Considering the context of distress

Ella Rhodes reports on recent developments in mental health provision.

An independent report by the Mental Health Taskforce, chaired by the Chief Executive of Mind, Paul Farmer, has set out recommendations for mental healthcare in the NHS. In the wake of this report, Prime Minister David Cameron called for greater focus on mental health in society and committed £1.2 billion extra per year to be spent on mental health by 2020

The report, ‘The Five Year Forward View for Mental Health’, recommends that there should be round-the-clock care available for people facing a mental health crisis. It calls for an integrated physical and mental health approach, including increased access for 30,000 more women a year to access specialist perinatal care.

Turning to prevention, the Mental Health Taskforce to the NHS in England calls for better access to mental health care for children, and the provision of support for those with mental health problems to gain, or stay in, employment. In addition the report looks at other societal issues known to affect mental health, for example building an evidence base for specialist housing support for vulnerable people with mental health problems.

Meanwhile a survey by the British Psychological Society, in conjunction with the New Savoy Partnership, has revealed that many psychologists are struggling with the issues they aim to treat. 46 per cent of psychological professionals said that they felt depressed and 49.5 per cent reported feeling they were a failure. One quarter said they had a long-term, chronic condition and 70 per cent reported finding their job stressful.

We spoke to Chartered Psychologist Anne Cooke from Canterbury Christ Church University, editor of the Society’s report Understanding Psychosis and Schizophrenia, for her view on these developments and the future of mental health services in the UK.  She praised the mental health taskforce report for its focus on prevention as well as treatment. ‘I also welcomed its emphasis on alternatives to hospitalisation for people in acute crisis, although I was disappointed it didn’t mention the huge potential of non-medical crisis houses – I have argued elsewhere that we need one in every town.’ 

Though Cooke agrees the funding proposed by the government may help a little, she said the sources of strain on psychologists and therapists  are multiple. ‘Over 40 per cent in the recent BPS and Savoy Partnership survey named managerial fixation on targets as a reason for their stress.’ She also suggested a need to tick boxes and ‘fit’ people into diagnostic criteria could lead to problems: ‘Without the potential for flexibility, both client and therapist may go away disappointed.’ The emphasis on ‘brands of therapy with their various techniques also risks devaluing those aspects of psychological care that we know are often the main “active ingredients”: listening, time, compassion, care, adaptability,’ she added.

The social causes of psychological distress, which are numerous, are impossible to treat with individual therapy, Cooke said. ‘Whilst major causes of mental ill-health, poverty and inequality, are growing exponentially, our current technocratic Zeitgeist encourages us all to see our problems as individual and psychological rather than social. Psychologists need to broaden our focus and draw attention, for example, to the psychological impact of current policies.'

Cooke and fellow Clinical Psychologist Jay Watts recently published an article in The Guardian discussing these issues and have been inundated with messages from those who do not feel safe to speak out. Cooke said: ‘I understand the pressure to present a front of success, competence and ever-greater achievement in stretched times, to pretend we are okay, fine, good. Yet I also believe we must fight for and model an insistence upon organisational structures which make the intense emotional labour that our role requires sustainable… that recognise and contain workforce distress and try to refuse or relieve contextual pressures which cause it.’

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