At the coal face

Tom Elliot writes.

For decades the Community Mental Health Team in localities throughout the UK has been known as ‘the coal face of mental health’. Like the shutting of the pits in the 80s our CMHTs are under threat from NHS England’s New Community Mental Health Framework (see

It is the latest instantiation of neoliberalism within the NHS that promotes a market driven and industrialised approach to mental health care. The Framework emphasises the outcome-based values within primary care IAPT services, primarily, returning people to work. Whilst it may better integrate primary and secondary care, this seems to be to the detriment of complexity and depth of working. The work of the psychologist in CMHTs is mostly providing individualised assessment, formulation care and treatment for individuals who have been at the extremes of human distress. Whilst the Framework is said to provide pathways for specialist services, accessing any is difficult with exclusions and gateways on never ending pathways through diversion schemes and call centres such as Single Points of Access. Not to mention huge waiting times.

Increasingly, psychologists and psychotherapists working in CMHTs are being drawn away from their individual therapy that values the basic idea that emotional and mental distress can be helped by talking. Instead, they may be overseeing suboptimal ‘interventions’ where unqualified staff such as support time recovery workers offer basic behavioural activation sessions. I argue that these outcome-based approaches create the very distress and depression that therapy in CMHTs has long been valued for healing. Having worked in CMHTs for 23 years, I have seen many incarnations and operational models come and go. However, this is a threat to the core of what psychologists and psychotherapists do well. Talking therapy from CBT to Psychoanalysis should be fuelling CMHTs and not allowed to become a dying ember.

Tom Elliot CPsychol AFBPsS
Margate, Kent

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