Psychotherapy and the NHS – Time for some Honesty?

A phone-in on 5 live this week has prompted a desire to comment on the issue of mental health and therapeutic intervention. The phone in was ostensibly on social anxiety and the main bulk of the callers recounted the crippling impact that suffering from this mental health problem had on their life or the life of a cherished family member. In this respect the phone-in could have been on depression, self-harm, bi-polar or any other recognizable psychological disorder. The commonality being the catastrophic effect that these issues had on the sufferers ability to live a fulfilling, rich, expansive, happy life. Listening to the testimony of these courageous callers was humbling.

What struck me however was that the general experience that these callers had had from the statutory mental health services was wholly inadequate. Many of them were languishing on endless waiting lists. Many of those that had had some access to talking therapies had a very brief intervention that had limited impact on their long-term mental health.

There was a common opinion on this situation from the callers themselves and from the various psychologists, therapists, charity workers and other mental health professionals that contributed to the program. The opinion was: We need to fund mental health services better and give greater access to quality, long term psycho-therapy. This goal is also high on the political aspirations of many politicians and lobby groups.

While I agree that more money should be made available, it seems to me that public funds will NEVER get close to providing the sort of intense, prolonged and complex therapeutic interventions that so many people need to achieve the quality of life that they long for. The very best that can be hoped for, surely, is that sufficient provision is found for appropriate crisis intervention to stabilise and protect those who are in such a dark place that they are imminently at risk of serious and irreversible harm to themselves or others.

Front-line mental health professionals are going to continue to be presented with clients who are afflicted with depression or anxiety or who finds themselves so traumatised by their life experience that they are tortured by  maladaptive, dangerous and life-denying defensive behaviours, addictions or character traits.

I wonder if the most compassionate response to such people might be a little brutal honesty:

“The problems that you are living with are likely very deep rooted in your view of yourself and the world around you. These core-beliefs have developed in response to your experience of life starting as a young child and unfolding as you have grown-up. There are likely some deeply traumatic experiences that were so unbearable that you had to develop protective beliefs and behaviours that protected you from further harm. The roots of your current problems have probably been screened out of your present awareness as part of this defensive strategy. A superficial treatment of your current symptoms will at best give temporary relief before new stresses trigger these deeper dynamics again. If you do not resolve these deeper dynamics that drive your experience of yourself, your life and your relationships it is likely that you will continue to struggle with life and fail to lead the type of fulfilling and meaningful life that I am  sure you would want for yourself.

The good news is that the field of psychotherapy has developed extremely powerful models, techniques and tools for helping people carry out this difficult personal work. There are many different approaches and what is best for you will probably take some investigation and trial and error. This is very difficult, though not impossible work to do alone. It is much more likely to succeed if you can find a therapist that you can build a close long-term, supportive and trusting relationship with. This is the space where you can gradually find the courage to uncover and face the issues that are at the root of your difficulties. This can take months or more likely years. It is a long difficult process but without it your life experience is unlikely to fundamentally improve.

The bad news is that this help is not, and probably never will be available on the NHS. If this is important to you then I urge you to do everything you can to find the £30-£50 per week that you would need to obtain this help privately. There is an army of highly trained and experienced therapists out there. If this involves sacrificing other aspects of your life or taking on extra work then so be it. Its your life, its up to you. I’m sorry but this really is the best advice I can give you.”

A little stark? – maybe. Dangerous? – in this un-sugarcoated  form it is a bitter pill to swallow. Maybe the core skill of our front line professionals is to use the precious little time that they have with clients to somehow get the basic point illustrated above across. It should of course be tailored and nuanced to suit the individual with as much sensitivity and skill as possible. Maybe however if people could walk away from their brief contact with the NHS mental health services with this vision in their hearts and minds perhaps it will set them on a path of courageous self-discovery and exploration that may lead to the kind of life that they dream off.



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