IAPT was started around 10 years ago simply ‘to get people back to work’. This was a proposed as short-term fix using a one-off trial of cognitive therapy, intended for a very short-term goal. Then something went badly wrong. They call it, “mission creep”. CBT spread like cancer across most state funded mental health services. It's good for one or two conditions - certainly not for all. It's roll-out has resulted in a hugely expensive disaster. It has created depression where healthy thinking used to live. CBT is the same ‘mind-software’ that advertisers use to get you to buy things. “You can afford it, treat yourself, don’t worry about the fuel bills, have a holiday instead”. By ignoring the core problem in our life, we always end up in greater pain!
My work in the NHS spans more than 17 years. It has been wonderful at times but recently, very disheartening. I started my career as a social worker, then a midwife, eventually becoming a mental health nurse. Now I am fully qualified psychological therapist. I am fortunate that I completed my training before the dreadful decline in treatment started. I still try to put my patients care first. This is an explicit condition of most professional health registrations.
Working for NHS Mental Health, I discovered that my employer actively attempts to prevent us all from placing the patient's welfare first. In fact, in Mental Health the patient nearly always comes last.
The business goals of the management now sometimes require the falsification of patient records. The department only gets paid a bonus when a patient makes an improvement or recovery. This so called recovery is no such thing as it is only relates to the symptoms and not to the actual psychological difficulty.
In records, we are encouraged to leave out or put in, whatever will leave an impression of care and responsible actions. It is sometimes a work of fiction. CBT is controlling all our thoughts. Even the reports of clinicians. It is an artificial working existence. Put a smile of you face and put up with the flaws in the service - flaws imposed upon us.
This above deception is artful and immoral and has utterly transformed mental health treatment. Any older staff have to be down-skilled in order to treat in this neglectful way. Most have therefore left in disgust. Tony Blair gave birth to this monster. The advice he took on Mental Health was as flawed as was his “45 minute warning” advice, contained in the now infamous, ‘dodgy dossier’.
The results of treatment affecting payment hinge upon a patient's tick box feedback which can change according to the weather or even a headache!
In some Mental Health services, devious methods are used to get the patient to change their reported condition. In many locations it is whispered to us, "try not to treat patients who we predict, will be unable to reach a profitable reduction in totals reported on their patient questionnaire". Yes this is the NHS today! Where do NICE (National Institute for Health and Care Excellence) stand on these common dishonest practices? Are NICE and the Care Quality Commission both turning a blind eye.
Many staff in Mental Health have a constant gentle pressure placed upon them to manipulate the patient into falsely reporting how they feel. It’s true. We are also told not to report notes on computers revealing much of the patient's presenting condition.
The reason for the above we are told, is that the patient may eventually gain access to their records and discover how we have been neglectful of their care. For example, by observing them in a poor state but then never following through with appropriate treatment. Why don’t we follow up? Because better care just isn’t there. We are banned from giving treatments that are complete or thorough enough to do the task responsibly. Again, we just treat symptoms – not the cause.
Under-reporting can only have been a directive by NHS Trust lawyers, grooming the NHS legally to survive the consequences of their neglect and to increase the amount of reduced care that they can get away with giving.
We are constantly 'guiding' people to have CBT therapy. In many places, we don't inform patients that the NHS should be offering them a choice of treatments. The majority of people, especially those having more complicated worries, tell us that CBT has been close to useless. This is evidenced by thousands of patients dropping out of treatment, or by returning time and time again, requesting something more meaningful.
CBT is a way of making people be quiet about their deepest sorrows. Soon after treatment, they are right back to square one. It’s like having your appendix out, only instead of removal, they just open you up, pop in a pain killer and stitch you up again. The ‘operation’ can even be carried out by a fake psychological therapist or perhaps a volunteer working from a computer generated instruction sheet.
We are constantly searching for ways to disguise the failures of CBT. The press are utterly fooled by an industry of many opportunists. The real evidence is the daily sight of people being constantly sent away feeling lost, let down, or tricked. Some will be heading for suicide. Others live with the view that they were led along a fake-care pathway, that was never really intended to genuinely attend to their problems – only the symptoms of their problems (if that!).
I do not wish to suggest that things are all bad. Many people will benefit from any interested contact no matter how small when faced with many of the common problems that life presents. Many staff are kind. Staff do try hard and are trained to believe that they are helping – but mostly they are not dealing with the problem and know it.
Corporate style statements hide the truth. Staff are given grand titles as if enlisted to a despot’s rabble of armed recruits. They know very little about life or of mental health complexity. Many staff have limited access to compassion or insight. You can't train people to really care - only to give a nicely worded substitute and a sweetie. Good staff are kept so terribly busy that they seldom have time to stop and reflect on their work, or their own lives. There is no budget for action on responsible care, only words.
I saw a recruitment advertisement recently, for NHS Mental Health staff in an IAPT (Improving Access To Psychological Therapies) service. It was calling for therapists with no qualifications, to come and work as volunteers with “risk” patients. If this is the quality of recruitment that our NHS is moving towards then we should be thoroughly ashamed. How do they get away with this?
A vast number of patients are going through really sad, stressful and challenging times. For some, it may be a highly dangerous stage of life. Yet the NHS is often simply using these people to generate 'numbers' for politicians. We are harming patients, we hinder them, we increase risk, we waste their precious time and selfishly create our own job security. To do all this, we become forgers - faking the quality of our work and of statistics.
We play management games with numbers employing lifeless business values from some exceedingly smart beaming characters who are running (or ruining) NHS Mental Health services. Staff want to do well but are mostly set up to fail and to carry a sense of serious guilt about that. The NHS Trusts are desperate for good feedback from their staff but we really can't do that. If the patient's suffer then we suffer - so why should you go home with a contented smile on your face? Some of us cant even sleep!
Incidentally, the NHS Trust Executives have their personal performance targets assessed on a tick box methodology by politicians, just as patients do. These politicians and NHS executives ultimately dictate control of the computer software which regulates care.
Computers are the electronic arms of the politicians and of all work practice. These arms stretch right into the rooms where patients are being seen. They control the language, the treatment and effectively even the clock on the wall. These remote control managers have their fingers on the oxygen tube of ethics, sitting between the patient and the care they should get.
As soon as the patient’s session has finished, the practitioner is straight back to the keyboard to massage information to create a longed for explosion of corporate security and bliss. The computer should help to improve care but instead, it enforces withholding. This is ruthless – it’s almost never about truth.
What we need now is a highly trained, less-CBT orientated, experienced psychological workforce returning to the NHS. We then need to power-down the IT systems and leave them off for 15 years. We need to free-up staff, get rid of the ‘software of neglect’, so that we can properly attend to the patients needs via our own professional assessment, experience and judgement.
Politicians and business executives should be prevented from their current micro-management of health provision. The people who regularly press the 'neglect them' button on their keyboard – sometimes with fatal consequences, should in some cases, be arrested and charged with failing in their duty of care. The CQC should be put on notice for failing to pick all this up and NICE should be told to get out more!
Politicians? Oh give me strength. No wonder all this is happening!
It really is time for the media to wake up and to speak up for humanity. Stop believing government handouts, or have you given up too!
As for you? Fight for the return of genuine therapies and longer treatments. Demand that you get something a lot better than CBT. Tell your GP whenever your talking-therapy has been useless. Ask him/her why they are wasting money in this way. That is, if you still have a GP - or is he/she now just a computer too?
Good luck. Remember that you and your family deserve to be treated with a genuine therapy and that it should not only be about treating the symptoms.