Now here’s an interesting question (or two) for you:
Do you believe that offering more “talking therapy” on the NHS should increase or decrease the amount of psychotropic drugs prescribed in the UK?
Do you think that an increase of 3600 therapists would produce greater or lesser use of Prozac in the UK?
Before you wonder if this is a trick question, it isn’t designed to be. It has been a long standing assumption that the reason most long term prescribing occurs is because of the absence of alternatives. Before any of you object and say that the use of both is current “good practice”, Id point out that one of the key arguments for introducing IAPT (Increasing Access To Psychological Therapies) was that depression could be treated for around £800 per person through therapy, rather than the more costly use of anti-depressants.
Why am I raising this? Simply because data that has just been released that demonstrates that there has been a rise of 46% in the number of antidepressants that have been prescribed between 2006 and 2010. Please note the size of the increase – 46%! In other words we are not just talking an increase here, but an increase of a half over just four years – a period that maps exactly onto the training and introduction of 3600 new therapists.
SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham
http://www.skillsdevelopment.co.uk/rbt.html
It would appear that such an introduction hasn’t even TOUCHED such prescribing. In fact a cynic might even wonder if the two might be linked in some way. The Guardian states that the increase is due to the recession. However, even a cursory glance at the data indicates that the overall trend both predates the recession by 2 years and that the overall trend has not been effected by the onset of the recession, possibly because unemployment level increases have been (relatively) low (so far) in comparison with earlier recessions in the 1990s and 1980s.
Maybe this is the reason why the pharmaceutical industry never complained about the introduction of IAPT, with a total investment of towards £700 million - the biggest financial investment in the training of professionals in behaviour and emotion change skills, in history. Maybe they knew something all along that we didn’t! In fact, although I was as excited as anyone with the introduction of IAPT, I always had doubts as to whether it would achieve what it claimed to. Leaving aside questions of whether you can translate costings from treatment in a research setting to the costs in the general community, it always struck me that bigger issues were stacked up against it.
SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham
http://www.skillsdevelopment.co.uk/rbt.html
There is a bigger problem that we face in attempting to help people who are distressed or need to change their behaviour. This problem is the “pathologisation” of behaviour and normal emotional states in our society. The biggest, but not the only, cause of this is the increasing classification and extension of medical diagnosis to a growing range of normal experiences. Shyness becomes “Social Anxiety”, worrying becomes “Generalised Anxiety Disorder (GAD)” and unhappiness becomes “Depression”. This means that increasingly large sections of the population are seen as “suffering” from a “condition” or mental “health” problem, which we know requires “treatment” in a “medical “ (or quasi-medical) setting. Equally, it is worth pointing out that there has never been a single diagnosis in history that has not had a pharmaceutical answer identified for it. The increase in diagnostic categories has also been accompanied by the increasing widening of their use – whether we are talking about the term “depression” or “PTSD”. Physical diagnoses have largely not been extended but their associated social categorisation has been. Hence the term “disability” is used to cover a considerably wider range of behaviours and conditions today that was the case 20 years ago for instance.
I don’t want to suggest there have been no benefits whatsoever from this change. However, the price we pay psychologically, socially and financially is an increasing tendency for us to view ourselves as “pathological” in some medical or quasi medical way. With this in mind, a "medicine" seems like a very logical next step … or at the very least a useful adjunct to other forms of help.
This issue of “pathologisation” crops up continually here at The Skills Development Service.
My colleagues and I attempt to address it with our clients and through our training on an almost continuous basis. Indeed, I genuinely think that the time is ripe for promoting an alternative way of conceptualising our work with our clients. A new way of helping us and a new way to conceptualise what we are trying to do. Our focus on “Resource Based Therapies” is designed to revolutionise the way we think and work with clients, to focus on their strengths, what causes them to thrive and what they would like to be doing as an alternative to having their current problem.
SDS is currently running its BPS Approved Certificate in Resource Based Therapies in London, Leeds and Birmingham
http://www.skillsdevelopment.co.uk/rbt.html
Come and join us and have your thinking challenged about the way you are working at present. Most importantly, have your passion for your work reinvigorated. Over the coming weeks I will be highlighting a number of key elements of what an alternative looks like and how it can revolutionise your work with clients. Speak with you again soon.
Take care
Paul Grantham
Consultant Clinical Psychologist
The Skills Development Service Ltd
I am very pleased to introduce to you today a new SDS tutor, my good friend and colleague Dr Fiona Kennedy: SDS Trainers
