Mersey Care NHS Foundation Trust

4. Mx W complains about aspects of care and treatment they received from the Trust between August 2023 to July 2025.

5. Mx W complains the Trust did not provide them with therapy from August 2023 until July 2025, despite their repeated requests. Specifically, Mx W complains the Trust: • carried out a dissociative identity disorder (DID) assessment in July 2024, that they believe was unnecessary • conducted this assessment at a time when they were already experiencing personal challenges • incorrectly removed the DID diagnosis • provided a second opinion, but the process did not directly involve them further • did not conduct a second assessment or other recognition of their DID diagnosis, despite repeated requests • did not communicate with them about wait times for therapy.

6. Mx W says the above events meant they were without therapy for nearly two years. Mx W tells us this delay along with the assessment, the period surrounding it, and the removal of the diagnosis, had a significant and detrimental impact on their mental health and well-being. Mx W tells us the lack of communication about wait times caused them distress.

7. Mx W seeks an apology, service improvements, reimbursement for the cost of private treatment totalling £2710, and financial remedy for the impact on them.

8. In August 2023, Mx W told us their GP referred them to the Trust’s mental health team. The Trust said it received the completed referral in September 2023.

9. Throughout June and July 2024, the Trust completed the dissociative identity disorder (DID) assessment. From this, the Trust determined Mx W did not meet the criteria for a diagnosis of DID.

10. In September 2024, following Mx W’s request, the Trust conducted a second opinion of the assessment. The Trust said following this it could not support a DID diagnosis. The Trust planned for Mx W to receive 1:1 therapy.

11. In July 2025, Mx W began 1:1 therapy at the Trust.

15. 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 have done this and have not found any indications that something has gone wrong.

Therapy and decision to conduct DID assessment

16. Mx W complains the Trust did not provide them with therapy from August 2023 until July 2025. They also complain during this time, the Trust carried out a DID assessment, which was unnecessary as they were not seeking a diagnosis and had clearly asked for therapy.

17. We have considered these two concerns together as they are closely linked.

18. The Trust said it received Mx W’s referral to the psychological therapies team in September 2023. It said it received documents from Mx W’s private psychologist which suggested a working diagnosis of DID. It said the private psychologist asked the Trust to complete a full assessment to determine whether a formal diagnosis applied.

19. A working diagnosis is a provisional, evidence-based view of a patient’s condition, used to guide immediate care and further investigation. This is therefore different to a formal diagnosis.

20. The Trust also said the information from Mx W’s private psychologist was limited and so it considered it appropriate to conduct the DID assessment. It said following the assessment, it could offer treatment based on psychological needs and goals.

21. We discussed the above and reviewed the available records with the help of our adviser.

22. GMC guidance says ‘You must provide a good standard of practice and care. If you assess, diagnose, or treat patients, you must work in partnership with them to assess their needs and priorities. The investigation or treatment you propose, provide or arrange must be based on this assessment, and on your clinical judgement about the likely effectiveness of the treatment options.’

23. The records show, following Mx W’s referral, the Trust was uncertain about Mx W’s diagnosis. This was because Mx W’s private psychologist suggested a working diagnosis of DID.

24. As this private psychologist indicated DID was only a working diagnosis, the Trust conducted the DID assessment to see if it could provide a formal diagnosis.

25. Our adviser explained it is reasonable and appropriate to try and establish a clear diagnostic framework as this helps to determine what therapy a patient requires.

26. For this reason, we consider the Trust’s decision to conduct the assessment to help determine what treatment Mx W required was in line with the GMC guidance. Therefore, we do not consider the Trust’s decision to conduct this assessment was unnecessary.

27. The records indicate the Trust discussed the outcome of the DID assessment and that they did not meet the criteria, with Mx W, on 4 August. On 9 August, Mx W requested a second opinion of the DID assessment, which the Trust agreed to conduct.

