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Alastair Campbell on mental health -

Bendy girl, who writes Benefit Scrounging Scum, draws my attention to an odd outburst from Alastair Campbell. Campbell is well known as Tony Blair's PR man and, despite previous differences, is close to Gordon Brown. He has a personal history of alcohol abuse, now under control, and of a severe depressive illness.

Whilst the other Alastair was delivering the worst and most dishonest budget in living memory, Alastair Campbell was speaking at an event organised by MIND. One of the other speakers was

Henck van Bilsen [who] is a consultant cognitive behaviour therapist who also leads a degree programme in CBT at the University of Hertfordshire.

Alaistar Campbell says:

[Henck van Bilson] spoke of a 'revolution' taking place in mental health services in Britain. He said the government had taken a conscious decision - he called it historic - to invest in improved access for mental therapies. As a result, he said, without having to go through a GP, it would be possible for people to go straight to a new regional centre for psychological therapies, and hopefully get help.

It is the kind of thing which you never hear about on the TV, rarely read about in the papers, but it matters to a lot of people. And it was refreshing to hear someone being so passionate about a choice a government had made, and talking so eloquently about the benefits that would bring.

MIssed the Budget : Saw why it mattered

This is all part of what the government calls IAPT -“Improving Access to Psychological Therapies”. It sounds so plausible.

The “Improving Access to Psychological Therapies” (IAPT) agenda plans to establish a comprehensive network of psychological therapy centres throughout England. In these centres 30-40% of the workforce will comprise of low intensity high volume workers. These workers will be trained to a suitable level of proficiency in evidence based interventions mainly CBT based.

The training provision for low intensity workers is responsive to the IAPT national curriculum and the guidance issued by the National Institute for Clinical Excellence which emphasises cognitive behavioural therapy (CBT) as an intervention strategy in the management of common mental health problems.

University of Hertfordshire

CBT (cognitive behavioural therapy) is a perfectly reasonable treatment modality for some forms of mental illness. Unfortunately, it has been built up by a cynical government into something that it is not. It is not, as it is now portrayed, a universal panacea for all mental disturbance. Far from it. But it sounds good, doesn't it?  

In fact, most people do not even know what the word "cognitive" means. Be honest. Do you? Do you really know? Put the word "cognitive" in a sentence. Most people cannot. Which makes CBT even more attractive and mysterious. "Behavioural therapy" sounds a bit threatening, doesn't it? The "smack bottom/have a sweetie" Pavlovian approach. But "cognitive behavioural therapy" has the mystique of the unknown. And it's a "talking therapy" and that is a good thing.

In the old days, we would have talked to our mothers, our extended families, the vicar, the priest or the Rabbi. We used to call that "getting some sympathetic, helpful advice" about our problems. And, when you have stripped away all the cryptojargon, what more is there to CBT than "helpful, sympathetic advice"? We no longer take advice from the extended family or from the church. We prefer to see our secular priests. GPs are often the secular priests but they do not talk any more. They just dole out soma. Or that is what the government tells you and, sadly, it is  in some cases true. And you cannot see a psychiatrist unless you are rich or Stephen Fry (or both) because most psychiatrists do not soil their hands with routine (routine = "you and me") psychiatric problems. They lazily hide behind the dumbed-down "health care professionals" in the CMHT.

It is not. It is yet another example of dumbing down health care. For the majority of problems it will matter not one jot. A sympathetic ear is all that is needed, and it is sad that our society is no longer able to provide such an ear without "professionalising" what should be a natural process. For those with serious mental problems, CBT will be of less value and may even be harmful. The government styles the CBT practitioners in the following way:

30-40% of the workforce will comprise of low intensity high volume workers. These workers will be trained to a suitable level of proficiency in evidence based interventions mainly CBT based

The linguistic gymnastics performed by this government in their attempt to disguise dumbing down never ceases to amaze me. "Low-intensity, high-volume workers". Oh! Brave New World. Bring on the Epsilons. These "low-intensity high-volume workers" will have even less skills than the average member of the CMHT. They will be medical epsilons. Diagnostically untrained and incompetent they will be unable to see beyond the confines of their protocols. When you only have a hammer, all problems are nails. And before long, the epsilons will have done a "prescribing course" and they too will be empowered to dole out soma. I use the example of soma deliberately, for there is a modern expectation that all citizens have a "right" to be happy. Just failed an exam? Have a tablet. Granny just died? Have another one. The system will thus work, after a fashion, for most of the clients will just be suffering one of the commonplace upsets of life. They will not have mental health problems. Bereavement, for example, is very unpleasant, but it is not a mental illness and does not require medication. For those clients who do, however, have serious mental problems, they are likely to be messed up before, finally, they become patients and see a doctor. 

I am a GP who is particularly interested in mental health problems. I know not all are. I am already desperately frustrated that I have little support from the local psychiatrists. I do not have access to CBT on the National Health Service. I do have limited access to counselling services but only for short bursts of treatment. To some extent I resent the Alastair Campbell assumption that my gate-keeping role is of no value but given that nowadays I have limited secondary resources, my gate-keeping role has become little more than a source of frustration. I find it difficult enough to get help for people with serious mental illness, never mind getting help for those with mild to moderate problems.

Alastair Campbell is always worth listening to on mental health. He speaks sympathetically and with kindness about the problems faced by the mentally ill. He is right about the need for more psychologically based therapies though, on this occasion, he has been carried away by the perceived merits of CBT. He is wrong about removing the gate-keeping role of the family doctor. I would of course say that. Sadly, Alastair Campbell is likely to have more influence on mental health care than Dr Crippen for he has the ear of the Prime Minister, and I do not.