Professional Cannibalism
Last week a bleak tweet from Goldsmith’s UCU trade union branch announced the start of the Higher Education Hunger Games. Hot on the heals of Leicester’s cull - Goldsmiths, Wolverhampton, Roehampton, hundreds of academic jobs sacrificed within days of the REF2021. In a perverse but calculated turn, this number includes the REF winners of million pound grants and evidence based impact. Right across the social sciences, humanities and even the professions, those disciplines with ambiguous relationships to the employability metrics will fight it out for survival on the basis of their short term return-on-investment in the HE market. Marketing over philosophy, apprentice degrees in retail over art therapy, the reaping has begun.
Welcome to the era of professional cannibalism.
The Hunger Game Rules determine the professional architecture that delivers public service, most graphically in mental health services. The mental health workforce enters a public system designed to nudge and budge us into wellbeing and fitness for work. The conditionality of accessing services is founded on behavioural economics underpinning government policies and operationalised through the mechanisms of behavioural psychology. Recover, work and take responsibility for you own states of mind.
There is growing acceptance that in order to evidence the ROI of free to access therapy, the performance data is gamed producing unrealistically high recovering rates - ranging to 50% to 75% recovery claims on digital providers’ websites. This magic accounting is linked to unsustainably low budgeting in mental health such that short term, standardised and manualised, online and non-clinical interventions secure the main commissions. This in turn determines the training of the future mental health workforce, a rapidly diluted model of cognitive behavioural therapy (CBT), short-term and centred on recovery and economic returns to the further detriment of long term and dynamic therapeutic offerings.
And it is in this way that in order to keep the mental health show on the road, we are forced to eat our own as independent and person centred modalities are cut from university curricula for their frustrating unwillingness to tick the evidence-base boxes and we watch our professional ecosystem fail.
One of the reasons why this professional crisis is rarely referenced in the public debates about mental health is the reluctance of people working within mental health services to raise their concerns. In order to keep us working hard in the wellbeing game, intricate systems of control manage the performance of mental health workers to deliver recovery targets are rigidly maintained. Designed to generate a mixture of fear and denial which works to keep us hesitating on taking a side.
Therapeutic schools are lined up in order of their usefulness in legitimising the downgrading of our expectations of what therapy looks like. This leaves the guardians of ethical and independent practice to seek sanctuary in early retirement and private practice sustained by the last generation of occupational pensions. The middle age of the clinical professions left to slog it out in the performance management stadiums of online therapy platforms and the therapy call centres of the euphemistically called Employee Assistance Programmes offered in the post-pandemic workplace.
That an unwaged fully trained psychotherapist can be enlisted to provide six free phone therapy sessions to traumatised NHS workers in a time when food banks are being set up in hospitals for staff tells you everything you need to know about the gnawed bones that are hiding in the mental health closet.
In my research and writing, as well as my experiences as a patient, I keep going round and round wondering what it is we think we’re now doing in the therapy business. Increasingly I experience our work as based on a dangerous and cruel optimism. This is not to attack individual researchers or therapists, but it is to raise a question about what are we doing working within this context?
An idea that helps me unpack the experience of being within this performative system is Dalal’s thesis of ‘hyper-rationality’ where he argues that the performance management system which emphasizes rational, decontextualized and standardized CBT leads to a distortion of our experiences of therapeutic spaces on both sides of the relationship. Such that ‘the number itself becomes more real than the thing it is apparently representing, so much so that in some instances the numbers become the reality” (Dalal, 2018:4).
This is not simply a dystopian invitation to stare into the abyss. Its also an invitation to find a thread that links my experiences to what I know about the world and my place in it. As disruptive as it may be to my ability to play the game, acknowledging the presence of hyper-rationality helps me to make a leap of faith that raising our consciousness of the system in which we operate is the start of our professional recovery. That knowing about and understanding the dynamic systems within which we work can be helpful.
Despite the enormous cannibalistic risks of opening up a debate about what ‘real’ therapy is, our professional recovery necessarily involves a re-imagining a reality where mental health can be returned to its principles of lived experience, love and care. Free association and the therapeutic alliance. Relating. To remember where we come from before the mothers and fathers of our tradition have escaped or died. To think about alternatives that move beyond the usual suspects and business-as-usual combined with money-as-the-magic-solution. As is now acknowledged in the critical mental health networks, why would you keep paying for increased access to something that is just pretending to be therapeutic?
Over the next few weeks I’m going to be quiet and work with a progressive group of thinkers on what it means to build our mental health in this crisis. Not that anyone will use this to inform policy, nor will there be any measurable impact, it’s just an attempt to find hope in re-imagining where we go from here.
To submit your own ideas to the UK Government’s Mental Health & Wellbeing Consultation go here. Tucked in amongst the nudging and neuro-linguistic programming the key questions are:
How can we all promote positive mental wellbeing?
How can we all prevent the onset of mental health conditions?
How can we all intervene earlier when people need support with their mental health?
How can we improve the quality and effectiveness of treatment for mental health?
How can we all support people with mental health conditions to live well?
How can we all improve support for people in crisis?
Submission deadline: 11.45pm 7 July 2022