What Nick Clegg didn’t say about mental health services | @guardianletters
Before we beatify Nick Clegg for his laudable intention of improving mental health provision (Revolution in mental health care revealed, 8 October), let us pause and consider the parlous state of our society after nearly five years of coalition government and how this may be linked to mental illness. The Lib Dems have supported the wanton fragmentation, further costly privatisation and impoverishment of our social and health services (including financial cuts for supportive charities) within the context of counterproductive and unnecessary austerity. Much mental illness arises from a milieu of multiple deprivation. The rapidly growing population of the poor, sick and disabled have had a torrid time at the hands of Iain Duncan Smith’s department and from the cuts to benefits and services.
Furthermore, as a recently retired teacher, I have been appalled by the growing levels of student anxiety, depression and self-harming. I believe that some of this correlates with the Govian target-driven, joyless, exam factories that schools have become.
Philip Wood
Kidlington, Oxfordshire
In the coverage of the Liberal Democrat proposals for an expansion of provision of talking therapies, there has been little or no discussion of what the NHS will actually be providing, except for the fact that one prime goal is to get people off benefits and back to work (which some therapists would regard as an unethical goal). Many readers who are outside the debates on what constitutes adequate therapy probably imagine that millions of people are going to get something like the activity portrayed on TV in In Treatment or The Sopranos: two people in a protected space, choosing to work together at an agreed pace and duration to clarify and unravel (to the degree that is possible) the psychological issues of one of them. This is indeed what you get if you seek private psychotherapy and counselling (which may not be as expensive as you think).
But what the Liberal Democrats (and the Department of Health) mean by their version of a talking therapy is not like this at all. They are introducing, without any serious discussion, a palpable class system into the provision of therapy. If you can afford it, get “real therapy” privately. If not, then accept that your treatment will be governed inappropriately by the medical model of diagnose-then-cure, and that everything will take place within tight financial parameters – hence very few sessions. Much treatment will be carried out by scantily trained practitioners.
It is not hard to understand why the professional organisations of psychotherapists and counsellors do not speak up regarding this, though they know very well that this is the situation. The anticipation of jobs for their members – often unnecessarily retrained to deliver the state’s version of counselling and psychotherapy – has silenced them.
Andrew Samuels
Chair, United Kingdom Council for Psychotherapy 2009-12, and professor of analytical psychology, University of Essex
The announcement by Nick Clegg of reduced stigma and greater parity between physical and mental health services has been welcomed uncritically by the media and mental health charities. However, the coalition government should be judged on what it has done, not what it says. In Sheffield, where Clegg is an MP, the budget of the mental health trust is a seventh of that of the acute trust, and annual audited accounts show that the mental health budget has fallen disproportionately year-on-year since 2010, with services cut to dangerous levels. Nationally, more than £120m has been leeched out of mental health budgets, in effect to pay for the coalition’s privatisation agenda. If it ever reaches the front line, £120m of new funding will not restore services to 2010 levels, let alone “revolutionise” access to treatment of mental illness.
Conclusion: neither the Tories nor the Liberal Democrats can be trusted with the NHS.
Jeremy Seymour (retired psychiatrist)
Sheffield
The promise to reduce waiting times for people needing access to talking therapies is very welcome. Mental health has long been the Cinderella of NHS provision.However, what Nick Clegg’s speech did not address is the standard and type of treatment that will be available. The experience, training, supervision and institutional support of those staff delivering the talking therapies is crucial to the effectiveness of the treatment delivered. Working clinically with people in distress inevitably impacts emotionally on the practitioner – and the more distressed and disturbing the nature of the mental health difficulties are, the greater is the impact on the clinician and the clinical team. This is not a criticism of practitioners but a description of the nature of working with psychological and emotional distress and disturbance.
Therefore mental health staff need good training and supervision, supportive institutions and regular access to opportunities to openly discuss their work with colleagues and skilled facilitators, who are experienced in working with disturbing mental health issues and with the impact such work inevitably has on practitioners. Without this consultative support there is a danger of staff burnout; of a retreat into illness; of mental health staff getting caught up in the distress of their clients; and, at the worst, staff finding themselves reacting to the disturbing states of mind of their clients.
So let us reduce waiting times but, crucially, let us equip the staff working in mental health with good training, skilled supervision and opportunities to regularly reflectively examine the inevitable impact of the work they are engaged in. There is no short cut to this essential requirement.
Stanley Ruszczynski
Clinical director, Portman Clinic, Tavistock and Portman NHS trust
Nick Clegg plans to put treatment for mental health conditions on a level with physical health from 2015. In order to be clear, is that putting it on a par with the GP funding that has been cut by nearly £1bn, leading many surgeries to face financial collapse? Or is it putting it on a par with the A&E departments in crisis due to the number of hospital beds axed and where 5,000 A&E patients waited over four hours? Or perhaps on a par with cancer care, which saw a decrease in funding between 2009 and 2013 despite rising rates of diagnosis?
Mr Clegg might find it easier to seize the agenda on mental health had the austerity policies of his coalition government not ripped through the heart of mental health services. More than eight in 10 GPs now believe that their local mental health teams cannot cope with mental health caseloads, and nearly half said that the situation in their area had got even worse in the past 12 months. Research has shown the links between austerity economics – with its added financial strain, income inequality, debt, absence of essential services, and its regressive taxes like the bedroom tax – and the damaging impacts of such policies on people’s mental health.
Dr Carl Walker
Chair of the taskforce on austerity and mental health, European Community Psychology Association
Front page: “Revolution in mental health care revealed. Taboo over issue must end – Clegg”. Solution to 15 across in crossword on page 47: “Loony bin”. Nick Clegg knows where to start work now, doesn’t he?
David Carr
Leeds