Wednesday 15 September 2010


A fine turn-out in Bridgend for the microbus now on the home straight on the "Road to Recovery". Poor weather cannot dampen enthusiastic crowds enjoying the surf vibe at the same time as learning from the show-case of Hafal's variety of services in the County.

One of the local concerns raised is the lack of psychological services - and this is not a problem confined to Bridgend. There is a curious phenomenon about talking therapies which Hafal has observed, namely an unspoken but pernicious prejudice that such therapy is suited to low level mental health problems but a bit pointless for people with a serious mental illness. The false reasoning for this prejudice would be that (i) serious mental illness is probably genetic and at any rate to do with chemical dysfunction so talking is pointless; (ii) serious mental illness often results in a lack of ability to follow a discussion so talking therapy won't work; (iii) talking therapy can be distressing and you don't want to upset somebody that ill; and (iv) serious mental illness requires the sledgehammer of powerful drugs so talking therapy won't make any significant difference. Talking therapies are sometimes grudgingly acknowledged as having a marginal function in alleviating distress but not really touching the illness itself. Sometimes carers and family,
especially parents, may resist the idea of talking therapies because they fear the revelation that poor upbringing could have caused the illness (and there are bad memories still around of the simplistic, "blame the parents", Laingian ideas from the 1960s).

A further problem is that there is a lack of evidence about the effectiveness of talking therapies, largely I believe because the studies have not been done - there is little incentive for the pharmaceutical companies to fund such research though there are exceptions.

But I suggest that common sense tells us that talking therapies can make a decisive difference. The evidence for this is the experience of patients who, when they pursue recovery holistically or (put another way) get their lives sorted out, can overcome significantly, and sometimes completely, the symptoms of mental illness, the damaging effects of symptoms, the risk of relapse, and difficulties in recovering from relapse. Talking therapies should be directed towards assisting patients to pursue recovery in this way as well as directly addressing symptoms such as paranoia and depression. In practice many patients are scarcely talked to beyond what is necessary for the purpose of diagnosis and prescription.

Interestingly many members of the public believe that talking therapies are the norm for people with serious mental illness. If you are a mental health services insider try asking an intelligent member of the public what they think goes on in mental health services. I have done just that and most respond that they think the services may be rather shabby but nevertheless they picture the analyst's couch, the group therapy sessions, and the expert staff taking time to assist patients to understand and address their illness. Why would they expect anthing less in a modern health service? They are appalled to learn that in hospital it is a common experience to receive no talking therapies at all and scant communication of any sort. They wonder how it can make sense to pay vast sums for every bed but not pay a little more to have therapists engaging intensively with patients? They are right to be appalled.

And let's be clear that any old talking therapy isn't good enough. There needs to be a proper choice not confined to the superficial massaging of symptoms which much of the current trend for cognitive therapy involves. There is a need for high quality, no-short-cuts therapies which help patients get to grips with their lives. I must declare an interest here: I was lucky to find excellent therapists using transactional analysis to address my own illness in both one-to-one and group work over many months, an experience which changed my life and inspired my career move into mental health services. It still makes me shudder to think what would have become of me if I hadn't had the means to pay for therapy and had to rely on what the NHS could provide - maybe five minutes with a GP and a prescription for happy pills? Things are a little better today but not much I fear.

For a detailed overview of talking therapies and more on the case for "equal status" for talking therapies to treat serious mental illness see Hafal's guide here.