"We work to relieve and to prevent this treatable condition by providing information and support services."

A Single Step, issue Winter 2007-08

Reforming Psychological Therapies in the UK

Introduction

Mental health is a fundamental human right. Every year 15-20% of us feel that that right is compromised in some way as our emotional health interferes with our ability to operate within society as we would wish. And yet, the vast majority of people with depression labour on alone. Most of us do not seek assistance. The stigma of help seeking is everywhere. If we do seek help, the mental health services are forbidding arenas set up to treat the most severely distressed. People with 'common' problems such as depression are left to fend for themselves.

Psychological Therapy as an Elite Endeavour

Today, the issue of happiness and wellbeing is more in the public eye than at any other time in the past 50 years. The reasons are a mixture of economic and moral arguments. The UK now spends more of its gross domestic product on the economic impact of unhappiness than on reducing poverty. Effective treatments, pharmacological and psychological, exist and yet information, support and psychological therapy is unavailable to the majority of people. For most people in distress, effective treatments languish behind impenetrable barriers, suitability checks and service opt-ins. It is inconceivable that such a situation would be even remotely tolerated in any other health condition.

Psychological therapists often claim that chronic under-funding has resulted in such a situation. However, it is psychological therapists who have designed systems of access which prevent rather than facilitate help seeking. It is they who have tolerated long queues whilst remaining fixed to traditional practices which bear no relationship to the needs of depressed people.

  • When people with depression say, "we want help at the moment we pluck up the courage to admit our needs" psychological therapists often only offer complex opt-in systems as 'motivational' tests.
  • When people with depression say, "acknowledge my own strengths and resources" psychological therapists frequently respond with interpretation and the search for deeper meanings.
  • When people with depression say, "we want a service which is convenient and accessible" psychological therapists repeatedly ask people to visit their clinics in person and at a time of the therapist's choosing.
  • When people with depression say, "we want a culturally competent service" psychological therapy is almost always offered by a person from a different culture, a different class and a different community.

Reforming Psychological Therapy: Reforming Information and Support

The current preoccupation with happiness and wellbeing provides an opportunity to reform the provision of psychological therapies - essentially the democratisation of psychological therapy. When we do seek help, when the downs become so bad that we need to reach out for assistance, in most cases we are merely asking for two simple things: information and support. There is no reason, therefore, that people should not be absolutely and unreservedly entitled to the same recovery information as that possessed by psychological therapists and in a form which is understandable, non-patronising and appropriate to their culture, class and community.

This process is underway in a radical and unique project funded by the Department of Health in Doncaster. Here, information and support is being provided to people with depression within 24 hours of them seeking help. Workers recruited and trained from within their own community support people, often conveniently using the telephone. They provide highly competent advice on drug treatments, psychological therapies and support services. They act as coaches, guiding people through their own recovery at a pace and means of their own choosing. In less than six months more than 2,500 people in Doncaster have been helped in this way - 2,500 people who would previously have had to cope alone.

The Department of Health is planning to commission another ten psychological therapy projects in 2007-2008. They could be commissioned to look like the same old usual elite psychotherapy services or they could look like Doncaster. The more that organisations like Depression Alliance and individuals with depression speak up, the more likely these new services will look like the one in Doncaster. Let us hope many people do speak up. Psychological therapy is not the preserve of an elite cadre of psychological therapists. It belongs to everyone.

David A Richards
Professor of Mental Health
University of York, UK

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Moving People
Motherhood and Depression
Undoing Depression
Choice in Depression: Making Progress
Employment and Depression
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