Long-term mental health problems and NHS privatisation

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Chimera

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I don't follow politics, and I don't understand economics, so it is quite possible that the answer to the following question is a simple "yes" or "no", with simple reasons that can be given, and that I might even understand (eventually).

It's not obvious that a corporation can see a person with long-term mental health problems as a profit opportunity.

Secondly, it seems likely (but again, I'm factually ignorant of such matters) that the NHS has, for years, been progressively reorganised with a view to splitting off as much of it as possible into profit-making entities. (New Labour was just as much in thrall to global capitalism as the present government of the UK.)

So it seems possible that the NHS has developed a capacity for denial of the existence of long-term mental health problems, accompanied by an insistence on packaging all mental health problems as short-term 'episodes', with a definite beginning, a definite end, a definite medical diagnosis, and a definite preferred set of treatments (that you can't be sued for, basically).

Thus all of mental health becomes more amenable to statistical analysis, which is a prerequisite for subsuming it under an insurance (actuarial) model, along much the same lines as the US's notoriously expensive (huge proportion of GNP) healthcare system. (This has already made great inroads into the UK, particularly in the form of Unum/Atos - which again came in under New Labour, not the Coalition.) And this purely economic agenda is hidden under the pretext that it makes psychiatry and/or psychology more 'scientific'.

I don't have a clear logical view of this area. (Lots of complex personal reasons for that.) And even when I do have a clear logical view of something, I can still tip over into a kind of paranoia. So am I just being paranoid about this, or does my hazy view of it, as far as it goes, correspond more or less to reality?

I just wonder if this accounts for some of the daily, even hourly sense of sheer dread under which I now live. Every single contact I have had with the NHS since around 2006 has seemed to add a little bit to this terrifying picture. I hope I'm just imagining it. I also hope that I'm amenable to rational argument. (As a recent thread embarrassingly illustrates, I can be a tough nut to crack, but I do listen.)
 
pepecat

pepecat

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Like you i don't really follow politics, and don't really understand economics, but i agree with everything you suggest. To me, it seems the same.
The whole IAPT Initiative which the govt put forward would suggest (to me) that we're headed in a money / results oriented direction, and that, together with the recent passing of the NHS bill by parliament, scares me when i think about my MH treatment. If i get ill again in a two, three, ten years time, i have a feeling that i won't be as lucky with treatment as i have been this time.

Looking at the IAPT website, the two pilot (pathfinder) areas both increased access to CBT, and only CBT. Now while this is a good therapy for some conditions and some people, it's not for everyone. But the NHS like it cos it's (a) brief - usually 8/10/12/20 sessions (b) cheap - cos it's brief (c) measurable - give the client a questionnaire when they start, 'homework' to do, and a questionnaire when they finish, and bingo, statistics!!
Again, whilst CBT works for some people, it is not for everyone. It seems to me that the NHS are trying to go down a 'one size fits all' thing, which is - even to a laywoman like me - ridiculous. Nonsense. Utter and sheer stupidity. You can't fit mental health into the same tick boxes as you can with (for example) heart surgery, waiting times, asthma management. Doesn't work.

I imagine though, that gp consortiums (consortia?), who are now going to be controlling budgets and deciding what to spend their money on, are going to want quick and cheap MH services, so CBT it'll be then. Or do they spend their money on physical / surgical cases, and only manage MH with meds (cos writing out a prescription is FAR easier and cheaper.....) Similarly, if people have private health insurance, i can't see companies paying out for 2 years of psychodynamic stuff when 8 weeks of CBT are also an option. The whole thing sucks.

People who have milder 'common' MH issues will probably benefit from CBT (and do, i know), but for others (including myself) it just isn't the case. I understand CBT, what it is, how it works, how i SHOULD think. I just can't / don't do it. It's an intellectual exercise as fas as i'm concerned, and that's it. And one that i'm not particularly interested in pursuing. As i say, it works for some people. Just not me. And i'm scared that in future i'll be shoehorned into some CBT box whether i like it or not.
 
CBTish

CBTish

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A corporation can certainly profit from a person with long-term mental health problems. A corporation only has to persuade someone rich to pay for some kind of care for the person, and then spend less on the care than the rich person pays. The money left over is profit for the corporation.

