Informing the mental health strategy for England

BABCP submission to DHSC call for evidence on Informing the mental health strategy for England

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) is the lead organisation for Cognitive Behavioural Therapy (CBT) in the UK and Ireland. Our mission is to support the development of CBT, and those who deliver it, to improve the mental health of people across the UK and Ireland.

As the leading organisation for CBT in the UK and Ireland with over 26,000 members, we are committed to promoting the highest standards of CBT practice, training, and supervision. We hold all our members to the highest professional standards, which they commit to by adhering to our Standards of Conduct, Performance, and Ethics. Alongside the Association for Rational Emotive Behaviour Therapy (AREBT) we keep the CBT Register UK and Ireland. This is the only officially recognised register of BABCP and AREBT accredited CBT therapists, supervisors and trainers, and evidence-based Parent Trainers. The CBT Register is a Professional Standards Authority (PSA) Accredited register. BABCP also provides individual registration schemes for Psychological Wellbeing Practitioners (PWPs), Children’s Wellbeing Practitioners (CWPs), Mental Health Wellbeing Practitioners (MHWPs), Education Mental Health Practitioners (EMHPs); and Evidence Based Parent Trainers (EBPTs) Accreditation. These registration schemes are approved by NHS England.

Our role in accrediting and registering CBT therapists, PWPs and, of relevance to this inquiry, CWPs and EMHPs provide us with a privileged overview of the people that our members work with, including children and young people in community, healthcare and education settings.

Hospital to community

Effective partnership working at a community level is essential for the provision of person-centred care. These partnerships address the broad range of factors which can influence a person’s mental health recovery, such as:

• physical health
• employment
• housing
• addiction
• social care

We are piloting six community-based mental health centres across England to understand how services can better work together at a local level to improve people’s outcomes. We would like to hear practical insights that support wider transformation of mental health care in communities.

We welcome practical examples and evidence on how mental health services can work more effectively across:

• the wider NHS, including new neighbourhood health centres
• services to support people with co-occurring mental health and neurodevelopmental conditions
• different sectors, including education, employers, local authorities and the voluntary, community and social enterprise (VCSE) sector

BABCP welcomed the move to community care from hospital-based when the 10-year plan was launched. However, for community support to be effective, there need to be enough resources in the community and access to evidence-based treatments as well as safe and accessible infrastructure. While some progress has made, some key barriers that remain include the long-term lack of staff and funding for mental health services so that people can afford to work in care services long term (1).

We welcome views or evidence on what further support, in addition to NHS services, should be provided for people with severe and enduring mental illness to:

• help them stay well
• maintain participation in education, work and community life
• avoid crisis and/or hospital admission
• reduce length of stay in inpatient units

There is good evidence showing that CBT can improve the symptoms of many severe and enduring mental health illnesses including psychosis, personality disorders or eating disorders. NICE guidelines establish that adults with psychosis or schizophrenia should be offered cognitive behavioural therapy for psychosis (CBTp) stating that “CBTp in conjunction with antipsychotic medication, or on its own if medication is declined, can improve outcomes such as psychotic symptoms” (2).

CBT has proven to be effective in reducing symptoms and improving functioning in various personality disorders, as this papers outlines (3).

Furthermore, NICE guidelines also recommend Dialectical Behavioural Therapy (DBT) for those with borderline personality disorder (4).

Similarly, NICE also recommends CBT for Eating Disorders (CBT-ED) as the psychological treatment for children and adults with eating disorders.

Most recently, Mental Health Wellbeing Practitioners (MHWPs) have specifically been added to support those with severe and enduring mental health conditions get improved access to brief, psychologically informed interventions aimed at improving wellbeing, motivation, confidence and coping skills, while also supporting collaborative care planning within a multidisciplinary team.

To reduce crisis episodes, there is a need for those with severe and enduring mental health illness to receive treatment that can prevent suicide and self-harm. According to an umbrella review, there is evidence that CBT has a positive influence on suicide, including suicidal ideation and suicide attempts (5).

The Government should consider adding more capacity for this area of workforce as this will add benefit and accessibility to those with severe and enduring mental illness contributing to potentially avoiding crisis and hospital admissions and facilitating participation in everyday life.

Significant barriers persist in specialist services, including long waiting times, regional inequalities and individual characteristics inequalities, rising thresholds for CAMHS, and challenging transitions to adult services (6).

