Although Michael Fitzpatrick concedes some treatments for mental health problems are valid, too much is spent on those that are not
A campaign sponsored by the government’s happiness tsar, Lord Richard Layard, and backed by the entire medical, psychiatric and social policy establishment is recommending “evidence-based” psychological therapies for up to one-third of the population.
In the run-up to the general election, the We Need to Talk campaign, including the main mental health charities, are demanding that politicians honour commitments to rolling out the Improving Access to Psychological Therapies programme which was launched in 2008, so that anybody can gain access to cognitive behavioural therapy, family therapy or inter-personal therapy within 28 days.
The high-profile campaign for universal talking therapies raises two questions. Is this concept of “state-of-the-art” primary care services, to be delivered by therapists fast-tracked through day-release training programmes, firmly based on scientific evidence? What will be the consequences of this emphasis on basic counselling for everybody for the provision of expert psychiatric care for adults and children with severe mental illness?
According to Lord Layard, the scale of Britain’s mental health problem is “massive”: one in three families are affected. He believes that one in 10 children and one in six adults have a “diagnosable problem requiring professional help”. It is immediately apparent that these rates of diagnosis can only be achieved by the dramatic inflation of familiar diagnostic categories and the expansion of the scope of psychiatric labelling from a small minority of sufferers to a substantial proportion of the population.
The claim that these vast numbers of people with mental illness are treatable arises by extrapolation from the results of small academic studies to vast clinical populations.
If diagnosis lacks determinacy, so also does treatment: it is by no means clear what elements of the “talking” cures favoured by Lord Layard and his supporters produce the outcomes they observe (and quantify with dubious empirical validity).
The problem that dogs the application of the rigorous mathematical methods of randomised controlled trials to psychiatry is that so little is understood about the workings – and malfunctionings – of the human mind. As the great Irish psychiatrist Maurice O’Connor Drury observed, there are too many unknowns in psychiatry for these methods to be either safe or applicable.
There is, however, some evidence for the value of particular treatments, including medications as well as psychotherapeutic interventions, in relation to conditions such as schizophrenia and bipolar disorder, anxiety and depression. It is indeed a scandal, as Lord Layard and others have pointed out, that adults, adolescents and children with these conditions often experience inordinate delays in gaining access to appropriately skilled assessment and treatment.
Unfortunately, the diversion of resources to providing dumbed-down psychotherapy for everybody will not help to improve access to high-quality psychiatric care for those who really need it.
➔ More on the roll-out of the Improving Access to Psychological Therapies
➔ IAPT programme details
Michael Fitzpatrick is a GP in Hackney and author of Defeating Autism: A Damaging Delusion, published by Routledge
This article is published in the 29 April 2010 edition of Community Care under the headline “Dumbed-down psychotherapy will hinder high-quality care”