The splitting off of the NHS depends how you look at it. The uniform NHS brand and logo that we see today are relatively recent. For most of its existence the NHS was a collection of separate parts. Uniform branding concealed the separateness of the parts for a while, and now some of the parts are becoming more obviously separate again. You are right in thinking that all this — first the branding, then the splitting — happened under New Labour.

Whether the parts are "profit-making" also depends how you look at it. For most of the NHS's existence, if one part spent less on care than the Treasury paid it, the Treasury immediately took back all the money left over. This caused a big problem, because there was no incentive for any part of the NHS to save money, and the whole NHS became wasteful and inefficient. The new thinking is that some parts of the NHS can decide for themselves (within reason) what to do with any surplus money they might have. This gives them an incentive not to be so wasteful, but some people see it as profit-making.

I don't think there's denial of long-term mental health problems. The provider corporations in the NHS make money out of them just like they do out of short-term problems. Denial wouldn't make commercial sense.

IAPT was designed to improve access to therapy for the two most common mental health conditions, anxiety and depression. It wasn't meant for everyone, and it didn't replace existing services for people with other conditions. I agree with you that the relationship between IAPT and other services is mismanaged in some places, but I think that can be fixed.

The consortia, now called Clinical Commissioning Groups, will control the details of budgets and contracts but they won't decide what to spend the money on. They'll spend it on what they're told to spend it on by local Councils' Health and Wellbeing Boards. There's no reason to suppose those Boards will instruct their CCGs to go down any "one size fits all" route.

If you see CBT as just an intellectual exercise, then you haven't experienced good CBT. There's no shoehorning people into any boxes around here, and no telling patients how they should think, but this is not the NHS, and I know that standards of CBT in parts of the NHS are not always what they should be. Ironically, statistics could be part of the solution to that problem, by making it obvious exactly where NHS treatments are failing.
 
pepecat

pepecat

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Thanks CBTish - you seem to know more about it than me!
Presumably though, whe push comes to shove it'll still be about money. The NHS has to save money (according to cameron), so there must have to be some prioritising of who gets what within the system. Suppose it's like the 'postcode lottery' that already exists at the moment.

I haven't had any CBT. My only experience of it has been via that moodgym website. I know how it works and how it's supposed to work, but i was more interested in understanding why i think / act / react the way i do, and it seemed to me ( i hasten to add) that CBT is kinda like pruning dead branches off a bush, but not necessarily about finding out what made the bits die in the first place. For me, i needed to go deeper than that and get to the root of things.
 
CBTish

CBTish

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You're right, money will still partly determine the NHS's priorities. But the overall priorities in each area will be set by the local Health and Wellbeing Board, which has no financial responsibility for delivering services. The Board will be free to say what it thinks people need. The "postcode lottery" will remain, because each local Health and Wellbeing Board is probably going to see things a little differently.

I liked MoodGym when I tried it, but it's not really CBT. It's only "based on" CBT, in the way that some drinks that are packaged like fruit juice are only "fruit flavor drink". The basis of CBT is what's called a formulation, which is individual to each patient and gets to the root of things in exactly the way you describe. Unfortunately some therapists find formulation difficult or don't bother with it, and some don't seem to have heard of it. But if you are choosey about your therapist you can get proper CBT that deals with the why, even in the NHS.
 
pepecat

pepecat

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Thanks CBT ish.
I have psychodynamic psychotherapy on the NHS and i'm finding it really useful. Hard, but good!
 
CBTish

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You are doubly lucky, then, I would say. Firstly because psychodynamic therapy is pretty rare in the NHS these days, and secondly because psychodynamic therapy is difficult for a therapist to get right, so it's pretty rare for it to be useful. I hope it continues to go well for you.
 
