Is Bipolar Disorder Worked With in NHS Talking Therapies, and What Are the Views of Staff and Service Users? Results From a Linked Staff and Service User Survey and Freedom of Information Request

Abstract

CBT is effective for Bipolar Disorder (BD), however there is often poor access. Despite IAPT-SMI pilot sites, there has been no roll out of CBT for BD in NHS Talking Therapies Services. This study aimed to examine the extent to which BD is seen in these services. A survey was conducted of 147 service users with BD and 106 staff. A freedom of information request was also responded to by 48 NHS trusts. Forty-nine percent of those with BD had tried to access NHS Talking Therapies, with this being before a formal diagnosis for 42% of those who had tried to access. 29% were told that they could not be worked with as they had BD. Main reasons for referral were depression followed by anxiety disorders and PTSD. Staff surveys and FOI requests showed that relapse prevention work was rarely conducted with BD though comorbid conditions in particular anxiety and PTSD were often treated. BD was rarely routinely screened for, and staff were rarely trained about working with BD specifically. FOI requests showed that a formal BD diagnosis made up only 0.2% of overall referrals, with those with BD being significantly more likely to be discharged after an initial assessment (OR = 4.69). There are few people with a formal BD diagnosis seen within NHS Talking Therapies services, however, increased screening may help with earlier diagnosis of those who present with depression. Comorbid anxiety and PTSD are usually worked with in these services. Staff have limited confidence and additional training is warranted.