Tag Archives: DCP

Relationship over Technique or Technique over Relationship?: Reflections on a Conference on Psychological Therapies in the NHS

Clinical Psychologist Chris Clinch presents a personal summary of his experiences at the DCP South West Conference in February 2016

Chris Clinch (Clinical Psychologist in Somerset) writes a personal summary of his experiences at the conference, which was then shared through the Division of Clinical Psychology network and reproduced here with a light edit by Mary O’Reillly:

This conference was partly hosted by the BPS and had some high level contributors from government and the NHS. We were therefore offered a glimpse into the ‘bigger picture’ of how well mental health is understood (or not) by those in positions of influence. My role for DCP South West was to report back and to expand the conversation via twitter. I was new to this and may have got carried away in the twittersphere but it was, after all #timetotalk.

Tweet: Perhaps looking after the workforce is actually the biggest challenge for the NHS

Professor Sir Simon Wesley, president of the Royal College of Psychiatry reminded us that the NHS can be a painfully difficult place to work and began the key theme (for me at least) that ran through the two days: The currency of our work is compassion, relationship and understanding. We need to receive the same compassion and understanding from our organisations if we are to provide it.

Tweet: Effective care happens when there is safety, relationship, understanding and a whole person view.

You can, of course decide to do away with compassion and understanding, as if it is a luxury which the NHS can no longer afford. You might instead adopt the narrative of productivity, where generic workers become more like technicians administering doses of therapy than whole people trying to understand other whole people within relationship. However, the evidence is that you might end up with large percentages of therapists who feel depressed or like failures (BPS survey of 1400 therapists, also reported in The Times) and (surprise, surprise) your therapy will be less effective and recovery rates will be lower (Prof. David Clarke, head of IAPT slides). Whilst Alistair Burt MP saw IAPT as a world-beating success, Jeremy Clarke CBE, Therapist and Chair of Ministerial Advisory Group for Mental Health didn’t hold back on this – he said that IAPT ‘needs to understand why it hasn’t worked.’ My conclusion was that the thinking behind talking therapies is psychologically sound, but the impact and sustainability of the project has been undermined in organisations that have lost sight of relationship and the need to be flexible and person-centred in how it’s delivered.

Tweet: Care suffers amidst mistrust, disconnection, toxic organisation and reductionist approaches

Mathew Patrick, Chief Executive of South London and Maudsley Trust put it well, when he described the ‘soufflé phenomenon’, where an organisation can present itself as buoyant and uplifted by new ideas, whilst the centre is in fact collapsing. How refreshing to hear him say ‘we have to engage with staff on the front line – their lived experience is hard. They are sensitised to rhetoric’. In truth, it was alarming to hear the results of the BPS survey, but the formulation wasn’t hard to sketch out – people like us who are experiencing deteriorating services, poor employer engagement and loss of autonomy are struggling. What is more, to use a CAT therapy phrase, it’s ‘out of dialogue’. Dr Claire Gerada, head of College of GPs @clarercgp was candid, calling the government on “the madness of double speak and lies in calling ‘cuts’, ‘efficiency savings”.  The BPS charter for psychological staff wellbeing and resilience was presented as the start of a fight back. This wasn’t just lip service, whichever way you cut the cake the evidence is that looking after and developing staff seems to make sense – in terms of recovery, financially and ethically.

Tweet: @PaulBurstow: ‘We have to embed supervision and reflective practice if we want to serve the people we serve’

Conference was partly reassured by various speakers that psychologists could be an important part of the solution. Karen Turner, Director of Mental Health at NHS England seemed to say better line management was needed (slides) although I couldn’t help thinking good supervision and fewer cuts might be more effective. Surely we are well placed to understand the client holistically? Who can model reflection? Who can support colleagues to thrive (or perhaps survive) via good supervision? Who can provide the evidence of effective intervention?

There was much talk of parity of esteem between mental health and physical health. This was of course encouraging, although at times I worried that some speakers therefore mistook mental health as essentially ‘the same’ as any other physical health issue, with organic causes and medical solutions. Technique over relationship. Surely this is the path to prescriptions for call centre therapy and overwhelmed staff who feel like they are failing to cure their ‘patients’? Prof David Haslam (Chair of NICE) slides made great efforts to challenge this, stating that we should not be involved in ‘cookbook medicine’ and that NICE guidance ‘should be made meaningful for the individual service-user’ by a generalist clinician (sounds familiar?). Relationship over technique.

Tweet: Lord Freud, Minister for welfare reform says ‘promoting mental health in govt has been wading through treacle’, but things changing

To be honest, Lord Freud, millionaire banker with the job of pushing through unwelcome welfare reforms, the guy who suggested people with disabilities are ‘not worth’ the minimum wage, was going to have a tough time here. He coped with it well….by not taking any questions and leaving by a side door. However, he did give an insight into how government is coming round to an understanding of the importance of addressing mental health. This may be because it is expensive for people to be claiming benefits and not working, but nevertheless mental health is now being taken seriously in the right meetings. This was echoed by Alistair Burt MP Minister for Community and Social Care, who said he is ‘chased relentlessly’ by Luciana Berger MP (Shadow Minister for mental health) and Norman Lamb MP (ex-minister for health) on these issues. Paul Burstow (another ex-minister for health, now an NHS chief executive) advocated for parity of esteem for mental health and physical health and I was left thinking that these voices would be more valuable in government, rather than in opposition.

I felt that, despite my scepticism, these leaders ‘got it’ and were pressing a narrative in the right meetings with the right people. Luciana Berger in particular seemed to be an ally of Psychology. She called for a ‘mental health impact assessment’ on ministerial decisions, and was prepared to criticise the NHS for complacency around IAPT. She suggested that the drop out rates are too high (26%) and recovery rates for anxiety and depression were modest for those who remained (45%). In a similar vein, she recognised the trend towards ‘call centre IAPT’, which she considered ‘not for everyone’. I said under my breath, ‘should call centre therapy be for anyone?’

Paul Farmer and Jaqui Dyer, chairs of the Mental Health Taskforce urged us as professionals to read, discuss and promote their report (see link), which represents a five year plan to address the predicament of mental health services. They reminded us that MH has not been a priority in health, but there is a real window of opportunity. For Jacqui Dyer, her own therapy was ‘a lifeline to who I am and who I could be’. Well, she found out that she was an expert by experience and a black woman with power. What she ‘could be’ turned out to be a truly influential voice where it matters because of her experiences and insights, not in spite of them.

There are several other important presentations from the conference still available, such as the Manchester model of integrated care and Peter Fonagy on Children’s Services / CYP IAPT’s Future In Mind report (slides).’

Chris’s hope is some of this motivates you to follow some links to other discoveries. He found the conference to be confident and outspoken, which contrasted with the psychological voice nearer home. It was refreshing to look outwards and reflect on some of the values that sustain us as Psychologists. This is what the DCP exists for locally and nationally: we can be stronger as a collective voice.

chris.clinch@sompar.nhs.uk

Image: Jo Hemmingfield, the DCP Experts by Experience English Lead, makes a point during one of the conferences sessions:
Advertisements