Friday 1 February 2013


It is time to fight back against a longstanding prejudice shared alike by thoughtless, old-fashioned mental health professionals and by thoughtless, "progressive" mental health campaigners, namely the call to make psychological therapies available to those using primary care services without mentioning those using secondary mental health services.

The old-fashioned types either don't like psychological therapies much at all or else they think they are a waste of time - or worse - for people who have serious illnesses. I recall a speech by an eminent psychiatrist who asserted confidently that psychological treatment for people with schizophrenia would most likely just "upset them" by "raking up childhood experiences" etc, demonstrating that he was unable to distinguish a proper concern about silly Laingian flim-flam (see this post) from the value of deploying the right talking therapies to assist people at any level of illness including colourful psychosis.

The thoughtless progressives, on the other hand, tend to just forget about the people who are seriously ill when they discuss psychological therapies (that's if they ever remember about them) or else they are uncomfortable with discussing the role of psychological therapies in the context of medical treatments, preferring to stick to simple principles like "talking good, drugs bad" which is fine for many cases of anxiety and moderate depression but isn't the reality for most people in Hafal's client group.

So, let's be clear: Hafal calls for...

1. The availability of psychological therapies across Wales for people who experience a psychotic illness as a matter of routine.

2. A priority for psychological therapies to be available first to people who experience a psychotic illness and who are in greatest need.

3. Psychological therapies for people with a psychotic illness to be available and widely used within mental health units and hospitals - and to become a standard provision.

4. Psychological therapies to begin as soon as possible for people with psychotic illnesses - as NICE guidelines state - and started in the acute phase.

5. The availability of a full range of psychological interventions. People receiving secondary mental health services are likely to need specialist psychological interventions, but are also likely to have primary care needs too (anxiety, depression, etc).Therefore, people receiving secondary mental health services should have the full range of psychological interventions available to them.

See our excellent guide to both medical and psychological treatments here.


Please don't mistake my distrust of sloppy anti-psychiatry for thoughtless pro-psychiatry. I am as troubled as anybody by the claims of psychiatry over the years and to this day - and the best psychiatrists are surely those who are most hesitant and cautious about the very principles upon which the authority of their profession is based.

If you want to examine this difficult subject then see how much you agree with the thinking of Thomas Szasz who died recently having pressed over the last 50 years one of the most coherent attacks on conventional ideas about mental illness and its treatment. I don't agree with quite a lot of what he says - but he lands some hard punches.