Talking Therapies - are they all they're cracked up to be?

Lord Victor Adebowale, Chief Executive of the charity Turning Point, calls access to psychological therapies as 'the biggest shift in mental health provision in the last 50 years'. (Big Issue April 5th 2010). Lord Victor goes on to state that IAPT (Improved Access to Psychological Therapies) 'gives a lot of people access to psychological treatment who suffer from depression and anxiety, whose relationships may have broken down or who have housing issues. It's the first intervention in that triage, and it's a path for people to get their lives back together'.

It's great that Lord Victor feels so positive about Improved Access to Psychological Therapies (IAPT). Turning Point as an organisation may well be equipped to help deliver therapies to more and more people in an increasingly effective way. It's also the case that psychological therapies are more readily available in some areas, through being delivered in community settings such as family centres and libraries.

However, for many people in the mental health system, particularly those diagnosed as having a 'severe and enduring' condition, psychological therapies can be exceptionally difficult to obtain. Firstly, the IAPT programme is only available to people in primary care who are under a GP. There is no eligibility for IAPT if you happen to be in secondary care or under a community mental health team. The reason for this is that people in secondary care are deemed to have therapeutic provision 'in-house' or within the professional team. If an individual is under section and hospitalised, he or she has the legal right to psychological therapies within 2 or 3 days of their request.

What happens in practice is often very different.  A colleague desperate for therapy applied for it from his secondary care team (his legal right).  Pushed from pillar to post, he finally received therapeutic treatment only through the intervention of the local MP. In the absence of a therapist being in post at the time, the treatment was delivered by the Head of Clinical Services.

It is great that charities like Turning Point are promoting greater access to psychological therapies. It is also great that therapies are being delivered in some locations through a slimmed-down faster process such as a well-being service. Nonetheless, if you happen to be someone with a 'severe and enduring' mental health diagnosis you will have no access to the IAPT programme. The accessible therapies under secondary care depend entirely on whether there is a suitable professional in post within your community mental health team. Despite rights enshrined in law, service users with a 'severe and enduring' condition are often denied psychological therapies.