Vulnerable patients at risk as therapy sessions end
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Mental health organisations have raised concern about guidelines for fixed terms of talk therapy after the suicide of a young woman from Camden, who killed herself two weeks after her therapy sessions came to an end.
At an inquest into the death of 24-year-old Anushka Natalia Van Staden-Voce, from West Hampstead, the coroner recommended that in the future closer attention should be paid to patients nearing the end of courses of treatment.
Student Anushka, who was from West Hampstead, was treated at the Dartmouth Park Unit in Highgate Mental Health Centre for two years before her death.
Her devastated parents asked whether fixed-terms of therapy could be circumvented to avoid similar tragedies in the future.
Currently, the National Institute for Health and Clinical Excellence (NICE) offers guidelines for the duration of therapy needed for specific mental health disorders, but it is up to individual NHS trusts to determine the exact course.
For a borderline personality disorder, which Anushka had been diagnosed with, NICE leaves it up to a patient’s doctor to determine the length of treatment based on the local mental health trust’s resources.
The length of therapy for cases countrywide is determined at the start of treatment and sometimes includes the chance of an extension of up to four months.
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Anushka’s doctors had decided on an 18-month treatment period and she was given the maximum extension of four months. But as her two year therapy course came to an end, her family and friends said the young woman - who they remember as “utterly genuine, empathetic, fun and gentle” – became withdrawn, spiralling into depression that her doctors did not pick up on.
Along with her parents, Anushka’s friends said they felt that more should have been done.
Close friend Lottie McGann said: “I believe that something needs to be changed in regards to the after care and treatment for those suffering with her disorder, as well as others.”
Bridget O’Connell, head of information at the mental health charity Mind, said that access to the right therapy for the right amount of time can have a huge impact on how effective treatment is.
“For people who don’t improve after their allocated block of treatment is finished, it’s essential that they can access alternative types of counselling or treatment, for the duration they need it in order to get better,” she explained.
She added that as well as paying close attention to the end of therapy, more needs to be done to get people into therapy in the first place.
Ms O’Connell noted that according to research conducted by Mind, one-in-five people who have a mental health diagnosis wait more than a year to receive treatment.
Marjorie Wallace, chief executive of the mental health charity SANE, said that although the NHS faces constraints, there are instances where flexibility is key. She said: “Unfortunately the NHS cannot afford indefinite therapy for everyone, but there are cases where flexibility is critical and special care should be devoted to offering adequate support when therapy does come to an end.”
She added that the complexities of borderline personality disorders mean that there are no other kinds of effective treatment available and improvement depends on trust between a patient and his or her therapist.
She said: “We hope that tragic deaths of people like Anushka can be avoided by increased regard for the fact that people with personality disorders can be equally at risk as anyone with a comparative physical or mental illness.”