28. On 19 September, the Trust discussed the outcome of the second opinion with Mx W. They explained the second opinion did not support a formal diagnosis of DID. However, they discussed the assessment highlighted difficulties it would be helpful for Mx W to work through and so they referred Mx W to 1:1 therapy and the care navigators, with Mx W’s consent.

29. Throughout October, Mx W requested the Trust conduct a DID reassessment. The Trust said this was not indicated at that time.

30. In late October, the Trust backdated Mx W’s referral for therapy to September 2023, when Mx W was referred to the therapy team.

31. Unfortunately, Trust did not have availability for Mx W to start therapy until July 2025. We do not condone long waiting lists and realise waiting for therapy can be distressing. Sadly, long waiting lists are a known effect of the increasing demand on NHS mental health services, and not necessarily indicative of failings on the Trust’s part.

32. During Mx W’s wait for therapy, the records indicate they had support in place. From Mx W’s referral to the Trust we can see they had regular contact with the Trust’s community mental health team. From September 2024, we can also see Mx W had regular contact with the Trust’s care navigators.

33. Based on the above, we consider the Trust’s decision to conduct the DID assessment before providing therapy was in line with GMC guidelines. Unfortunately, the Trust did not have availability to provide therapy until July 2025.

34. For this reason, we do not consider there is an indication anything went seriously wrong here.

Timing of DID assessment

35. Mx W complains the Trust conducted this assessment at a time when they were already experiencing personal challenges.

36. The Trust said Mx W’s assessment took place over a period of seven weeks and there was no documented distress or crisis within the assessments.

37. On review of the available guidance, our adviser explained there is no listed or set circumstances which say a DID assessment should not be conducted.

38. This means we cannot say the Trust’s timing of this assessment, in June and July 2024, did not follow the relevant guidelines.

39. As explained above, we consider the Trust’s decision to conduct the DID assessment to help establish what treatment Mx w required, followed GMC guidelines.

40. Considering the above, we have not seen an indication anything went seriously wrong here.

DID diagnosis

41. Mx W complains the Trust incorrectly removed the diagnosis.

42. The Trust said based on its assessment and second opinion, it could not support the DID diagnosis.

43. ISSTD guidance lists the diagnostic criteria for DID as:

• the presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

• at least two of these identities or personality states recurrently take control of the person’s behaviour.

• inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

• the disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behaviour during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).

44. These guidelines say one way to assess dissociative symptoms and diagnoses is through a structured clinical interview for dissociative disorders (SCID). This is a 277 item interview which assesses five symptoms of dissociation; amnesia, depersonalization, derealization, identity confusion and identity alteration.

45. Our adviser explained one of the main characteristics of DID is having different personality sub systems, which can be online or offline at different times. These personalities can impact the person’s autonomy and shape their behaviour and choices. They also experience amnesia around what those different personalities do and decide.

46. The records indicate the Trust conducted a SCID assessment, in line with the above. The records from this assessment do not indicate Mx W met the criteria or experienced the above. Therefore, we consider the Trust’s decision it could not diagnose Mr W with DID was in line with the ISSTD guidelines.

47. For this reason, we do not consider there is an indication anything went seriously wrong here.

48. We understand Mx W strongly feels the Trust’s decision was incorrect and we appreciate how distressing this must be. We hope our careful consideration provides them with some reassurance.

Second opinion

49. Mx W complains the Trust provided a second opinion, but the process did not involve them further.

50. The Trust said the second opinion did not involve Mx W and it was based on the first assessment. It noted it was not clear the Trust informed Mx W of this.

51. It said it conducted a thorough assessment, and no clinical rationale was identified to support second face to face re-assessment at the time.

52. The Trust apologised the second opinion process was not communicated with Mx W properly at the time. It said it has taken learning from this and will ensure the team’s communication around the second opinion process is clearer moving forward.

53. The records show the Trust conducted a second opinion, involving a different clinician who reviewed the recently completed assessment information.

54. On review of the available information and guidance, our adviser explained there is no guidance that states a second opinion of a DID diagnosis should directly involve the patient.

