Leeds and York Partnership NHS Foundation Trust

7. Miss X complains that Leeds and York Partnership NHS Foundation Trust (the Trust) failed to provide the appropriate care and treatment throughout 2023. She complains:

• the Trust used exposure therapy over a two-year period despite clear evidence, feedback and clinical notes acknowledging that this approach was ineffective and only making her illnesses and symptoms deteriorate • she was discharged from Community Mental Health Teams (CMHT) at a point she felt worse than when she was referred • a request for a different therapist was refused • there are inaccuracies in her medical records • there were therapeutic interventions offered that were missed out or incomplete.

8. Miss X states the impact was that:

• she has agoraphobia and has been unable to leave the house since leaving treatment • she struggles with suicidal thoughts, depression, panic disorder and also been struggling with PTSD • she has trust in medical professionals.

9. Miss X states she would like an outcome of an apology and policy changes

10. Miss X has received treatment for her mental health since she was an adolescent and had a previous five-year involvement with Child and Adolescent Mental Health Services (CAMHS) before being discharged from this service in 2018.

11. From 2020 to 2021, Miss X had a block of therapy which explored formulation and the use of cognitive strategies to manage her mental health with the Community Mental Health Team (CMHT).

12. In 2022, a discharge plan was written for Miss X.

13. In 2022, Miss X was referred to medical psychotherapy. This was rejected due to Miss X having been very recently in therapy.

14. In early 2023, Miss X was offered a brief intervention of narrative exposure with three further top-up sessions which was then extended to ten sessions.

15. Miss X and her mother wanted to continue with CBT (cognitive behavioural therapy) rather than exposure therapy and expressed their concerns that exposure therapy was not working.

16. At the end of 2023, Miss X was discharged from CMHT after therapists expressed concerns, she was using the service as a way of not regaining her life.

22. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We consider any gaps between the two and whether this amounted to a maladministration or service failure.

23. If we identify a failing, we consider the impact and injustice on the aggrieved and if we can link this to the failing. We refer to this as ‘flowing from the claimed injustice’. We must be able to link this to reach a full decision.

24. Following this we then look to establish what the organisation has done to put matters right for the failing (the ‘remedy’).

25. If we consider more could be done, we may make a range of recommendations. Though we consider the individual circumstances of each complaint, it is for the Ombudsman to determine remedy that is fair, proportionate and reasonable.

26. Having done so, in some circumstances we have not found a maladministration or service failure, in other instances where we have seen a failing, we have found the Trust has already done enough to put right the impact of these events.

Exposure therapy

27. Miss X complains the Trust continued with its use of exposure therapy despite clear evidence and feedback from both her and her mother that this was making her illness and symptoms deteriorate.

28. NICE OCD guidance recommends that adults with anxiety, phobias, PTSD and OCD should be given cognitive behaviour therapy (CBT) and exposure and response presentation therapy (ERP) as part of their initial treatment. ERP is given so that by safely and gradually facing feared situations, people can reduce anxiety, break avoidance patterns, and build long lasting, long-term symptoms relief.

29. Miss X was originally offered a block of therapy which ended in 2021. During this time, she explored CBT and a number of interventions were offered which included exploration and formulation of her difficulties and exploring how she could use cognitive strategies to manage them.

30. At the end of Miss X’s block of therapy, discharge was considered. At this point Miss X was still struggling to move forward with her goals, continued to struggle with her mental health and due to having recent therapy her referral for further help elsewhere was rejected.

31. In early 2023, Miss X was offered three top-up sessions which was later extended to ten sessions to support Miss X with consolidating the work she had done in therapy. From the records we can see this was not intended as a further block of therapy but was intended to support Miss X in putting some of the changes discussed into practice which included working on ERP.

32. After discussion with our adviser, we understand it was entirely reasonable Miss X was offered exposure ERP and this was in line with policy and guidance.

