Let's talk: a different take on improving access to psychological therapies
| Published date | 01 October 2006 |
| DOI | https://doi.org/10.1108/17556228200600013 |
| Pages | 23-26 |
| Date | 01 October 2006 |
| Author | Moira Fraser |
| Subject Matter | Health & social care |
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Let’s talk: a different take on improving
access to psychological therapies
Dr Moira Fraser
Head of Policy, Mental Health Foundation
The Journal of Mental Health Workforce Development Volume 1 Issue 2 October 2006 © Pavilion Journals (Brighton) Ltd
Abstract
The recent focus on improving access to
psychological therapies led by Richard Layard has
generated wide-scale debate. This article looks at
this debate and the potential long-term
implications of Layard’s recommendations.
Key words
psychological therapies; access; Layard; mental
health services
Most people who use mental health services, and indeed
those who work in them, have never even seen a gift horse
before, let alone checked its oral hygiene. The recent focus
on improving access to psychological therapies led by
Richard Layard has generated wide-scale debate on an
issue that rarely crosses the public consciousness, and the
promise of 10,000 new therapists is verywelcome. Mental
health campaigners – many of whom have doggedly
flown the flag of talking treatments with little progress to
show for many years – can hardly believe their luck.
People who use mental health services have long said
that the main form of care they would like, and which they
can’t get, is talking treatments. In the 2005 Your Health,
Your Care, Your Say consultation, members of the public
gave an overwhelming and unprompted response that,
apart from a regular health check for everyone, better
support for mental well-being including tackling
depression was their top priority (Department of Health,
2006). Many people report extreme difficulty in gaining
access to psychological therapies, made worse by the failure
to collect any data on access or waiting times nationally.
So the announcement of two ‘demonstration sites’
mainly for the wider provision of cognitive behavioural
therapy (CBT) in Doncaster and Newham is a
monumental step in the right direction. However, we
need to ensure that we don’t get carried away on a
promise that is far from being delivered. A closer look
reveals some issues to be teased out before we should crack
open the champagne and party poppers.
Happiness - an attractive idea but
missing the point
First, there is a concern that the current discourse around
this issue may be misleading, and may do a disservice to
those experiencing mental health problems. Happiness –
one of Professor Layard’s favourite topics – is a term that the
general public can engage with but has little to do with
mental health, and the two issues are becoming
increasingly conflated in the media debate (The Independent,
2006). When a person loses their job, has a bereavement,
experiences racism or has to live in poor housing, it would
be rather odd if they were altogether happy.Unhappiness is
anormal response to adverse life events and is there, in part,
to help us manage our lives and seek solutions to problems.
True, unhappiness can provide the backdrop to the onset of
depression, anxiety or other issues. But the debate around
happiness should be separated from that around poor
mental health as it implies that adequate support and
treatment for mental health problems are an added bonus
to help a person cheer up rather than a necessity to deal
with a soul crushing, debilitating and alienating experience.
However,Layard promises access to psychological
therapies – principally CBT – to those who have been
denied it in the past, and many will jump at the chance.
But Layard has also made it clear that in order for his
vision to become a reality, a clear economic argument will
need to be made. We will need to show that providing
CBT will enable people currently out of work, who may be
claiming incapacity benefit, to re-enter the workplace and
help contribute to all our pensions in the years to come.
Somewhere, far off in the distance, I hear an alarm bell
ringing and the more I consider the implications of this,
the more uncomfortable I become.
Since when did clinical need involve
employability prospects?
One of the hallowed principles of the NHS, from its
inception, is that it should provide services, free of charge,
on the basis of clinical need. Not on the potential to get
or keep a job. However, two of the five key indicators in
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