55. Therefore, the Trust were not required to directly involve Mx W in the second opinion process. As such, we consider the Trust’s actions were in line with GMC guidance which says in providing clinical care you must adequately assess a patient’s condition.

56. As the Trust have acknowledged, it did not explain the second opinion process to Mx W at the time, apologised and has taken learning from this. This is positive to see.

57. It is likely had the Trust explained the second opinion process to Mx W this would have reassured some of their concerns about this process. However, this does not change the fact the Trust was not required to directly involve Mx W in the second opinion process.

58. For this reason, we have not seen an indication anything went seriously wrong here.

Reassessment

59. Mx W complains the Trust did not conduct a second assessment or other recognition of their DID diagnosis, despite repeated requests. Mx W told us the Trust repeatedly refused their request for a second assessment or other recognition of the DID diagnosis.

60. The Trust said it did not identify any clinical need to conduct second face to face re-assessment at the time.

61. As explained above, the records show the Trust conducted a thorough DID assessment which did not indicate Mx W met the criteria for DID. The Trust therefore could not recognise a diagnosis it did not consider Mx W had.

62. In terms of the reassessment, our adviser explained a second assessment so close to the first assessment can sometimes mean patients try to give answers or information that is more aligned with the diagnostic criteria. This therefore impacts the validity of the assessment and is not a true representation of the patient’s symptoms.

63. In October 2024, the records state Mx W asked the Trust for a reassessment. The records note Mx W reported researching the assessment themselves to prepare ‘correct’ answers, so they would meet the criteria for DID.

64. This note also shows the Trust explained to Mx W a second assessment so close to the first assessment would not be valid as it would in essence be Mx W handing the Trust a self-assessment they had completed.

65. Therefore, it seems the Trust felt a second assessment would not be an adequate or valid assessment of Mx W’s symptoms and so it decided not to conduct this. This is in line with GMC guidance which says in providing clinical care you must adequately assess a patient’s condition.

66. Based on the above, we do not consider there is an indication something went wrong here and will not consider it further.

Communication

67. Mx W complains the Trust did not communicate with them about the waiting times for therapy.

68. Following the DID assessment and second opinion, the records show the Trust and Mx W agreed a plan for 1:1 therapy. In late October 2024, the Trust backdated the therapy referral to September 2023, when Mx W was initially referred to the Trust.

69. From October 2024 onwards, the records show the Trust was in regular contact with Mx W about their position on the waiting list. It told them they were first on the list, was clear in January 2025 that it did not know exactly how long the wait would be, acknowledged and discussed Mx W’s understandable frustrations.

70. In early 2025, the Trust provided more information about the reasons for delay. It discussed that the therapy team was down a fulltime staff member but was recruiting. It explained timing depended on staff availability and upcoming discharges.

71. Once the Trust knew when a new team member was due to start, it gave a realistic ‘latest by’ date to Mx W. It also explained the team may be able see Mx W sooner if capacity became available. The therapy team then contacted Mx W in early July to arrange therapy appointments.

72. We recognise it can be difficult to give precise waiting times for therapy because availability can change if discharges do not go as planned or other priorities arise.

73. In this context, we consider the Trust’s communication with Mx W about the wait for therapy was appropriate. The Trust was open about uncertainty, explained the reasons for delay, and provided realistic information when it could. This is in line with GMC guidance, which says clinicians must be honest with patients and provide the information they want or need to know.

74. For this reason, we do not consider there is an indication something went wrong here, and we will not consider it further. We thank Mx W for bringing their complaint to us.

1. We have carefully considered Mx W’s complaint about Mersey Care NHS Trust (the Trust). We were very sorry to learn about Mx W’s concerns and recognise this has been a very difficult and distressing time for them.

2. Following our careful consideration, we have not seen an indication anything went seriously wrong in the concerns Mx W has bought to us. Therefore, we have decided not to consider it further.

3. We recognise this outcome will not be the one Mx W was hoping for. We hope Mx W finds some reassurance in how we have carefully considered their concerns about the Trust and that they followed the relevant guidelines.