions and build services that recognise the complexity of people’s lives, experiences and healing journeys.

Compassion should never be treated as a luxury within our health system. It should be its foundation.

Join the conversation

These questions are at the heart of today’s public event exploring the future of mental health care in the NHS.

“NHS Mental Healthcare: The Erosion of Compassion and Empathic Care” will bring together practitioners, campaigners and members of the public to discuss how mental health services are currently delivered, what the data is telling us, and how we can move towards models of care that prioritise empathy, inclusion and meaningful therapeutic relationships.

The discussion will explore the realities behind the Talking Therapies system, the implications of high drop-out rates, and the need for greater diversity in therapeutic approaches as the NHS moves towards expanding community-based mental health services.

This conversation is open to patients, therapists, NHS staff, community organisations and anyone concerned about the future of compassionate mental health care.

Find more information and register here.

Mental health care affects us all. If we want a system rooted in compassion, empathy and real healing, we must be part of shaping it.

Further information

Join Mental Health Action
https://mentalhealthaction.uk/

Letters to Integrated Care Boards on NHS Talking Therapies
https://mentalhealthaction.uk/list-of-open-letters-on-the-failings-of-nhs-talking-therapies-by-icb-area/

NHS Talking Therapies Data Dashboards
https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/mental-health-data-hub/dashboards/nhs-talking-therapies

NHS 10-Year Health Plan
https://assets.publishing.service.gov.uk/media/6888a0b1a11f859994409147/fit-for-the-future-10-year-health-plan-for-england.pdf

Claudia Turbet-Delof is a Hackney Socialist Independent Councillor, a MBACP Registered Person Centred Counsellor and Community Therapist at The Counselling Space. Twitter @madeinbolivia / @HackneyIndSG