Momentum “The World Transformed” Policy Lab on Capitalism and Mental Health – Saturday 21st Sept 3.00-5.30 in Brighton


Nicola Saunders and Paul Atkinson are organising an event at Momentum’s The World Transformed on Capitalism and Mental Health on Saturday 21st September at 3.00 – 5.30 pm in Brighton. Jacqui Dillon and Malcolm Philips are joining us to introduce the meeting.

The focus of the event is to gather together from the people at the meeting concrete proposals for radical alternative policies on mental health for the next Labour Manifesto. This will be part of Momentum’s Policy Lab programme through which an alternative manifesto will be presented by John McDonnell and others to the LP manifesto discussion.

Our aim is to quickly identify together the main policy areas and spend as much time as possible in smaller groups discussing and formulating policy proposals for each area. It really matters then that we manage to attract as wide a range of experience and opinion on transforming mental health policy.

The online Momentum flyer for the event lists five “speakers”. This is a bit misleading. In fact, Nicola will chair;  Malcolm, Jacqui and Paul will kick things off with very brief talking points around the kind of issues we face in the mental health arena; Jon Ashworth, shadow Minister for Health, will say something brief at the end of the session.

As far as possible, the meeting will belong to the people who come along. So please come if you can. Get tickets here. And please circulate the invite to anyone who might be interested.

Warm greetings from Paul and Nicola

Recovery In The Bin

This User Led group is for MH survivors and supporters who are fed up with the way colonised ‘recovery’ is being used to discipline and control those who are trying to find a place in the world, to live as they wish, trying to deal with the very real mental distress they encounter on a daily basis.

Recovery In The Bin 18 Key Principles, agreed and adopted by group members on 6th February 2015.

• We oppose the ways in which the concept of ‘recovery’ has been colonised by mental health services, commissioners and policy makers.

• We believe the growing development of this form of the ‘Recovery Model’ is a symptom of neoliberalism, and capitalism is the crisis! Many of us will never be able to ‘recover’ living under these intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers.

• We believe “UnRecovered” is a valid and legitimate self-definition, and we emphasise its political and social contrast to “Recovered”. This doesn’t mean we want to remain ‘unwell’ or ‘ill’, but that we reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by market forces, humiliating treatment techniques and atomising outcome measurements.

• We are critical of tools such as “Recovery Stars” as a means of measuring ‘progress’ as they represent a narrow & judgemental view of wellness and self-definition . We do not believe outcome measures are a helpful way to steer policy, techniques or services towards helping people cope with mental distress.

• We believe that mental health services are using ‘recovery’ ideology to mask greater coercion. For example, the claim that Community Treatment Orders are imposed as a “step towards recovery”.

• We demand that no one is put under unnecessary pressure or unreasonable expectations to ‘recover’ by mental health services. For example, being discharged too soon or being pushed into inappropriate employment.

• We object to therapeutic techniques like ‘mindfulness’ and “positive thinking” being used to pacify patients and stifle collective dissent.

• We propose to spread awareness of how neoliberalism and market forces shape the way mental health ‘recovery’ is planned and delivered by services, including those within the voluntary sector.
• We want a robust ‘Social Model of Madness’, from the left of politics, placing mental health within the context of the wider class struggle. We know from experience and evidence that capitalism and social inequality can be bad for your mental health!

• We demand an immediate halt to the erosion of the welfare state, an end to benefits cuts, delays and sanctions, and the abolishment of ‘Work Capability Assessments’ & ‘Workfare’, which are both unfit for purpose. As a consequence of austerity, people are killing themselves, and policy-makers must be held to account.

• We want genuine non-medicalised alternatives, like Open Dialogue and Soteria type houses to be given far greater credence, and sufficient funding, in order to be planned & delivered effectively. (No half measures, redistribution of resources from traditional MH services if necessary).

• We demand the immediate fair redistribution of the country’s wealth, and that all capital for military/nuclear purposes is redirected to progressive User-Led Community/Social Care mental health services.

• We need a broader range of Survivor narratives to be recognised, honoured, respected and promoted that include an understanding of the difficulties and struggles that people face every day when unable to‘recover’, not just ‘successful recovery’ type stories.

• We oppose how ‘Peer Support Workers’ are now expected to have acceptable ‘recovery stories’ that entail gratuitous self-exploration, and versions of ‘successful recovery’ fulfilling expectations, yet no such job requirements are expected of other workers in the mental health sector.

• We refuse to feel compelled to tell our ‘stories’, in order to be validated, whether as Peer Support Workers, Activists, Campaigners and/orAcademics. We believe being made to feel like you have to tell your ‘story’ to justify your experience is a form of disempowerment, under the guise of empowerment.

• We are opposed to “Recovery Colleges” and their establishment, as a cheap alternative to more effective services. Their course contents fall short of being ‘evidence based’, and fail to lead to academic accreditation, recognised by employers.

• We believe that there are core principles of ‘recovery’ that are worth saving, and that the colonisation of ‘recovery’ undermines those principles, which have hitherto championed autonomy and self-determination. These principles cannot be found in a one size fits all technique, or calibrated by an outcome measure. We also believe that autonomy and self-determination, as we are social beings, can only be attained through collective struggle rather than through individualistic striving and aspiration.

• We demand that an independent enquiry is commissioned into the so-called ‘Recovery Model’ and associated ideology that it stems from.

