Psychic pilates

t has taken decades of campaigning, with some help from American television, to shift the UK’s attitudes towards therapy. Now that we’ve finally understood it might help, what are the chances of getting it? The UK’s largest therapeutic programme, Increased Access to Psychological Therapies (IAPT) is an ambitious one aimed at getting people back to work. It uses high and low intensity cognitive behavioural therapy (CBT) interventions for between four to sixteen weeks, cheap as chips, often online, but with the brave ambition to reach anyone who needs it (recession = loads of us). Despite the unknown impact of the proposed Health and Social Service bill and welfare reform the government has made some big society noises about happiness and its responsibility for subjective wellbeing. Hurrah? Well that, comrade, depends largely on whether you are delivering these services or not. In the main, and I don’t wish to get too technical for you here, the therapists delivering mental health services are mad, yup, total-loony-tunes-la-la because they are working under an employment relations system which is essentially Dickensian but without the laughs. Even Little Dorrit wouldn’t put up with it. The people that deliver IAPT services are no longer called therapists, they are Psychological Wellbeing Practitioners (PWPs), many of whom are in fact experienced therapists and clinical psychologists, punching below their weight, paid minimum wage and wondering whether it was worth the many years of clinical training and internships (nope). Vocational or not, under these conditions and under-paid-non-therapist is a vulnerable worker and confronted with an enormously unhealthy choice caring for patients in a way that may be totally inadequate or not treating them at all. What you actually get on the NHS these days is formalised and standardised to the extent that if a patient does not pick up the phone for an initial assessment, within a 15 minute allotted time period they are referred back to their GP, presumably to wait for a further 6 months. Within these services there is a hatred for the patient that keeps us on the phone for too long, making it impossible to meet the quota of 8 satisfied clients a day. Reaching the quota involves not listening to the real and deteriorating situation of patients. Under these conditions the only way to responsibly help patients is to refer them on to other more intensive services. Hatred is passed on, dump and run. PWPs that offer more support, mainly through giving more time and going off script, are forced to keep this secret from employers because it breaks their contract of employment, leaving them to carry the full ethical and clinical consequences of their interventions. I doubt you could get clinical insurance to cover this situation and it exposes therapists to precarious states of mind, counterproductive for people employed to contain the anxieties of others. You don’t have to be mad to work here but it’s extremely likely. Many experienced and wonderful therapists have retreated to private practice, unable and unwilling to navigate a broken system. This means that there is some great therapy available out there, but only for those people that can afford it. Anyone without money is left with a four-session-selfdirected-online-non-therapy and the real stuff becomes a kind of psychic pilates, available to those that can pay but probably don’t desperately need it. The NHS definitely has to regain its responsibility towards patients, but also to its therapists. This means respecting that a decent wage and a decent job is a requirement for that precious and increasingly rare quality of sanity.