Sussex Partnership NHS Foundation Trust

3. Mr O complains about aspects of his care and treatment at Sussex Partnership NHS Foundation Trust (the Trust), in particular:

• In February 2025 the psychiatrist and psychologist decided he did not meet the criteria for secondary mental health services (assessment and treatment (ATS)) without talking to him first.

• In a call on 29 May 2025 the service manager kept reiterating it was Mr O’s fault and that he should engage with the cognitive behavioural treatment (CBT) tools.

4. He said he has been left with no support for his mental health. He said the issues caused him stress and deterioration to his mental state.

5. He would like an apology and service improvements.

6. Mr O was in his late 30s when the issues at the Trust started. He told us he has had a diagnosis of agoraphobia for about a decade (since his late 20s).

7. Agoraphobia is a type of anxiety disorder where a person has intense fear of situations or places. This can lead to them avoiding places or environments, potentially impacting their daily activities and quality of life.

8. Mr O’s GP referred him to the Trust’s assessment and treatment service (ATS) service in January 2025. The Trust’s website says the ATS services are the entry point into specialist mental health services for adults.

9. It says the ATS are now part of the new neighbourhood mental health teams (NMHTs). These teams bring together local NHS mental health services, GPs, and community and voluntary organisations to offer joined up, personalised support for mental health.

10. The Trust’s standard operating model (SOP) for core services in NMHTs (Trust’s SOP) says the aim of the NMHTs is to improve the mental health and wellbeing of the adult population across Sussex. The Trust emailed Mr O’s GP on 25 February 2025 rejecting access to the ATS service.

ATS criteria

14. Mr O complains in February 2025 the psychiatrist and psychologist decided he did not meet the criteria for secondary services (assessment and treatment (ATS)) without talking to him first.

15. The Trust’s response of 12 June 2025 said, ‘As we agreed, neither the assessment and treatment service (ATS) in Lewes nor Health in Mind (HiM), are currently the indicated mental health services for you.’ HiM is the free NHS talking therapies service for adults in East Sussex. The Trust’s response of 11 September 2025 said,

‘The triage team discussed your referral in January with…lead psychologist, and…consultant psychiatrist.’ The consensus was based on…your current needs would not meet those specific criteria for secondary specialist mental health services.’‘It was acknowledged…you had just completed a third cognitive behavioural therapy (CBT) intervention with HiM. However, it appeared that these had been of limited benefit in terms of reducing your agoraphobia. There was the option of re-referring to HiM six months after completion of therapy.’

‘The consultant psychiatrist reviewed your records and found…you had been prescribed approximately 10 antidepressants, plus antipsychotics...anxiolytics. He felt that further attempts to change the medication might…do more harm than good.’

16. It concluded by saying the ATS cannot provide ongoing support to patients whose needs do not meet the specific criteria for specialist secondary care, but support is available from its voluntary sector partners. Mr O’s medical records of 25 February 2025 say,

‘Given that Mr O has already gone through multiple rounds of therapy and medication adjustments with limited results, ATS is not accepting this referral. Their recommendation is that the patient needs to continue consolidating the work done in CBT and apply outside therapy sessions, without further ongoing support from them.’

17. The Trust provided its SOP for core services in NMHTs and confirmed its eligibility criteria was the same at the time of Mr O’s complaint. Page 9 of the Trust’s SOP gives its eligibility criteria for acceptance to its service. The records show Mr O’s GP referred him to the ATS service on 24 January 2025. This says:

‘I am referring/ hoping to get some further help for Mr O…has struggled with anxiety and agoraphobia…He suffers with panic attacks and struggles to go outside and function on a day-to-day basis…I believe that he needs more intense/ alternate therapy than CBT is currently providing him…’

18. The Trust rejected this referral on 25 February 2025, with the same information given in the Trust’s final response of 11 September 2025. The Trust’s SOP eligibility criteria say the aim for NMHTs is to be available to people with mental health needs. Some of those are listed as follows:

• Experience mental health issues impacting on day-to-day quality of life and need support to manage their mental health issues, maintaining wellbeing and resilience.

• Have common mental health conditions such as anxiety and depression who may need variable levels of support to reduce the risk of experiencing a mental health crisis and whose needs cannot be met solely by NHS talking therapies.

