The offering of wisdom through healthcare or a clever way to get the workers to work (what IAPT is and what IAPT should have been)

Cognitive Behaviour Therapy is the new dogma vaulted above all other
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.

Another day ends

And I hope, stupidly, it is the last.

It will come though. That last day. I can hope.

Assumptions, help-seeking and suicide

I think this area's become one of my bugbears for a couple of reasons. One's personal experience. The other's professional experience. This piece is in part written from personal experience and present present personal experience which I've kept off my blog.

I sat here this morning rethinking the prejudice of men's help-seeking behaviour. Mental health is a predominantly feminist movement. There is little consideration of the masculine epistemology of mental health. In all honesty I'm not even sure what that is. It might be resilience. It might be the things which men value about mental health, i.e. sucking it up and getting through the pain. These are the values of mental health taught in the public school system and considered a traditional or historic ideology which the female ideology in mental health surpasses. Supposedly anyway.

So much is based on assumptions. It's not surprising. So many people do it. Unfortunately assumptions can be informed by prejudice and they can be wrong. I'm as guilty of this as anyone. Good science, by which I mean any endeavour which truly seeks to unveil the absolutely truth (or as close as we can get to it), is a battle against this sort of practice of assuming assumptions and prejudice are in any way truths.

If I asked anyone why they thought that men in general didn't seek enough help for mental ill health they'd probably tell me to stop being boring and asking stupid questions. The people I'd have more respect for would answer it is because they kill themselves more.

I'd say that's absolutely true in that men successfully terminate their lifes much more often than women. It is a terrible fact that men kill themselves three times more successfully than women.

This does not prove that men don't seek help for mental ill health. As one might gather by the emphasis in the previous paragraph this proves that men are more successful at killing themselves. In truth the research shows that the methods they chose are more violent and that's the reason why they're more successful.

The fact that women attempt suicide a lot more than men and this effect is prevalent across the Western world seems to escape most people. While men kill themselves more women attempt to kill themselves more.

But that's not what I'm thinking about this morning. (Or what I should be thinking about which is the precarious state of my life and the fact that 4 months hard work has left me penniless. I'm avoiding the thoughts and emotional impact of my current life by escaping in a variety of ways.) What I'm thinking about is the relationship between suicide and help-seeking.

The assumption is help-seeking and suicide have a relationship. It is assumed that help-seeking stops people attempting to kill themselves. In a paper on help seeking behaviour and gender the authors struck upon a surprising result. The attitudes to helpseeking for mental ill health were only slight different between men and women in overall levels - the difference wasn't big enough to be statistically significant. The largest difference in attitudes is about help-seeking from a GP and this is reinforced by another (very poor) figure showing men use GPs significantly less than women in adult age (this figure is for working age only, the report from where it comes from states that women's problems, baby problems and family planning visits would inflate the difference and that at above working age the effect is not seen at all). This small difference in attitudes to seeing a doctor for mental ill health does not account for the suicide rate and men clearly seek help from other sources.

For the last decade men and women have sought help roughly equally from The Samaritans suicide helpline. This services is accessed by hundreds of thousands of people every year in the UK. The data is publically available on their website. It is consistent that men contact the Samaritans ever so slightly more than women - statistically insignificant though so really it's safe to say both genders contact the Samaritans equally.

Clearly help-seeking isn't helping. While men use the Samaritans as much they kill themselves more. While women use the Samaritans as much they try to kill themselves more. What's the big factor here: help-seeking or method? Clearly the method.

There is an assumption that talking helps people who are actually going to kill themselves. Again this precision is based on refining the truth. Some think about killing themselves as a solution to their present problems. Talking about these problems can help as can toughing it out. The latter isn't an accepted way of getting through things because the assumption is by not talking about it a person is more likely to kill themselves. There is little respect for personal process or the process through which resilience is developed.

Some people who I've spoken to about the high attempted suicide rate in women have explained these attempts are about help seeking or attention seeking. Those people are idiots. I have no idea where this false assumption comes from. Probanly some psychological bullshit from people who've never been through the experience nor attempted to understand the human beings who attempt suicide. The very idea that someone takes their life to either get attention or seek help is the sort of assumption which is made by people who understand fuck all about mental health. There is one and only one conscious thought which most (perhaps all but a very small handful) are thinking about when they try to kill themselves: they want to die. There are a million and one ways to seek help and gain attention which don't involve the conscious process where an individual gets to the point where death is the only option.

There are many modes, many mental states before, many circumstances and individual personalities in suicide. A lot of suicides often happen when there's a change in a person's states and almost invariably when it is a lowering of status. So it's not usually people who are alone but people who become alone (through a relationship breakup for example) who are at risk of taking their life. It is not people who are poor but people who go from rich to poor, it's not the unemployed but people who go from employment to unemployment. This category of suicide may be helped by the individual being able to talk about their circumstances but the assumption that they will or they should is bollocks. The individual is going through a terrible part of their journey in life. It gets so bad that some individuals can not see a hope. Once the decision is made to end it there is no normal or logical process of help seeking for people who are new to suicidal thoughts. What is the point of seeking help which has the aim of changing a decision which was very hard to make in the first place? Help seeking after making the decision to kill yourself is irrational. I guess these types of suicides are often quite quick - there is little time between the triggering event and action. These are the sort of suicides which people think are the totality of suicide.

