Health Secretary Andrew Lansley was in Berkshire today. He made a speech promising that psychological therapies (the IAPT programme) would continue to be developed in the NHS.
That’s good news, isn’t it?
It’s not the whole story, though.
Life’s difficulties
Berkshire Healthcare NHS Foundation Trust publishes a leaflet, Talking Therapies, that explains the programme to the general public:
What is Talking Therapies?
We have a team of advisors and therapists who can help you to overcome life’s difficulties and problems, or manage them better.We are friendly and approachable, so it’s easier for you to find someone who can help.
We offer easy access to a range of helpful tools and therapies including cognitive behavioural therapy (CBT).
CBT is effective in helping people to overcome life’s difficulties.
The problem with this is that “life’s difficulties” are not the same as mental health problems.
If you have an emotional response to some event or circumstance in your life, a difficulty or problem perhaps, that is completely normal. That’s what emotions are for.
If you have an emotional response for no apparent reason, and it lasts for a long time and is so severe that it prevents you from living your life normally, that’s mental illness.
“Life’s difficulties and problems” are precisely what psychological therapy is not about.
Politics
Why would a health service provide treatment for things that are not health issues? Politics. The previous government, being (arguably) somewhat socialist, liked to encourage the view that people are dependent on government for every aspect of life, presumably because people who feel dependent on government tend to vote for socialist parties.
Berkshire Healthcare is not the only example of NHS resources being used to manage political problems. A link in the leaflet takes you to an NHS webpage, Credit crunch stress, whose purpose is to make it seem that money problems are some kind of illness your family doctor can cure.
The politics of IAPT require statistics that prove the programme is a success, and loading IAPT with people who are not mentally ill helps to make certain this happens. What about the people who really are mentally ill? Do they benefit at all, or are they just pushed aside?
The answer to that probably varies between trusts, and it’s difficult to determine. The impression I get is that where IAPT is implemented it has reduced the time you have to wait to get an appointment, but the appointment might be with someone who cannot do much more for you than hand out leaflets about the credit crunch.
On the other hand, CBT therapists are being trained and employed as a result of IAPT. Surely some of them must be competent, and surely some of them sometimes must get to see patients who really are ill. It’s difficult to be sure.
Management
Another feature of IAPT is that it is not necessarily NHS at all. In some places it has been contracted out to private companies. An example is Derby Psychological Therapies Service, a subsidiary of Trent CBT Services Ltd., which provides IAPT services in Derbyshire and London.
There are good and bad aspects to such contracting-out. The good part is that if things go badly wrong the contract can be terminated, whereas if NHS management get things badly wrong they are almost impossible to sack.
The bad part is that the contract is managed by NHS management anyway. So there are two parallel management structures to be paid for — one in the NHS and one in the company. As a result, contracted-out services necessarily cost more, or rather, deliver less for the available budget. This might be outweighed by greater efficiency in the company, because it is not constrained by NHS working practices, or it might not.
So there is considerable uncertainty about how much of the Health Secretary’s announcement is good news.
Perhaps Mr L envisages a little positive peer pressure to be the answer in mental illness, as well as for overweight kids? I’m sure mentally ill people could just pull their socks up if they really tried.
Lola x
Its a difficult one for Govt / for the mentally ill as those whom trying to better the situation. The policies of Govt on the domestic as upon the international stage, having increased the problems over past two decades, in rising by 1,000 % thus the ever strain on NHS funding. The service simply can’t provide for the ever increasing needs of people, where people’s needs not only to be confined unto physical, but the growing mental health requirements. Thus frustration of those whom try bettering the situation. The frustration of the mentally ill whom given much cause for complaint, the frustrations of those in the NHS whom simpy overwhelmed by an rising tide of complaints. Thus the overall situation having the effect that more succumb to the pressure, where many doctors / nurses / police / lawyers / traffic wardens / school dinner ladies/ but put their names forward, in joining therapy groups / where in need of an large bowlful of pills daily in coping with / mental health.