Danyon Chesters

Me From Jackie Doyle-Price MP

Departm ent Parliamentary Under Secretary of State for Mental Health,

inequalities and Suicide Prevention

of Health &
Social Care 39 Victoria Stet
SWIHOEU
Your Ref: 10727/CH 020 7210 4850

Our Ref: PFD-1169006

Ms Alison Patricia Mutch OBE
HM Senior Coroner, Manchester South
HM Coroner's Court
1 Mount Tabor Street
Stockport SKI 3AG
20" May 2019

Thank you for your correspondence of 26 February to Matt Hancock about the death
of Mr Danyon Robert Chesters. I am responding as Minister with responsibility for
mental health and I am grateful for the additional time in which to do so.

I was very sorry to read of the circumstances of Mr Chesters death. I appreciate his
loss must be extremely distressing for his family and loved ones and I offer my
sincerest condolences.

I have noted carefully the matters of concer raised. It is essential that we look to
make improvements where we can to ensure the safety of healthcare and prevent
future deaths and I am grateful to you for bringing these matters to my attention.

My officials have made enquiries with NHS England, the Royal College of
Psychiatrists and the British Association for Counselling and Psychotherapy
in advising me about this response.

Firstly, I note that Mr Chesters chose to access private mental health therapy after
being advised of a significant waiting time for NHS treatment. The decision to
access private treatment is, of course, a personal one, and one that can be made for
many reasons. However, it is regrettable if such a decision is influenced by
difficulties in accessing NHS treatment.

It is the responsibility of the local NHS to commission services to meet the needs of
their local populations. With regard to access to psychological therapies, one of the
stated targets of the Improving Access to Psychological Therapies (IAPT)
programme is that for new referrals, 75 per cent of people referred will enter
treatment within six weeks, and 95 per cent within 18 weeks.

Published figures for February 2019' show that, for those who completed a course of
IAPT treatment, a national average of 88.6 per cent had waited less than six weeks to
enter treatment, and 98.8 per cent of people had waited less than 18 weeks, from the
point of referral, both figures above target.

The IAPT programme began in 2008 and has transformed treatment of adult anxiety
disorders and depression in England. IAPT services offer a range of therapies
recommended by the National Institute for Health and Care Excellence (NICE) for
depression and anxiety disorders, in line with a stepped care model, when
appropriately indicated.

The Five Year Forward View for Mental Health’ set out a commitment to expand
IAPT services and improve quality further, with an ambition to increase access to
psychological therapies for an additional 600,000 people with common mental health
problems each year.

As well as investing more in IAPT, we are supporting the NHS with an additional
£2.3billion investment in real terms by 2023-24 in a comprehensive expansion of
mental health services. Outlined in the NHS Long Term Plan’ published in January
2019, this includes an expansion of community services and better access to
psychological interventions in the community and primary care.

Turning to the concerns about the co-ordination of care when a patient accesses
private mental health therapy, I am advised that private therapists, such as counsellors
and psychotherapists, will often take GP details from a client in order to be able to
contact them should they have concerns, for example, around risk of suicide or
serious harm. However, counsellors and psychotherapists in general are not
medically trained and would not become involved with any medication that a client
may have been prescribed.

? pttps://www england. nhs.uk/wp-content/uploads/20 1 6/02/Mental-Health-Taskforce-FYFV-final.pdf
> hitps://www,longtermplan.nhs.uk/

As you will know, private therapy is an unregulated occupation and can encompass a
range of practitioners, from those who may have undertaken correspondence courses
with educational institutions to highly qualified psychotherapists. Clients wishing to
access private therapy are advised to enquire about a potential therapists’
qualifications and experience.

The UK Council for Psychotherapy, the British Psychoanalytical Council and the
British Association of Counselling and Psychotherapy provide accredited registers of
practitioners who have met their standards and voluntarily signed up to their
respective codes of practice and ethical conduct.

The British Association of Counselling and Psychotherapy for example, provides an
ethical framework within which all its members are expected to operate, underpinned
by good practice resources. This includes guidance on managing confidentiality and
identifying situations where confidentiality may need to be breached*,

Your report does not indicate if Mr Chesters’ therapist had concerns about suicidal
ideation or intention. However, it may be useful to note that specific advice is given
where a client is identified at risk of suicide or serious self-harm.

The guidance acknowledges that ‘...this is one of the most challenging situations
encountered by counsellors, with the ethical management of confidentiality
inextricably linked to decisions about when to act in order to attempt to preserve life
and when to remain silent out of respect for a client's autonomy’.

The guidance advises counsellors to be explicit about reserving the power to breach
confidentiality for a suicidal adult client, for example building an appropriate
agreement in a counselling contract at the start of therapy, which can also include
agreement on who might be contacted should a client present at high risk, such as the
clients’ GP or crisis team. In addition:

‘Referral may be defensible in the public interest where the therapist holds a
reasonable belief that the client or others are at immediate risk of serious harm.
However, careful consideration needs to be given to the seriousness and immediacy
of the risk, the ethics of the situation, consent issues, and the appropriate action to be
taken’.

Furthermore, counsellors are advised to act within the scope of their personal
expertise, and to consider their own limitations, giving consideration to onward

referral with the client’s consent. It might be appropriate for example, to contact the
client’s GP to express specific concems about the nature of the risk and to discuss
how to respond to the client. Alternatively, and if appropriate, it might be possible to
contact a mental health crisis team who could consider a range of responses with the
practitioner and the client. Where a client does not consent to referral, and if the
client or others may be at risk of harm, the therapist should seek professional advice.

Suicide prevention is a key priority for this Government and we have set out clear
recommendations to the NHS on suicide prevention and reduction in the National
Suicide Prevention Strategy’ (2012), and the Cross-Government suicide prevention
plan (2019)*, However, suicide prevention and reduction should be a priority for all
who work with people with mental health problems, including counselling
professionals. I am pleased to note that the British Association of Counselling and
Psychotherapy has issued guidance to its members on ‘Working with Suicidal Clients
in the Counselling professions”.

I hope this information is helpful.

—_—

JACKIE DOYLE-PRICE

D s//www pov,uk/government/publications/syicide-prevention-stratery -for-england
D ://wwnw gov uk/government/publications/suicide-prevention- vernment-plan

7 https: .bacp.co.uk/media/2157/bacp-working-with-suicidal ts-fact-sheet- od