talking therapies. It combines changes in thinking and behaviour. It
uses wisdom found in Buddhist teachings and other sources.
There is clearly an epidemic of unhappiness in the UK as defined by the
psychiatric system and political thinking. Thanks to Lord Layard and the
We Need to Talk coalition a scheme was rolled out to provide CBT to as
many people as possible and quickly. The IAPT scheme has been expanded
and has changed significantly since its inception.
Thankfully. The dumb fuckers excluded people with real problems in
favour of helping those with relatively small ones. The reason was it
was justified by an economist who reasoned getting the people back to
work was the way forward. Behavioural modification through healthcare -
which is exactly what IAPT is - was aimed at keeping people in work or
getting them back to work.
It seems everyone in mental health thinks this sort of use of mental
healthcare is a good thing. I would myself if the work systems were
better. If people were helped to find meaningful or satisfying work then
perhaps I might agree that behavioural modification is useful. I still
wouldn't call it healthcare. I wouldn't use the slight of hand to say
that helping with misery, which apparently is an illness, is what I'm
doing when in fact my aim (the IAPT outcome measures include employment)
was weighed towards the purpose of getting the patient back to work.
This is the socio-political or socio-economic paradigm of mental health
blurred with the one of human compassion. Getting people back to work
for economic reasons is not directly related to compassionate goals for
the individual. It is about society's present or assumed needs.
The scheme originally excluded the severely mentally ill. £173 million a
year was to be provided for therapy for people with relatively small
problems compared to those with severe mental illness and significant
social disability who would be lucky to get any therapy at all.
A high level of disability usually means a person can't work. What would
be the point of offering healthcare to someone who can't work? In my
opinion there's a lot of reason to help someone regardless of their
employment status but I have high ideals for healthcare. Doctors treat
regardless of anything. If the patient is a murderer a good doctor still
treats them.
However....the IAPT scheme wasn't really healthcare. This is how it
could exclude those with the worst problems from this new funding for
Improved Access to Psychological Therapies (the full name of the IAPT
scheme). Were it real healthcare aimed at those who needed it then the
exclusions of people with psychotic disorders, obsessive compulsive
disorder or addictions (but people with addictions get fucked by
everything in mental healthcare in the UK anyway) wouldn't have existed.
It was aimed at getting people back to work. This was how Layard
justified the application of CBT to the masses. The We Need to Talk
Coalition included Mind and Rethink. They agreed that it was important
to ensure people with the severest disability should be excluded from
the IAPT scheme. I have ranted at them since I found out about these
exclusions. On the grapevine I hear the exclusions are being removed.
Thank fuck for that. There are some people who really need help. A
Rethink survey showed 50% of people with schizophrenia weren't getting
CBT last year - given their surveys aren't very good so they'd have lots
of people not responding and those who don't respond have different
results from those that do (and it is my guess that those who don't
respond in this case have worse results) I suspect the true figure is
higher.
Perhaps the scheme truly is offering compassion at last now that it
stops excluding those who have high levels of disability. I bet the
employment part of the outcome measures are still there though.
If Layard had seen the systematic review I've seen on job satisfaction
and physical and mental health then he'd take my chocolate salty balls
out of his mouth and invent a new and better scheme, one which rather
than using behavioural modification on individuals would aim to change
the dysfunctional employment systems which are partially responsible for
the endemic misery. The effect sizes are massive.
http://www.lums.lancs.ac.uk/files/executive/6603.pdf - 485 studies
included for a culminative sample size of 267 995.subjects. Sadly no
funnel plot has been done nor discussion of the apples and oranges
problem of meta-analysis (not every study is the same).
This is about changing society rather than changing the individual but
for reasons of compassion and healthcare. It's also obvious. Give
someone a shitty job and they feel like shit. This impacts on their
physical health too. Understand the complexities of an individual's idea
of job satisfaction and help create a society which makes this possible.
It is my opinion this is what Galen meant when he said "Employment is
nature's physician." Work can heal but it has to be the right kind for
the individual.
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