• Having more serious mental health needs (e.g. psychosis, mood disorders, and complex emotional needs that require specialist mental health treatment and support) and may need a detailed plan of specialist mental health care, support and evidenced based interventions to support the management of risk, reduce risk of relapse and promote recovery.

• Are at risk of experiencing a mental health crisis.

• Are at risk of suicide and/ or self-harm.

• Have complex mental health needs that would benefit from specialist mental health treatment and coordination of care.

• Require a responsible clinician to meet mental health act requirements.

19. We understand Mr O was eager to get further help to support and overcome his anxiety and agoraphobia, which he has experienced for many years. We acknowledge these may impact on a person’s daily life. Our adviser said the Trust’s criteria for secondary care services (Trust’s SOP) is reserved for more serious mental health illness, for example schizophrenia. They said Mr O’s diagnosis of agoraphobia would not meet the Trust’s criteria.

20. This is because Mr O’s diagnosis is suited to primary care and talking therapies. Primary care refers to the first point of contact a person has with healthcare services when they have a health concern or need medical advice, typically, GPs, practice nurses, pharmacists, and other healthcare professionals in community settings.

21. Talking therapies are treatments that involve talking to a trained professional to help people manage and overcome emotional difficulties, mental health problems or challenging situations. Our adviser said there is no suggestion Mr O had significant mental health needs that met the Trust’s SOP eligibility criteria or needed significant medication routine or monitoring.

22. They said Mr O was of no risk of harm to himself and others. He had not had crisis mental health involvement for many years. Therefore, the risk level was lower than what would meet the criteria for the Trust’s secondary care involvement. Our adviser said the Trust’s multidisciplinary team meeting (MDT) of 25 February 2025 says Mr O completed CBT recently within the month, being his third attempt at helping with his agoraphobia diagnosis.

23. They said the Trust acknowledged the benefits of the CBT were minimal, not sustained after the end of the treatment, and HiM said Mr O could re-refer to it in six months. HiM assessed the risks as low. The outcome of this discussion was Mr O needed to consolidate his learning from CBT treatment and implement outside of therapy sessions.

24. Our adviser said in their role they regularly encounter discussions in their MDT with psychology colleagues who advocate that patients who have just finished therapy benefit from breaks in between starting more therapy to consolidate their learning from the sessions. The records show Mr O had just finished a course of CBT treatment with HiM on 7 January 2025.

25. Therefore, they said it was appropriate for the Trust to conclude Mr O did not meet its ATS criteria. The HiM discharge letter of 7 January 2025 said, ‘You have not expressed any concerns about your safety…We have now closed our current referral to HiM. We wish you well in continuing to practise and benefit from the things that you have learnt.’

26. We can see when Mr O’s GP referred him to the ATS service again in May 2025 it said he considered HiM had not been beneficial for him and if the Trust could not provide help with gradual exposure, he asks where he needed to go to access that help.

27. The GP said, ‘Your email said HiM assessed the risk as low, Mr O says that maybe in six months he may feel worse and suicidal like he did in the past when the crisis team got involved, without the support.’ We can see NHS guidance for treatment of agoraphobia recommends a stepped approach for treating this condition and any underlying panic disorder.

28. This includes self-help techniques and lifestyle change, enrol on a guided self-help programme, and undertake more intensive treatments, such as CBT or medicine to control symptoms. The NHS guidance goes on to say CBT aims to break the cycle of unhelpful and unrealistic thinking which leads to negative behaviour. It says for example many people with agoraphobia have the unrealistic thought that if they have a panic attack it will kill them.

29. It says the CBT therapist will try to encourage a more positive way of thinking, leading to more positive behaviour of the person being more willing to confront situations that previously scared them. It says CBT is usually combined with exposure therapy, and the therapist will set relatively modest goals such as going to the local corner shop.

30. As the person becomes more confident, the therapist can set more challenging goals such as going to a large supermarket or having a meal in a busy restaurant. We recognise Mr O’s frustration and upset since he wanted more help for his agoraphobia. From review of the available information, we consider the Trust acted in line with its SOP for deciding Mr O did not meet its ATS criteria.

