UK Council for Psychotherapy response to Andy Burnham's speech on mental health

1 February 2012

Shadow Health Secretary Andy Burnham's suggestion that a Labour government might create a cabinet level post for mental health is exactly the kind of imaginative gesture that all psychotherapists and counsellors will welcome. Unfortunately, his speech to the Centre for Social Justice, outlining Labour's intention to foreground mental health in the future development of the NHS, disappoints in other respects.

An opportunity to move beyond the mental illness/mental health division has been missed. This is more than a merely professional observation; rather, it goes to the heart of the matter. The unique feature of emotional distress is that suffering is always a matter of degree. If we are thinking about depression, anxiety, worries about the meaning of life and toxic relationships, then we are certainly all in this together. The medical model of diagnose-plan-treat-research is just not what real psychotherapy that seeks to engage with real emotional distress is about.

The speech contains considerable praise for Labour's mental health innovations, such as the Improving Access to Psychological Therapies scheme (IAPT). This overlooks the rising tide of criticism of IAPT (including from people working in it) for narrowing the range of therapies available and restricting patients to a watered down version of cognitive behavioural therapy (CBT), often delivered by very lightly trained staff. Right now, this is leading to the destruction of many outstanding psychotherapy and counselling services across the NHS.

Scarcely a week goes by when UKCP does not hear of yet another psychotherapy or counselling service being destroyed - and the destruction justified by reference to the development of a new IAPT service. Many Labour MPs will now know that, often, there is very little or no consultation and patients with complex mental health problems who depend on these services, staffed by experienced and highly trained therapists, are just dumped. This flies in the face of government policy stressing the importance of patient choice and ignores research findings that patients offered a decent choice of therapies do better.

The situation is about to get much worse as IAPT gets rolled out for children and adolescents. Our internationally respected Child and Adolescent Mental Health Services must be protected against the IAPT juggernaut. Not to do so will be to create damage in the future. We call on Mr Burnham to investigate the current proposals to limit the range of therapies available to children to just two - CBT and parent education.

It is perhaps inevitable, then, that Mr Burnham's speech contains no references to the issue that is currently exercising the professional communities of psychotherapy and counselling - the one-sided and controversial operation of the National Institute for Health and Clinical Excellence (NICE) guidelines which ignore a massive amount of academic research on the efficacy of therapies other than CBT. Hence, in the majority of cases, it is impossible for patients to get therapy other than CBT. Following UKCP's lead, most of the important organisations in the field have signed a call for an expansion in the range of research that can be considered by NICE but, as yet, there has been little response. If it is serious about foregrounding mental health, Labour should support the efforts of these organisations and press the Department of Health to exercise influence on NICE.

UKCP also believes that, while economic and social factors definitely contribute to emotional distress, it does not follow that an emphasis on the economic and social benefits of easing such distress is the correct approach. People who are depressed or anxious, whose relationships have collapsed, or who are in the grip of addictions and compulsions want and need a safe space to express themselves in the presence of a trained psychotherapist. This is not psychobabble. Survey after survey shows that such patients respond to psychotherapy when the therapist is engaged and interested in building a relationship with them. We feel it is not ethically sound to give vulnerable people very short-term therapy with the secret goal of getting them back to work. Shouldn't they be asked if this is in fact what they want?

It would be ironic if Labour's future mental health policies were to sustain the existence of a two-tier 'class' structure in which people with even quite moderate means can obtain private psychotherapy and counselling - while the rest of the population is offered something very far from excellence. In fact, excellence has been sacrificed in favour of a quick fix.

Yet UKCP applauds Mr Burnham's references to the emotional issues of politicians and sportsmen and women. While the experiences of both sexes are obviously important, many psychotherapists have come to see that there a 'crisis of masculinity' at the base of many mental health problems in men, including powerful and successful men. This is caused by a range of factors including unemployment and fear of it, and perceived cultural changes involving the status of women. It is noteworthy that Mr Burnham and other well-known Labour figures such as Alastair Campbell have identified this problem - whereas the government and its advisers drawn from academic psychology have not.

Mr Burnham is also right not to buy in to the 'happiness agenda'. Nor have professional psychotherapists and counsellors. We don't want to become purveyors of a new 'opium for the masses'. We recognise that, as Freud put it, often the best one can hope for is to 'convert neurotic misery into ordinary unhappiness'. It is concerning to UKCP that Lord Layard, architect of IAPT, is now at the heart of yet another sales pitch - for 'happiness' and 'wellbeing'. Surely in this area above all others, we need not to over-promise?

UKCP believes that the happiness bubble will soon burst. It is simply an unrealistic idea and, in many ways, damages the very people the ideology is supposed to benefit. The theory is based on positive psychology which, after a brief surge, is now receiving sustained criticism. In effect, if we follow the happiness line, we will be saying to people 'If you are not positive, if you're not happy, if you're unemployed, if you have an illness - then this is your personal failing - there's something wrong with you'. Good contemporary psychotherapy tackles both the personal and the collective or social aspects of emotional distress.

UKCP issues an invitation to Mr Burnham to sit down and talk to us about the future role of psychotherapy in counselling in his vision of mental health services. We have many ideas to contribute. For instance, we want to explore a new partnership which reinforces the choice agenda for patients and truly improves access to psychotherapy - IAP! We think patients should be able to access psychotherapists and counsellors to obtain private treatment in the therapist's own clinical offices - but funded through the NHS. We believe that many psychotherapists would be more than willing to do this work, it would deliver extremely high standards, and could be delivered for less than such treatment costs the NHS at the moment.

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