There is a need for continuous investment in the workforce which is definitely in need of investment and continuous resourcing. For example, demand for children and young people’s mental health services has increased substantially in recent years, with large numbers of young people in contact with NHS services annually and continued upward pressure on referrals (7). However, higher demand has not been met with adequate resourcing of mental health provision able to deliver the care that is needed.  In 2023/24, there were 78,577 young people waiting over a year for mental health treatment from the NHS, with 44% of these waiting over two years (8).

We believe that the introduction of CBT-informed approaches in the community delivered by Psychological Wellbeing Practitioners (PWPs), Children’s Wellbeing Practitioners (CWPs), Mental Health Wellbeing Practitioners (MHWPs) and CBT Psychotherapists as well as Education Mental Health Practitioners (EMHPs) in education settings have been beneficial. However, systems aren’t sufficiently resourced and waiting lists are too long.

Workforce expansion, continued service transformation, strengthened stepped‑care pathways, improved GP training, and better coordination across education, NHS and community provision are crucial to ensuring continuity of care (9).

Analogue to digital

It’s important that children and adults can benefit from the opportunities that digital technology can offer to boost mental health and wellbeing. However, this must be balanced with safety and protection from risks to mental health.

We understand that many people would like:

• more personalised, tailored mental health support available digitally

• digital tools to be neuroinclusive (accessible and effective for people with neurodevelopmental conditions)

A 2025 report from Mental Health UK stated that people are also increasingly turning to AI chatbots for mental health advice.

We welcome evidence and innovative examples of how digital and AI tools can be safely used for adults and children to:

• improve mental health and wider societal outcomes

• support access to effective mental health support

• complement relational care

There is strong evidence that CBT can be digitally delivered successfully (10).

However, there are issues around accessibility as only those with digital literacy skills, with access to a computer, reliable internet connection as well as privacy and data security would be able to access it. CBTi would need adaptations and a clinician to oversee and be accountable for the treatment, and inclusion of full, evidence-based risk assessment, suicide and self-harm prevention planning as part of any digital delivery. Access to other accessibility needs, such as interpreters should be equivalent to ‘in person’ face to face options.

NICE has issued guidance for computerised CBT (11) and specific ones for children and young people (12).

BABCP has also issued guidance to members for online provision of CBT (13).

NICE also recently announced that it is recommending online help for adults with eating disorders while on the waiting list (14).

BABCP is aware of one study which showed considerably better outcomes for patients that used an AI-enabled therapy support tool alongside Cognitive Behavioural Therapy (CBT) Treatment. The tool was piloted with patients undergoing CBT treatment in the National Health Service (NHS) Talking Therapies services. The study revealed that  patients who used the tool achieved  higher rates of reliable improvement (94.3% vs. 69.8% in the control group) and reliable recovery (71.4% vs. 50.7% in the control group), suggesting that the use of AI-enabled therapy support tools in talking therapy can lead to increased patient engagement, better treatment outcomes and reduced cost of service delivery (15).

The Government should invest in the analysis of the data from NHS Talking therapies as it could lead to improved patient outcomes. BABCP understands that at the moment, the data is being collected but not analysed. There is a clear need to analyse the success examples and to learn from those and mirror them in different Trusts. (16)(17)

It will be important to do session by session monitoring as often as possible to enhance NHS Talking therapies data monitoring and improving outcomes – especially for those experiencing barriers to care. (18)(19)

While some data has already been used to improve the talking therapies manual to give better guidance on improving equalities (20) more work has to be done to continue working on the data to ensure we can use it to improve mental health services. For example, data reporting for CYPMHS is not as good as NHS Talking Therapy as it is not comprehensively collected in one place with outcomes broken down by type of therapy, mental health condition, etc. The Government and the NHS would benefit from creating a similar database for CYPMHS than the one that is currently available for NHS Talking Therapies for adults.

Sickness to prevention

The incidence and severity of mental health conditions has risen in recent decades, with young adults in particular now reporting substantially poorer mental health. Data from NHS England’s ‘Survey of mental health and wellbeing, England 2023 to 2024’ stated that 25.8% of young people are estimated to have a common mental health condition, up from 17.5% in 2007.

Many of the solutions to mental health problems involve education, employment, housing and participation in community life. Therefore, if prevention is to be effective, we need to think beyond the realms of clinical care and across the life course.

We are especially interested in how we can identify distress earlier and support people to maintain participation in education and work. Preventative approaches include:

• primary prevention – stopping mental health problems before they start

• secondary prevention – supporting those at higher risk of experiencing mental health problems

• tertiary prevention – helping people living with mental health problems to stay well

We encourage examples of good practice within and beyond the health system, including in work and education settings where people with a co-occurring mental health and neurodevelopmental condition may particularly benefit.

