What happens when even our mental health provision is depressed?

From 'Addressing the Deterioration in Public Psychotherapy Provision' (UKCP/BPC)

A recent report published by the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) entitled 'Addressing the deterioration in public psychotherapy provision' leaves us in no doubt as to the state of government provision of mental health services.

Some of the more impressive statistics from this survey, last conducted in 2012, give a disturbing insight into what psychotherapists are seeing on the ground. For example:

• Over three-quarters ((77%) of psychotherapists report an increase in the number of cases of patients with complex needs 
• Despite this, coming up for half (44%) report a reduction in the clinical experience and qualifications of psychotherapy practitioners
• In line with this finding, over two-thirds (67%) report a cut in higher band posts and an increase in the use of honorary staff or volunteers delivering services
• Over half (52%) report a fall in the number of psychotherapy services being commissioned

Given this situation, it is not surprising that patients are increasingly being forced out of the public system and into the private sector. What is repeatedly being heard by therapists is that patients are coming for private treatment having been let down by the NHS, which could not provide the type or length of treatment they needed. For those who have eyes to see, this amounts to the effective privatisation of mental health in the United Kingdom.

This development is having serious knock-on effects. We are now seeing the growth of a third party sector in mental health; private contractors brokering such individuals as 'Psychological Wellbeing Practitioners' (PWPs) to support services like the NHS's Increasing Access to Psychological Therapies (IAPT) programme.

These services are based on a watered-down version of Cognitive Behavioural Therapy (CBT), and can by no means be considered as bona fide psychotherapy. The interventions are entirely scripted and there is one compulsory outcome - that everybody feels well. Veering off script on the part of the practitioner is considered a breach of contract.

Such labour agencies and contractors are now buying up burgeoning NHS mental health waiting lists and replacing already inadequate provision with even more impotent alternatives.

With NHS services now being frankly undermined, the UKCP/BCP report observes:

"The [survey] responses paint a picture of public sector therapists taking on more complex cases, of experienced therapists being laid off and clients turning to the private sector for help they cannot get on the NHS."

This is an important read for anyone working in mental health. The UKCP and BCP say that they are 'deeply concerned' about the lack of provision for the army of people who are now slipping through the net, unable to access genuine help on the NHS and unable to afford private treatment. As they acknowledge, their registrants are providing an invaluable service, often themselves volunteering and supporting low cost treatment programmes. They are picking up the pieces for patients caught in the revolving door of the NHS system.

What's your experience of the provision of public mental health services, either as a patient, from the inside as an NHS therapist or as a therapist working in private practice? What do you see happening that is fostering the breakdown? Is the system redeemable? Are there any signs of hope? Do your experiences corroborate the findings of the UKCP/BCP report? We'd love to hear your thoughts.


Written by Jacqui Hogan