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Scottish Government submission of 24 June 2021

PE1873/B - Provide hypnotherapy for the treatment of mental health, psychosomatic disorders and chronic pain

Complementary and Alternative Medicines Services (CAMS) Policy

• The Scottish Government recognises that CAMS - including hypnotherapy - may offer relief to some people suffering from a wide variety of conditions.
• We recognise that many people choose to use CAMS, this is why the Scottish Government have been working during Covid to ensure this section of the retail sector remains accessible where needed.
• It is still up to individual NHS Boards to decide which CAMS they make available based on national and local priorities and the needs of their resident populations.
• If CAMS is available, it remains the responsibility of clinicians, in consultation with their patients, to discuss and agree the best treatment options based on individual clinical need.
• The Scottish Government recognises that hypnotherapy has been used for a very long time to treat a wide variety of symptoms and welcomes verified information to allow for consideration of its use in healthcare.
• We expect NHS Boards to ensure that the people of Scotland receive care that meets their needs and that this care is safe, effective, person centred and sustainable.
• The efficacy of treatments and safety of practices outside of conventional healthcare professions are not all subject to statutory regulation and we advise that careful consideration always needs to be given to potential risks prior to undertaking any unregulated treatments.

Mental Health

• “Matrix - A guide to delivering evidence-based psychological therapies” is a process for evaluating the evidence of effectiveness for psychological treatments. At present, hypnotherapy does not meet the standard of evidence required for recommendation for use as a psychological treatment on the NHS.
•  There are many other interventions that would be recommended (for example counselling, digital therapies and social prescribing) as evidenced based treatments where the main elements are around engagement and people feeling that they are getting help.
• People experiencing mental ill health should expect high quality care, which can include the prescription of medication if they need it. The prescription of any medication is a clinical decision made in discussion with the patient, and within the context of their care plan and recovery.
• We are also committed to improving access to alternatives to medication that increase choice and best accommodate patient needs and preference.
• Each case will be different but treatment should always be person-centred and informed by an ongoing assessment of needs to ensure the best possible outcomes for the individual.

Chronic Pain

• We expect clinicians to be aware of the Scottish Intercollegiate Network Guidelines on the management of chronic pain. While the guideline identified one systematic review which indicated benefit for chronic low back pain from ‘self-regulatory’ psychological interventions, such as hypnosis, it also sets out that “no good-quality studies were identified to evaluate the efficacy of hypnotherapy”, and recommends that further research is required to establish the efficacy of this intervention for people with chronic pain.
• Under normal circumstances, SIGN would look at the need to update the chronic pain guideline 3 years after the last update, i.e. 2022. However, given the pause on current work to address the COVID-19 pandemic and the number of guidelines that will need to be prioritised for review once SIGN are operating on a full business as usual programme, this cannot be guaranteed.
• Later this year, the Scottish Government will publish a new Framework for Chronic Pain Management that will update the current Scottish Service Model for Chronic Pain. The Framework will set out ways to improve access to care for people with chronic pain and deliver better health outcomes.

Scottish Intercollegiate Guideline Network (SIGN)

• The aim of SIGN is to improve the quality of healthcare for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.
• Comments relating to CAMS hypnotherapy in specific guidelines are provided below:

SIGN 136 (Chronic pain) has a section on complementary therapies which reports evidence for acupuncture, herbal medicine, reflexology, music therapy, aromatherapy and homeopathy. No              evidence found for hypnotherapy. The only one that had sufficient evidence to support a recommendation was acupuncture: Acupuncture should be considered for short-term relief of pain in patients with chronic low back pain or osteoarthritis.