We've written a response to an article in The Guardian by Rebecca Cotton, Director of Mental Health Policy for the NHS Confederation's Mental Health Network.
Rebecca's article provides some helpful advice for Simon Stevens, the incoming chief of NHS England, on what he needs to do for mental health.
To see the article please click on: https://www.theguardian.com/society/2014/mar/26/mental-health-investment-not-cuts-nhs-simon-stevens.
'We wish Simon Stevens well as he takes over from as Chief Executive of NHS England at a time of unparalleled challenge. Not the least of his problems will be how to steer a course through the forecast £30 billion budget gap. And, while one can only speculate at this stage on what course he may take, mental health must not remain the poor relation of physical health.
In early March we heard NHS England and Monitor recommended cutting funding for mental health services by 20% more than for acute hospitals. There can be no doubt at a time when more and more people are experiencing mental health problems and the suicide rate remains alarmingly high, that even more people will suffer and lives are likely to be lost as a result of these cuts.
Yet – publically and officially at least – NHS England states it is firmly committed to making sure mental and physical health are treated in the same way.
The British Psychoanalytic Council is not alone in thinking something doesn’t add up. The entire mental health sector has been united in staunch opposition to the recommended cuts. At today’s NHS Confederation Mental Health Network conference, Norman Lamb has stated that mental health providers must challenge unfair funding and hold their ground.
Rebecca Cotton is right to point the way towards more targeted investment in mental health services. It leads to better health outcomes and makes more long-term economic sense than more cuts. There are areas absolutely ripe for investment. It is generally accepted today, for instance, that the NHS’s psychological therapies programme needs to be extended to embrace a range of therapies more suited to treating people with complex mental health conditions such as personality disorders.
We hope Simon Stevens ensures that NHS England delivers on its commitment towards mental health and we are keen to know how the Government will hold NHS England to account.
Gary Fereday, Chief Executive, British Psychoanalytic Council'
Gay conversion therapy, sometimes known as reparative or ‘gay cure’ therapy, attempts to alter a person’s sexual orientation or reduce attraction to others of the same sex. It often assumes that homosexuality is a mental disorder.
The BPC thinks it is wholly unethical, has no evidence base and can cause a lot of harm to individuals.
At the request of the Department of Health, we have worked with UKCP, the BACP and other professional partners to produce a leaflet offering information and advice on gay conversion therapy.
The leaflet will be of help to anyone who feels pressurised to seek such therapy for their sexuality. It includes information on organisations which can offer safe and non-judgemental support.
The leaflet was written with the help of lesbian, gay and bisexual charity Stonewall:
The BPC also issued a position statement on homosexuality in 2011, which made it clear that we oppose discrimination on the basis of sexual orientation.
Gay conversion therapy is also antithetical to psychotherapeutic approaches. A psychotherapist may sometimes help people explore their sexuality but they should not try to change a person’s sexuality. The emphasis is rather upon helping people to have greater well-being and emotional health and upon helping people to maintain healthy relations with each other.
As Gary Fereday, the BPC’s Chief Executive, says:
‘Gay conversion therapy is diametrically opposed to psychoanalytic psychotherapy, where therapists should approach patients without any preconceived aims or prejudices. Patients may benefit from exploring their sexuality with a therapist, but this would be within the context of helping each individual patient come to live a fuller and happier life. The BPC’s vision is of a society which places value on emotional wellbeing and healthy human relationships whatever the sexual orientation.’
On 24th February 2014, the Guardian published an article by Patrick Strudwick, ‘We can’t leave mentally ill people at the mercy of unregulated therapists’. Patrick contends that the psychotherapy and counselling professions are far from adequately regulated. In effect, he thinks, people are at the mercy of ‘the untrained, the unqualified and the unethical’. Patrick has done a lot of excellent work in the interests of people at risk from gay conversion therapy, but in this instance, we felt his article actually risks harming vulnerable people. Here’s our reply.
We are grateful that you raise major concerns about the regulation of counsellors and psychotherapists. It is a subject the British Psychoanalytic Council takes extremely seriously and is why we regulate our members according to the highest professional standards. As well as being a voluntary regulator we have consistently held the view, like you, that statutory regulation (and protected titles) would be in the best interest of the profession and crucially the general public. This is why, during the last Government, we worked closely with the Health and Care Professions Council to try to achieve statutory regulation.
