Writer: Altay Shaw
Editor: Savina Hui
As it currently stands, the current referral time to seek psychiatric services in the United Kingdom is around 18 weeks, with about 75% of patients being seen in that time. Whilst on the surface that may not seem all that bad, it is important to note that the figure only refers to those who seek help from their doctor, meaning the true number of those who actually access services might be closer to 30%.
The more worrying aspect of these referrals is that the majority of contact made by patients amounts to a single individual session with no set target for further intervention. This may only be a single call to a crisis line or a single discussion with a doctor or counsellor, with little to no plans put in place to ensure there is a safety net for patients in the future. As such, there is a critical need to have a structured approach to initial referrals and continued care for patients with acute mental health needs.
Thus, health services around the world need to focus on the initial outreach and outcome for patients within that first session. Though the standard course of intervention for mental health conditions last a few weeks, retention of patients remains an issue. In 2024, Nuffield Trust reported that as few as 37% of individuals who were referred actually completed their treatment. Yet at the same time, the yearly referrals to services are increasing at around 4%, meaning more appointments but less adherence and engagement with services to see a meaningful improvement.
This typically moves the focus towards seeking pharmacological interventions. In the cases of anxiety and depression, this means antidepressants. The NHS Business Services Authority (NHSBA) report for 2023/24 showed that about 8.9 million individuals are currently on antidepressants. Whilst effective, these patients can be left on them for years, potentially leading to horrible withdrawal effects.
To help ensure patients are fully educated and know the options available to them, an anchoring system needs to be introduced for patients. Single session interventions (SSIs) are defined as “structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program”.Whilst it usually refers to phobias or education, it can also be thought of as an umbrella term, focused on delivering concise and clear information/treatment dependent on the patients’ needs.
As the SSIs are more flexible and can be tailored specifically to the condition, they can also be delivered in a variety of different settings and by a number of different professionals. These sessions can also be used to increase engagement with services, especially crisis services for patients who are experiencing acute episodes. However, limited data exists to show whether it is solely the SSIs that produce this effect or, if it is a combination of the care providers and the patients who were referred onto these specific pathways.
A meta-analysis of the data, suggested that SSIs show notable improvements for patients with depression, especially for young adults and children. Though the improvements were clinically significant, the review stated that it was hard to draw accurate conclusions as the providers and socioeconomic factors had not been consistently controlled. Although the latter seemed to show a lack of variance in outcomes, it still remains critical for future providers of SSIs to consider before providing them.
As such, SSIs roles appear to serve a smaller focused target. Predominantly as an anchor point for interventions to be implemented upon and not as a substitute for longer interventions such as guided self-help and talking therapies. There also needs to be a greater importance placed on providing access to services rather than simple discussion of them.
kinesismagazine.com 