31. This is because his symptoms did not meet the significant symptoms and support required by the criteria as mentioned by our adviser in the above paragraphs. We consider CBT was the appropriate treatment for his condition and it was reasonable for him to continue applying the techniques learnt.

32. Especially, since at the time of the referral in January 2025, he had only just finished a course of CBT, that same month. Therefore, we see no indications of failings in this issue. Our adviser said it was appropriate for the Trust to review Mr O’s recent medical notes (referral information, information from previous interventions, Trust’s SOP) at the MDT meeting and deciding he did not meet the ATS criteria without talking to him first.

33. They said it is not necessary for the Trust to have contacted Mr O, spoken to him or had a face-to-face discussion when deciding on his eligibility for secondary care services. Our adviser referred to the Mental Health Triage guidance. This says, ‘Urgency’ is a key construct in the mental health triage scale (MHTS).

34. It said the term ‘urgency’ in triage is defined as the optimal timeframe (from the point of triage) within which the consumer should be assessed face to face and/ or commence treatment. Our adviser said that it was appropriate for a medical team to decide Mr O’s eligibility, based on his medical records only, in line with category F of the Mental Health Triage guidance.

35. This category requires no timeframe for assessment or treatment and no face-to-face response. Category F of the guidance says:

‘A considerable proportion of referrals to mental health triage (MHT) do not require further assessment and/or treatment from specialist mental health services, and alternative services are more appropriate for addressing their needs, for example, general practitioners, community health services, private practitioners’

36. We understand Mr O believed CBT was not helping him overcome his agoraphobia and he wanted more intense treatment from the Trust to support him. From review of the available information, we consider the Trust acted in line with the Mental Health Triage guidance.

37. This was to decide he did not meet the criteria for secondary mental health services without talking to him first. As we mentioned in the above paragraphs, he did not meet the ATS criteria, and CBT was the most appropriate treatment for him. Therefore, we have seen no indications of failings in this issue and shall not consider it further.

Call of 29 May 2025

38. Mr O complains in a call on 29 May 2025 the service manager kept reiterating it was Mr O’s fault and that he should engage with the CBT tools. From review of the Trust’s complaint file, we could see Mr O emailed it on 29 May 2025 saying he just had an hour-long conversation with the manager at ATS. He said the conversation had made him feel worse than he did before.

39. Mr O went on to say from 4pm to 5pm the service manager initially spent the time to listen to him, but he then repeated the same thing the denial-of-service letter said and insinuating he was not using the information he gained from HiM (the CBT tools). He said he told the service manager that insinuating it was his fault for not using the CBT skills was insulting to him and ignorant of the situation he was in.

40. He said he wanted to raise a complaint against the service manager for his uncaring handling of the situation. The Trust’s response of September 2025 apologised Mr O believed the wording of the letter of rejection to the ATS service letter insinuated it was his fault for not implementing the CBT techniques. The Trust has not responded about the issue Mr O says the service manager kept reiterating it was his fault and that he should engage with the CBT tools.

41. There is no record of this call documented separately in the records. We looked at all the available information and acknowledge Mr O’s version of events that he said the service manager kept saying it was his fault and that he should engage with CBT tools. We acknowledge the issue has been frustrating and upsetting for Mr O.

42. Especially as Mr O has undertaken several rounds of CBT and considers this is of minimal benefit to overcome anxiety and agoraphobia. He was eager to get further support. From review of the available information, we have not seen any impartial evidence to confirm the service manager kept saying it was Mr O’s fault and that he should engage with the CBT tools. We are unable to reach a clear decision about this.

43. We understand it was a very difficult and stressful time, and we do not underestimate how challenging it has been for Mr O in trying to get further support for his mental health. We thank Mr O for bringing his complaint to us. We hope Mr O understands our reasons why we cannot consider the issues further.

1. We have carefully considered Mr O’s complaint about the Trust. We have seen no indication that anything went seriously wrong for the issue the Trust decided Mr O did not meet the criteria for secondary mental health services without talking to him first.

2. We were unable to reach a clear decision about the call of 29 May 2025 issue. We do not underestimate how challenging it has been for Mr O in trying to get further support for his mental health. We recognise this decision will be very disappointing for Mr O and hope this statement clearly explains how we considered his complaint and the reasons for our decision.