Unfortunately, as you mention in your article, statutory regulation was abandoned by the incoming coalition Government. We found this very frustrating after putting in so much time and effort. We have recently submitted our register for accreditation by the government-backed Professional Standards Authority (PSA) scheme. Whilst not full statutory regulation the scheme goes some way to increasing safeguards and it is well worth noting what the PSA has to say:
‘Anyone employing, recommending or using a practitioner in an unregulated occupation now has the option to choose one from a register that has been vetted by the Professional Standards Authority. It is important that they do so.
Oversight by the Professional Standards Authority ensures that voluntary registers have the authority, resources and processes to identify and address incompetence and harmful practices.
Individuals cannot be removed from one accredited voluntary register and join another when faced with a sanction, as we require voluntary registers to share information and recognise each other's decision to remove registrants.’
Your article, although clearly with the best interests of mentally ill people at mind, used language that many would find ‘scaremongering’. We are concerned that it may actually put off some people from seeking professional help who would benefit from it. You suggested that mentally ill patients are at the mercy of ‘the untrained, the unqualified and the unethical’ – yet countless severely ill or suicidal people have benefited from our highly trained, highly qualified and highly regulated psychotherapists – both on the NHS and as private patients.
We appreciate your endeavours to drive the issue up the political agenda. It is right that our politicians should be aware of the dangers of unregulated psychotherapists and counsellors and it the case that there are still some untrained, unqualified and unregulated individuals claiming to be psychotherapists in the UK. But it is wrong and potentially harmful to suggest that voluntary regulated professionals are a danger to mentally ill people.’
The Health Service Journal has published a letter from the BPC highlighting the need for greater choice of psychological therapies on the NHS.
Our letter was written in response to the latest figures from the Health and Social Care Information Centre on the recovery of people undergoing treatment on the NHS's Improving Access to Psychological Therapies programme (IAPT).
We are glad that the IAPT programme has helped many people experiencing depression and anxiety but are concerned that 51% of IAPT referrals are not leading to treatment - with many people declining or dropping out of treatment.
The issue is likely to be one of choice - and there is a real need for IAPT to have more options for people with more complex mental health difficulties.
At the same time, existing psychological services which provide interventions more suited to people with complex needs are under considerable pressure.
We believe that anyone experiencing a mental health difficulty should be able to access an appropriate psychological therapy on the NHS.
We have learnt from the Professional Standards Authority that their Accredited Voluntary Registers (AVR) team have asked the Department of Health to liaise with HMRC and the Treasury to review VAT exemption for health services provided by AVR practitioners and income tax relief on annual registration fees paid by AVR practitioners.
The AVR team have discussed the possibility of amending the 1994 VAT Act to include ‘accredited by a statutory body’ so that tax exemption similar to that of the statutory regulators could be extended to AVRs. DH has now responded, saying that this will not be possible.
The BPC and member institute The Association for Psychodynamic Practice and Counselling in Organisational Settings (APPCIOS) met with Meg Munn MP yesterday to discuss promoting the use of psychodynamic practice in schools.
Meg, a trustee of APPCIOS, kindly gave lots of useful ideas and was fascinated to hear the stories of accredited members currently making a positive difference in schools in Essex.
APPCIOS will shortly be producing a short documentary, which the BPC will make available on this website.
20th January 2014
Response to Government Mental Health Action Plan
The Deputy Prime Minister Nick Clegg launched a Government Action Plan for Mental Health today. The plan follows on from the Mental Health Strategy, launched in 2011, and sets out 25 key mental health priorities.
The British Psychoanalytic Council is pleased to see the Government renewing its commitment to mental health. The Action Plan spells out what the government hopes to achieve prior to the next general election and signals a change in gear for the delivery of mental health services.
Gary Fereday, Chief Executive of the British Psychoanalytic Council, said: “We welcome the Government aim for psychological therapies to help over 900,000 people every year and are delighted that the Department of Health is exploring how psychological therapies can help people with severe mental illness and personality disorders. Last November’s We Still Need to Talk report by the We Need To Talk Coalition highlighted Devon’s Specialist Personality Disorder Service, which offers a variety of effective psychoanalytic treatments to people with severe and complex personality disorder who would otherwise be placed in out-of-county secure units because of their high risk of suicide.