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chancer

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CBT is from my limited knowledge the best form for therapy of psychiatric patients, the role of CBT unlike other areas of psyhotherapy is to change a persons thought process/reaction to crisis rather than the more traditional "let's examine your childhood approach".
My major concern with the NHS changes is the fear that they go down the Psychiatry (drugs as first approach model) rather than the Psychology (therapy first then drugs as last resort). I would personally rather have therapy to help me try to change my behaviou patterns and thinking process rather than, take these toxic meds because we are trained psychiatrists and believe in the disease model (putting everyone in the same boat). I understand that some people need the medications however, I do believe they need to focus on each individual patients needs before prescribe prescribe prescribe. I was prescribed anti psychotic medication after a ten minute meeting with my psych doc and I wasquite articulate and level headed in explaining my problem....I have now been diagnosed with bipolar and have opted for the more therapy with medication to deal with crisis.
The biggest fear I believe we have regarding privatization is if we end up going down the American route where, big business pharmaceutical companies and their interest lobby groups get to much of a firm hold on our precious NHS. Sorry for ranting on a bit but, I am terrified that if the pharmaceutical companies get their way, more mental health patients will be forced on mandatary medications as they do in some states in the USA.....We need to make the government realize that people with mental health issues are just as smart and probably more informed than psychiatric interest groups would like them believe.
 
CBTish

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For some years now parts of the NHS, including some mental health services, have been contracted out to private companies, but those companies provide CBT and other talking therapies in the same way as NHS trusts do. Even people who have private health insurance in the UK, through big businesses such as AXA and Bupa, can choose to have CBT and other therapies. So, while you might be right about the USA, I do not see any signs that businesses here in the UK are forcing people to take medication.
 
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chancer

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I disagree, I know people who are under a contract with their Mental health authorities that they must take their medication...depo injections are a good example. Every time I am in hospital the pressure I get put under to take my meds is nothing short of bullying and even when I attend follow ups, I hear the same old mantra about how I should be on mood stabilizers. As it stands I have both the conviction of my beliefs and a strong willed personality which, enables me to say no but, I know people who have been practically blackmailed by the psych hospital to agree to remain on tne meds or they "could" be re-admitted. I just feel that we need to take note of these type of practices and ensure it deosn't get rolled out even further. A young girl I know diagnosed with schizophrenia cries every couple of months in despair when she has to have her depo injections. It deosnt make sense...she has never hurt herself or other people, she just hears voices and they scare her with stories about "what could happen". No one ever knows what could happen with anyone and toxic medication as a precaution is a disgrace unless the person has violent tendancies.
I have an issue when I sign into my mental health office with a seroquel pen, then the first drug my psychiatrist reccomends is seroquel and then...get this...rights the prescription with a seroquel pen, I put my house on it that a pen was not the only incentive he received from the drug rep from seroquel. MY fear is that although we are not in the same boat as America YET...that one day we might be since we have a tendancy to follow in their footsteps.
 
C

Chimera

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the role of CBT unlike other areas of psyhotherapy is to change a persons thought process/reaction to crisis rather than the more traditional "let's examine your childhood approach".
This is just a tangent, but I must object that this view of what psychotherapy is like is a complete fantasy, one beloved of journalists and the general public. In all my 40 years of involvement with mental health services, both public and private, I have never encountered even one single psychotherapist or counsellor who pushed the necessity of examining my childhood. On the contrary, they have, if anything, bent over backwards to avoid seeing even the most obvious effects of my upbringing on my present-day personality and problems. I am extremely compliant and suggestible (which is, ironically, itself a clear result of my upbringing!), so I have not resisted their authority much; and even when I have very timidly ventured my own suggestions as to the influence of my childhood on my own life (a subject on which I am, after all, the leading world authority), I have encountered resistance. I have also seen the same thing happening to other people, for instance a patient of R. D. Laing's, who left him when he said to her, "I don't want to hear about your childhood".
 
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chancer

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I might not have 40 years experience but, what I do know (because I have a friend who hasa very successfully psychotherapy clinic.
Areas of therapy she highlights as looking both at the problem on hand and past life experiences are Psychodynamic and Psychoanalytical and also integrative behavior therapy.
To make a statement such as "they have bent over backwards to avoid seeing even the most obvious effects on the present day" which was my point about how this is what differs CBT from other types of therapy. I'm a bit confused as to whether you are saying do self respecting therapist would delve into someones childhood as a way to help them move forward?
So if a client had been raped or sexually assaulted as a child or even witnessed a particular childhood traumatic experience then, it would be unproductive to examine this and just brush it under the carpet?
Surely a therapist would firstly find out what brought them in for therapy and get a thorough background to get an all round understanding of their client?
 