There is another category. There is the suicide which a person thinks about then chooses. It may not be a circumstance of life event. More life itself. Some people want to die and this can be a choice. I don't know the numbers. There is a figure quoted that 80% of suicides are because of mental illness. I assume what they're talking about is what I've attempted to describe in the previous paragraph. The 20% is what I'm trying to explain here. People with or without a long standing mental illness can want to take their lives for many reasons. For the mentally ill it can be the life of being mentally ill which they no longer want to live. For others it's simply life without mental illness they no longer want to live. It is assumed that this comes from depression but I'm talking about the decision to kill oneself outside that clinical syndrome.

For the latter there is no help seeking once the decision is made. It might be spoken about but the decision is a long thought out decision which requires no 'therapy' to change a person's mind. This is suicide after a life of hell and a continued life of hell, one which the medical system can neither understand nor treat.

Imagine a person who waits 4 years to kill themselves. While the decision might have been made in depression the depression itself is not continuous for 4 years. The decision stays constant though and 4 years later the individual kills themselves. This sort of suicide is not mental iullness though many would want to apply the paradigm to use brain washing and behavioural modification techniques. It is a rational decision executed by a competent person, perhaps one you may not understand but your lack of understanding does not make another's decision irrational.

The only help the individual would want is in the execution of their plan. Many indiviudals want peaceful, reliable ways to kill themselves. This should be a right however we live in times where it isn't., Even the Swiss who allow people to termiante their lives have attempted to block the right for the mentally ill. We are refused dignity in dying like we are refused equality and existence in life.

This is just the tip of the iceberg of how complex suicide, help seeking and individuals are. Just the tip.

Is it cost effective?

A good friend of mine asked me this about the Soteria paradigm. I answered with honesty. My great failing. I said no.

He has a higher standard of education in health policy. My friend studied at Harvard. He studied public health policy and has two other degrees, one in business and one in medicine. He used to be a GP in the UK too.

He asked a good question. I don't know if he read my retort. He didn't respond. I argued poorly perhaps. Or was too lengthy in my response. Perhaps even too fanatical.

I simply explained that what happens in first episode psychosis is traumatic and inhumane. Essentially but not to put too fine a point on it my message was fuck cost effectiveness. You're a fucking doctor.

Can you see why I'm better alone?

My point stands but I think I may have a better one. The lobotomy.

The lobotomy is cheap to do and with modern psychosurgery it would be very cost effective in the long term as well as have safety levels similar to clozapine.

The cost benefit from refining the ice pick operation means people no longer need to be prescribed expensive antipsychotic drugs long term. When it was successful the lobotomy achieved the same results as prophylatic antipsychotic medication.

There are many cheap and easy new ways to remove the frontal lobes with a much lower risk than the ice pick technique. Had the psychopharmaceutical not come along and been accepted the lobotomy would be the primary treatment today.

It would be cheap and cost effective compared to antipsychotics. They wouldn't be commissioned if the lobotomy was still around. Btw - I think it was the UN or the WHO who made the lobotomy illegal eventually but not after it had killed many of my kin.

This is a salient health economics argument apart freom 2 things. One is the risk of death but this can be acceptable to psychiatrists. The other is the inhumanity of removing bits of peoples brains. Sadly psychosurgery still continues to be experimented with.

The inhumanity of carving up people's brains for dislike of their behaviour is sick and repugnant to me. I hope the past few paragraphs have made you want to vomit.

Well today the inhumanity of psychiatry's coercive practives, the trauma of first episode and the use of barbourous treatments continues. It continues while the Royal college of psychiatry has a motto of letting wisdom guide.

It would be more humane if they tasted my chocolate salty balls.

Stoned pride

There's no such thing. I know. There's mad pride though. Gay pride too but that's not relevant here.

And yet why not? People get high to get crazy. Those who are born with it fight for their survival. Those who use chemicals to do it persecuted to a much lesser degree but make the choice to be mad. And good luck to them!

Societies worst punishment is exclusion and incarceration

Since the UK hasn't hanged anyone for a long time the worst punishment is incarceration. Imprisonment removes the person from society and takes their liberty.

Other punishments exist. A criminal record. In practice this excludes a person from many areas of employment.

There is also the exclusion caused by debt and bankrupcy. Financial exclusion and the prison of poverty.

Those punishments are the worst that just society will do to an individual.

And then there's the lives of the mentally ill. These punishments can be daily life.

The painter that thinks red is a sin

This is a silly thought isn't it. Were I Paulo Coehlo i'd probably write a short story on this.

I summaries it in one word in my simple thinking: psychiatry.

There are many colours which blend to make the individual and the collective. One colour is madness. Another is misery. These are not sins or illnesses to the pathologised, perjoratised and hidden from existence. These colours are vital to the tapestry: mine, yours and everyone elses.

Psychiatry hasn't duped society into believing a type of human or human is an illness. It's duped itself.

There is but the human condition. All colours are colours.