We are also aware from a survey we carried out with the United Kingdom Council for Psychotherapy, however, that psychotherapy services have been under threat on the NHS. Among its results, our survey found that posts and services are being downgraded, that our member practitioners are being relied upon to deal with increasingly complex cases while services are being decommissioned, and that patients are having to wait longer to receive psychotherapy. We therefore hope that the Government Action Plan heralds the end of such damage to non-IAPT psychotherapy services, which are often best placed to help those most in need.
We also welcome the announcement of a national Mental Health Intelligence Network and hope that it will include information on the full breadth of available psychological therapy services.
It is also good to see the Government looking into ways to overcome inequalities around service usage. We are aware from our own research that people from black and minority ethnic communities all too often are less likely to access psychological therapies.”
Rozsika Parker, author of Torn in Two: The Experience of Maternal Ambivalence and The Subversive Stitch: Embroidery and the Making of the Feminine, represented WPF/FPC on the BJP’s Board for many years. She remained a member of the Journal’s Editorial Advisory Panel until her death in 2010. She was well known for her commitment to creativity, in both art and clinical practice, and our new Essay Prize focuses on a critical engagement with this theme. The Journal is particularly interested in factors that support creativity in clinical or theoretical work, and those that may militate against it.
The Prize has two entry routes: a Student Path and a Post-Qualification Path. Authors should indicate under which route they wish to be considered.
Students or qualified clinicians are invited to submit original papers on adult or child psychotherapy or psychoanalysis, on either clinical or theoretical topics. The Student path is open to students on clinical trainings, on university courses in psychoanalytic studies, and on university courses where psychoanalysis is a significant component; the Post-Qualification path is open to clinical practitioners only.
In addition to the focus on creativity, the application of psychoanalytic theory to questions of gender, art, literature, film and music is also welcomed. Authors should consult the BJP’s submission guidelines (particularly in relation to confidentiality, where clinical material is concerned) and prepare their work with the Journal’s Aims and Scope statement in mind. Advice will be available should there be questions concerning confidentiality, or eligibility to submit work.
Submitted papers must not have been published elsewhere, or currently be under consideration for publication. Manuscripts should be up to 6000 words in length including references, not including an Abstract of 200 words. They should be submitted through the ScholarOne website. For submission information please consult https://wileyonlinelibrary.com/journal/bjp
The covering letter should state that the submission is for consideration for the Rozsika Parker Prize, and indicate under which path (Student or Post-Qualification) the paper should be considered. Information about training status, training institution and/or date of qualification; or university course and current status should be included.
A panel of senior clinicians and academics will judge the papers, and the prize-winning papers will be published in the Journal. A cash prize will be awarded in each category, along with a one-year online subscription to the British Journal of Psychotherapy or the International Journal of Applied Psychoanalytic Studies. The winning papers will be presented at a BJP event, to be announced in due course.
Closing date: 15 December 2013
For any queries, please email Ann Scott, Editor-in-Chief, at email@example.com
I am writing this on behalf of the ISPS* UK psychodynamics and psychosis research group. This is a small group currently focusing on taking small steps towards being closer to a position where an RCT is feasible and fundable.
One such small step could be a multi-centre audit of outcomes of psychodynamic and psychodynamically informed therapies in patients with experience of psychosis, and we are writing to ask if you would be interested in contributing to this? If so it would be very helpful if you could get in touch with an answer to the very brief 3 questions below.
1. In the last two years, have you offered psychodynamic or psychodynamically informed therapy to any clients with current or past psychosis*? yes / no / don’t know
2. Have you used outcome measures of any kind? yes / no / don’t know. If so, please could you tell us of any you have found helpful? ……….........................
3. Would you be interested in participating in a multicentre audit of outcomes for psychodynamic therapies in psychosis*? This would mean using some (simple) outcome measures which would be common to all participants) yes / no / don’t know
Or if you would simply like more information, please do contact us via Alison.firstname.lastname@example.org
Please pass this message to anyone else you know who could be interested.
Alison Summers, Chris Douglas, Angela Kennedy, Brian Martindale
ISPS UK psychodynamics and psychosis research group
* (ISPS = International Society for Psychological and Social approaches to psychosis)