33. From the discussion we also understand the cognitive strategies developed in Miss X’s block of therapy in 2021 are designed to be able to be applied and used for various different problems. ERP creates an environment that accesses an individual’s ‘fear mode’ in response to physical, social or psychological danger. Without this ‘fear mode’ it is difficult to practice the previous strategies developed as the environment would be too different.

34. From the records we can see Miss X struggled with ERP and there were limited gains made from this. We can also see the Trust made the decision to discharge Miss X from the service as it did not feel these interventions were working.

35. We are unable to comment on whether ERP made Miss X’s mental health worse and only whether the Trust correctly implemented ERP into Miss X’s treatment. This is because we understand Miss X was still struggling with her mental health after her CBT in 2021. We also understand how Miss X feels may be a subjective consideration and therefore we are unable to make a decision based on all the available evidence whether this is the case.

36. We consider the Trust acted in line with policy and guidance, making the correct decision when offering Miss X ERP treatment after carrying out CBT therapy. When this treatment did not have the desired effect Miss X was discharged from the service.

37. We do not see a gap between what should have happened and did happen in relation to this complaint.

38. For these reasons we will not consider this issue further.

Discharge and therapist

39. Miss X complains the Trust discharged her at a time she felt worse than when she was referred and her request for a different therapist was refused.

40. NHS England gives discharge guidelines for community-based mental health services which focuses on ensuring a safe, person-centred, and timely transition of care, typically aimed at supporting recovery in the patient’s home environment. It says discharge planning begins at the point of first contact, involving the patient, their careers, and community teams in the decision-making process.

41. The Trust worried Miss X had developed a long-standing dependency with mental health services and the community mental health teams. It was concerned continued contact with the community mental health teams would exacerbate her symptoms. It considered Miss X had said she did not feel her current treatment and The Trust’s current involvement was helpful and made the decision to end its involvement with her treatment.

42. The Trust made Miss X aware she was going to be discharged from the service and explained the reasons why. Miss X did not agree that this should happen and requested a different therapist.

43. The medical records show the mental health team made referral suggestions for other support options available however, Miss X did not agree to these referrals.

44. A multi-disciplinary team (MDT) meeting took place to discuss Miss X’s discharge and no interventions were identified.

45. Miss X’s request for a different therapist was considered at the MDT and rejected as the decision to discharge Miss X had already been made and the Trust did not feel adding a further therapist would be helpful to Miss X.

46. Following the MDT meeting Miss X’s care was then discharged back to her GP.

47. After discussing this with our adviser, we understand it was appropriate that Miss X be discharged back to her GP. We understand there were no immediate concerns regarding a risk to herself, and the process appeared safe and patient centred.

48. We also understand the Trust correctly followed NHS England’s discharge guidelines as it made Miss X aware that the further sessions given were short term top-up sessions. When the decision was made to discharge Miss X, both her and her mother were informed, and community teams and Miss X’s GP were also involved in the decision-making process as policy advises.

49. We consider the Trust acted in line with policy and guidance in its decision to discharge Miss X and refuse Miss X’s request for a new therapist. For this reason, we do not see a gap between what should have happened what did happen in relation to this complaint.

50. For this reason, we will not consider this complaint further.

Medical records

51. Miss X complains there were several incorrect entries in her clinical notes. She described a number of instances where she says details of symptoms and experiences were underrepresented. She also complains she found her notes did not always match her recollection of meetings she had.

52. NHSE records guidance says if something is factually incorrect such as a patient’s address or date of birth this should be changed as soon as the organisation is made aware and no later than one month after. Alternatively, if there is a disagreement between the patient and organisation, an organisation should not change the records if it believes the information to be factually correct.

53. NHS Complaint standards explain an organisation should attempt to resolve the issue quickly so that the person complaining feels listened to.

54. The Trust has apologised if Miss X feels its medical notes were not as detailed as she would like but explains these were not intended as verbatim accounts of clinical sessions. The Trust also explained it is not able to change clinical records unless they are factually incorrect but offered to add an addendum of Miss X’s complaints to the notes to reflect her concerns and views.