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Chimera

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I might not have 40 years experience but, what I do know (because I have a friend who hasa very successfully psychotherapy clinic.
Areas of therapy she highlights as looking both at the problem on hand and past life experiences are Psychodynamic and Psychoanalytical and also integrative behavior therapy.
To make a statement such as "they have bent over backwards to avoid seeing even the most obvious effects on the present day" which was my point about how this is what differs CBT from other types of therapy. I'm a bit confused as to whether you are saying do self respecting therapist would delve into someones childhood as a way to help them move forward?
So if a client had been raped or sexually assaulted as a child or even witnessed a particular childhood traumatic experience then, it would be unproductive to examine this and just brush it under the carpet?
I can't follow your argument. (The syntax doesn't parse, and I'm not terribly good at discerning what a person is driving at, in the presence of such surface glitches. I'm sorry if your meaning is obvious to everyone except me! I can sometimes be overly literal.)

However, I gather that one thing you are asking is whether I personally believe that therapists ought to delve into people's childhoods - is that right?

If so, then the answer is that I do believe that they should do so. I don't have any firm or detailed theory about it, and there may be exceptions. But it seems a wise thing to do as a matter of routine, just as a proper medical check is also a wise thing to do as a matter of routine.

But the fact that no-one has ever done so in my case (unless my memory is playing really atrocious tricks, which is possible, I suppose) almost amounts to abuse in itself.

To be fair, I do recall one psychiatrist, at the Maudsley Hospital, some time in the 1970s, making an insightful remark about my relationship to my sister and my brother.

Also, it is possible that I have been evasive when questioned, and perhaps therapists were responding to my evasiveness, rather than me responding to their lack of curiosity. In support of this hypothesis, there is the fact that on one occasion I said to a psychoanalyst that I felt bad about going on about my childhood all the time, and she responded, greatly to my surprise, by saying that in fact I had hardly mentioned it; and I have no reason to think she was mistaken.

Surely a therapist would firstly find out what brought them in for therapy and get a thorough background to get an all round understanding of their client?
That has never been my experience (unless my memory is playing tricks, as mentioned above). The reasons why are complex. My guess is that it is primarily because of the way therapists think and act, and secondarily because of my extreme wish to please them by conforming to their wishes (or what I take their wishes to be). I still feel very guilty about trying to make sure that my current counsellor has a comprehensive and accurate picture of how I see my problems; it feels like I'm going against the very spirit of therapy itself.

But I think that what you have just described is how any therapeutic relationship should be conducted at its outset.

I am extremely puzzled (and that's putting it mildly!) at how badly things have gone for me in my 40 years of trying to get help, for quite specific problems, about which I would have quite a lot to say if anyone were to ask me about them in a genuinely curious manner. I suspect that the therapists I've met were not adept at dealing with dissociation, and so just assume that the very compliant face I present to them is the only face I have. In a way, it is; but it is not the only aspect I have, and it bears very little relation to most of what I think and feel and experience. How I act with people is very much the behaviour of a survival machine. No-one will get past that if they don't care to inquire. I'm trying to become more proactive, but as I say, I feel terribly guilty about it.
 
J

Jamster

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EDIT: er i quoted the wrong post sorry...



This is the same as my experience. Except CBT therapists should understand and discuss the effects of problems in childhood.
 
C

chancer

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I think their may have been a misunderstanding from the different perspectives we were coming from. CBT has been suggested as the best type of therapy for dealing with bipolar patients.
I want to make it clear I am not a professional and I am just making my observations based on conversations with people who are actually qualified in their profession.
I asked my friend about your unfortunate experiences with therapy and her response was: The responsibility of choosing the right type of therapy should be tailored to the individual (all size does not fit all). If you..as the client feels the need to focus your therapy on your childhood then that's what you should be doing if it actually does have benefits to your treatment. Although, if a good therapist feels like you are going around in circles and not getting anywhere therapeutically then, it is their responsibility to discuss this with you and work with you as a team to find a solution that will be of therapeutic value. I wish you all tne best in the future with finding a professional and understanding therapist/councellor, just be honest with them on past experiences and a good therapist should be able to help you approach therapy with a clean unbiased slate with providing you with a safe environment to restart the process of understanding what you really need from their services. Good luck :)
 