There is strong evidence that CBT reduces the incidence, when used as a preventative measure, or the severity of mental health problems. A 2026 study in the US confirmed that Digital CBT reduced the prevalence of having anxiety, depression and/or an eating disorder through 2 years of follow up and substantially increased service utilisation (20).

Several other studies have confirmed that the use of CBT was associated with reductions in mental health problems including anxiety, depression, OCD, phobias, PTSD or eating disorders (21). However, more efforts need to be made in the provision of preventative care for other conditions such as psychosis (22). There are currently gaps in provision of CBT for psychosis and schizophrenia and other severe mental health problems despite NICE guidelines recommending it and it being part of the Community mental health framework for adults.

It is crucial to use evidence-based therapies, such as CBT early on in a person’s life as evidence consistently shows that around 50 percent of lifetime mental health conditions emerge before age 14, and approximately 75 percent by the mid-20s (23) underscoring the importance of prevention and early intervention.  Initiatives from the government such as the Mental Health Support Teams (MHSTs), Early Support Hubs or Youth Matters which can deliver evidence-based therapy, such as CBT outside of schools and in their community – e.g. youth services, local clubs etc and are crucial to prevent mental health issues from escalating. However, it is important to continue expanding this in every school and local authority and to ensure that CBT therapy, delivered by accredited or registered therapists, is offered, in line with current NICE guidelines.

Another key preventative measure is to embed health awareness in every area of society from early years to older adult care, and in relevance to this case in the transition to adulthood. This will provide young people with an opportunity to take care of their mental health by building it into school curricula, acting as a preventative tool allowing early.

Several studies have concluded that CBT is effective in reducing suicidal ideation and suicide attempts including among patients with depression thus reducing the number of lives lost to suicide.  CBT is scalable and cost-effective and personalised CBT programmed could be integrated into comprehensive suicide prevention strategies (24) (25).

Telehealth Brief Cognitive Behavioral Therapy for Suicide Prevention (26)
NICE guideline NG105 – Preventing suicide in community and custodial settings: Evidence review 8 for suicide awareness
campaigns (27)

Suicide has also been proven to affect more men than women (28) so it is crucial for any approach to be tailored to the needs of men; particularly encouraging men to seek help as when they do access services such as NHS Talking Therapies, the outcomes are comparable to those of women (29) (30). The Government should consider partnering with men’s mental health and suicide prevention charities to promote organisations that are reducing stigma and where men are actually accessing help, and providing additional NHS support to those settings (e.g. getting the evidence out there, providing/contributing to educational, screening, stigma-reducing and health-promoting activities)  including Andy’s Man Club and MIND.

There has to be a continued investment and increase in evidence-based therapies, such as CBT in the community, education, and clinical settings. Ensuring there is access to CBT at all levels would allow those who are struggling with their mental health but may not meet the criteria to access help.

There should also be an increase on CBT-i provision as it has proven to be an effective preventative intervention in the workplace to improve engagement and psychological outcomes (31).

Another important way in which the Government could reach the missing middle is through CBT-informed self-help. The Reading Well is a very useful initiative which includes resources to help people manage their health and wellbeing. The books included are recommended by experts. BABCP has contributed in the past – most recently in 2026- to its consultation to ensure the materials are relevant (32).

Factors enabling good practice

Too often, we hear that services are hindered by administrative barriers that prevent innovative, integrated and person-centred care. We are interested in the underlying enablers of good practice around the country, and the role national government can play in creating the conditions for reformed models of mental health support.

We are particularly interested to understand how access can be improved, for example through therapeutic support for certain groups such as women and girls subject to violence and/or child sexual abuse.

It is crucial to continue funding NHS Talking Therapies ensuring that the service is adequately resourced to keep up with increasing demand. It is also important that those employed to provide mental health support, such as low intensity or high intensity CBT, are adequately registered and accredited with BABCP to ensure that they met the required standards of knowledge and practice, ensuring public safety by being in an PSA-Accredited register.

As expressed earlier, it is also crucial to invest in data to ensure that it is used to improve outcomes. This study shows that NHS Talking Therapies services can simultaneously improve recovery rates and reduce unwarranted differences between therapists by systematically using outcome data and fostering a culture of continuous learning (33).

This study demonstrates how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. It concludes that integrating process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective (34).