55. An addendum was added to Miss X’s medical records on 19 June 2025 which included her complaint response.

56. We consider the Trust correctly followed policy and guidance when it said it was unable to amend Miss X’s medical records as it believes them to be factually correct. We also consider the Trust correctly followed the NHS complaint standards by resolving the issue quickly and adding an addendum to Miss X’s records to allow a satisfying conclusion to her complaint.

57. For this reason, we do not see a gap between what should have happened what did happen in relation to this complaint. We will not consider this complaint any further.

Therapeutic interventions

58. Miss X complains during her block of therapy in 2023 there were a number of interventions that were offered by the Trust that were missed out or incomplete. She complains that she was not given an autism referral and that IBS CBT and a Values of life Questionnaire were never sent to her.

59. She also complains a number of formulation and cognitive strategies she wanted to be carried out during her block of therapy in 2023 were not complete. These included formulation work on her panic disorder, dissociation formulation, thought and cognitive work and formulation fainting.

60. When considering the medical records, we can see an autism referral was discussed with Miss X in November 2023 after she demonstrated traits of autism during her sessions. Miss X refused a referral for autism at the beginning November and again in the middle of November when this was discussed with her.

61. In its complaint response the Trust has accepted it did not send the Values of Life Questionnaire and the IBS CBT to Miss X and has apologised for this. We can also see it offered to send this to Miss X during the complaint correspondence in March 2025.

62. The Trust says there was not a cognitive approach during the top-up sessions offered in 2023 and focusing on this approach would have taken away from the agreed focus of the top-up sessions which was to explore exposure and response presentation therapy.

63. There was a significant range of cognitive strategies utilised during Miss X’s previous therapy in 2021. After a discussion with our adviser, we understand further work on these difficulties, dissociation and fear of fainting would have been outside of the remit of the top-up sessions that were being offered.

64. We consider it was reasonable the Trust did not focus on these cognitive strategies during Miss X’s top-up sessions in 2023 and instead focused on an ERP approach and therefore do not see a failing in the missing work Miss X says the Trust did not focus on.

65. We consider there was no failing in Miss X’s autism referral as the Trust offered a referral for this on multiple occasions which Miss X rejected.

66. In relation to Miss X’s complaint the Trust did not send her the Values of Life Questionnaire and the IBS CBT we consider the Trust has already done enough to put this right.

67. Having identified a missed opportunity to send documents earlier the Trust has now offered to send these documents to Miss X. Here we have seen an apology and an offer from the Trust to send these documents to provide Miss X with the information she previously did not have.

68. We consider this to be fair, proportionate and reasonable and that the Trust have done enough to put this right.

69. For these reasons we will not consider this complaint any further.

Conclusion

70. We recognise this complaint and the circumstances around it have caused Miss X considerable distress and worry. We hope our report reassures Miss X that appropriate action has been taken to address her concerns.

71. We thank Miss X for bringing her complaint to us.

1. We have carefully considered Miss X’s complaint about Leeds and York Partnership NHS Foundation Trust.

2. Miss X says throughout 2023 the Trust failed to provide the appropriate care and treatment for her mental health. Miss X complains she was given exposure therapy that caused her mental health to deteriorate and the Trust offered therapeutic interventions that were not completed. She also complains there were inaccuracies in her medical records, she was discharged incorrectly from the community mental health team and her request for a different therapist was refused.

3. We sincerely appreciate this was a distressing time for Miss X. We hope this statement gives Miss X reassurance we have thoroughly considered her concerns. We are grateful for the time and effort Miss X made in bringing her complaint to our attention.

4. We would like to assure Miss X that for some of her complaints we have not seen indications the Trust’s care and treatment amounted to a failing.

5. Where we have seen a failing, we consider the Trust has already done enough to put the failing right.

6. In making our decision, we do not intend to diminish how stressful this time was for Miss X.