C

Chimera

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I asked my friend about your unfortunate experiences with therapy and her response was: The responsibility of choosing the right type of therapy should be tailored to the individual (all size does not fit all). If you..as the client feels the need to focus your therapy on your childhood then that's what you should be doing if it actually does have benefits to your treatment. Although, if a good therapist feels like you are going around in circles and not getting anywhere therapeutically then, it is their responsibility to discuss this with you and work with you as a team to find a solution that will be of therapeutic value. I wish you all tne best in the future with finding a professional and understanding therapist/councellor, just be honest with them on past experiences and a good therapist should be able to help you approach therapy with a clean unbiased slate with providing you with a safe environment to restart the process of understanding what you really need from their services. Good luck :)
Thank you. I'm seeing the counsellor again tomorrow. (I'm not actually 'in' therapy yet, just having a series of ad hoc appointments while I'm on a waiting list.) I have already conveyed to him that I definitely want counselling to concentrate on a certain kind of internal relationship I have with a part of myself somehow left over from early adolescence. (It's hard to describe in plain English, but it is a living, concrete reality.) I have very much held back from going into detail about the many horrendous things that have gone wrong, both inside and outside therapy, during the last 40 years, because such a discussion (the story could literally fill several books!) could all too easily eclipse the problems for which I needed to go into therapy in the first place, all that time ago. But I have thought of directing him to a relatively brief summary I wrote of that tangled history, if necessary. I'm agonising a lot over how to prevent therapy going wrong again this time; how to learn from my many past mistakes. But overall I feel quite optimistic that some good is going to come of it.
 
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khris

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Hi just to throw my 2 cents worth in about Cbt, I have done many sessions of Cbt over quite a period and they usually intend on doing 20 session but if there are no results after 6 it usually not for that person different people respond in different ways I felt it did not help me at all and made me worse and they did go down the childhood route with me they are trying to find the cause of the problem and change that. I stopped after about 35 sessions, I've being referred twice before and currently being referred for a 3rd time by my gp but I don't believe it helps but there is no other option for me apart from meds which me and my gp do not want to do.
 
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lionshope

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Hello chimera i can't say much tonight as i'm on empty now,but i have been reading your threads there intresting and i like your style of putting your thoughts into words..it does seem that you have so much you need to get off your chest and exspressed to your therapist,and i think that it would be very good idea to send/fax some of note work so that he can have a good read.i believe it will relax you before you next meet plus if you could maybe type/write down a shortlist of things for the day that you can remember.hope all goes well there and you find the words you need on the day.
 
C

Chimera

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Hello chimera i can't say much tonight as i'm on empty now,but i have been reading your threads there intresting and i like your style of putting your thoughts into words..it does seem that you have so much you need to get off your chest and exspressed to your therapist,and i think that it would be very good idea to send/fax some of note work so that he can have a good read.i believe it will relax you before you next meet plus if you could maybe type/write down a shortlist of things for the day that you can remember.hope all goes well there and you find the words you need on the day.
Thank you very much! I tend to get very frustrated by how long and complicated my posts get, even when I am trying to express only one apparently simple feeling or idea or intuition (which is usually the case), never mind when I am trying to summarise an entire load of anxiety! (That was the case with one very long post, yesterday, which I mention below.) But I'm glad if some of it does get across; at least that means I'm not totally living in a bubble of my own reality or unreality.

I still feel I should wrestle with the problem of keeping everything in mind, and only talking to the counsellor, rather than giving him yet more to read (unless, as I said, it all goes wrong today, and then I can fall back on communicating in writing, as Plan B). I can't always go through life being afraid of talking to anybody, even when it's a counsellor (and moreover, a counsellor whom I like and, paradoxically, feel relaxed with). At some point, I have to face my fear; and this counsellor seems to be making it possible for me to do that, in a way I have never done before. (My fear has never before had such a visceral expression as it had after my last two meetings with him.)

But I am going to cheat! I always carry around a folded sheet of paper in my pocket for making random notes of things when I'm out, and I'm going to write out on that a short summary of the rather long post I made yesterday, attempting to summarise why I felt so anxious about the prospect of today's conversation with him. It feels very like writing out a crib sheet before an important examination! I mean to read it over and over and commit it to memory before seeing him.
 
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