We call for our fellow mental health Survivors and allies to adopt our principles, and join us in campaigning against this new ‘recovery’ ideology by non-violent protest. We know our views about ‘recovery’ will be controversial, and used by supporters of the ideologies behind ‘recovery’ colonisation to try to divide us. However, we seek to balance the protection of existing services valued by Survivors with agitation for fundamental change.

Join us at Recovery In The Bin Facebook Group.


What’s wrong with psychiatry and how we might change things

British psychologist Gary Sidley and US reforming psychiatrist Peter Breggin discuss Gary’s journey of disillusionment with the NHS “mental health” establishment, and then freely indulge their thoughts and fantasies about what an ideal “mental health service” would look like. Find it here.

Gary Sidley’s new book is now available Tales from the Madhouse PCCS Books

Current psychiatric practices are based on pseudo-scientific assumptions that are barely more valid than those of witchcraft and demonic possession that dominated society’s approach to madness in bygone centuries. In Tales from the Madhouse, the evidence for psychiatry’s deficiencies are comprehensively reviewed, and disturbing anecdotes from the author’s 33 years of practice in mental health illustrate how these failings are currently playing out within psychiatric services throughout the UK and beyond.

Find his blog here.

The sorry state of NHS provision of psychological therapy.

Healthcare Today carried the following headline at the end of January – “Figures from the Health and Social Care Information Centre (HSCIC) show fewer than 6% of referrals made under the Improving Access to Psychological Therapies (IAPT) programme in 2012-13 resulted in ‘reliable recovery’”. Shocking surely? If this were physical health, wouldn’t there be an outcry about wasted money and human resources? Wouldn’t NICE’s confidence in CBT be a little disturbed?

But according to the HSCIC report itself, this is a story of success. “43% of patients completing a course of treatment under IAPT achieved recovery”. In its foreword, Lord Layard writes, “the dataset … supports … the Department of Health’s continuing commitment to parity of care between Mental Health and other Health services”.

So, what is going on? Is it 6% or 43%? The answer lies in the opacity and manipulation of IAPT’s evidence base, and the politics of mental health.

According to the reported statistics, 43% “of those referrals that had completed treatment and were at ‘caseness’ at their first assessment (127,060 referrals)” achieved recovery. However, this group of 127,060 represent only 14% of 883,968 new referrals during the year. 51,900 patients were deemed to have recovered  – 6% of the total number of referrals.

The four-year vision for the IAPT programme published in Feb 2011, and repeated with every quarterly progress report, is for a total of 3.2m referrals, 2.6m completed courses of treatment (81% of referrals) and 1.3m ‘recoveries’ (40% of referrals) between 2011 and 2015. Compare this with the actual figures for 2012-13 – 14% of referrals completed treatment and 6% of referrals recover.

Put another way, then, 94% of referrals to IAPT failed to receive a successful course of therapy, and 86% failed to complete any course of therapy at all. What happened to 757,000 referrals who never completed a course of therapy?

The ‘evidence base’ obscures rather than clarifies the picture. We learn that of the 449,000 referrals who do not enter clinical treatment of any kind, 37% were still on a waiting-list at the end of the year and a half of this group (84,000) had been waiting for more than 90 days. The other 283,000 non-starter referrals disappear from the data. Who are they? Where do they go?

From a different starting point, we are told that 60% of new referrals ‘ended’ during the year. This figure includes referrals who completed treatment and those who either never started or failed to complete. A quarter of this 60% dropped out of the process ‘unexpectedly’ and another quarter ‘declined the treatment offered’. Why? What happened to these people?

These are not new questions being asked of the IAPT statistical light show.

In Nov 2013, The We Need to Talk Coalition report on access to talking therapies proposes from the results of its survey that 10% of IAPT referrals have been on a waiting list for over a year, and that 50% have been waiting for 90 days or more.

Tellingly, an article in Pulse Today in November 2013 reports an analysis of IAPT data for the previous year, 2011-12, by researchers from the University of Chester’s Centre for Psychological Therapies in Primary Care (CPTPC), published in two papers in the Journal of Psychological Therapies in Primary Care.

In the first paper, an analysis of IAPT data from the NHS Information Centre for 2011-2012, the team reported that the official figure for patients moving to recovery was 44%, based on those patients who were ‘at caseness’ to begin with and were considered to have completed treatment.However, when the researchers considered all patients entering treatment – completing at least one session – the figure fell to just 22%. If the full quota of patients referred for IAPT was considered, the proportion of patients moving to recovery fell even further, to just 12%.”

So, it seems one year later the proportion of patients moving to recovery has fallen even further, to just 6%.

Apart from the raw numbers, the report is full of obscure terminology and statistical caveats which are surely incomprehensible to the uninitiated and intended to hide as much as they reveal. For example, what a course of treatment consisting of two sessions means; what reliable recovery or reliable improvement really mean; how to read the complex flow chart illustrating the relationship between the two; and, even more, the perplexing diagrams of the various types and stages of threshold to recovery – all are beyond me at least.

Nor can I get my mind around this caveat concerning which case may or may not be counted to measure an outcome of ‘recovery’:

Not all referrals that have ended are eligible to be assessed on outcome measures such as recovery. It is possible for patients to exit the service, or be referred elsewhere, before entering treatment, or without having the required number of appointments to determine the impact of IAPT services. As a result of this, in order to be eligible for assessment a referral must end with at least two treatment appointments, allowing any changes between those two (or more) appointments to be calculated. This is known as completed treatment, but may not be the same figure as the number of referrals with an end reason of completed treatment, as the method allows all referrals with the requisite amount of treatment appointments to be assessed (even if the end reason is that the patient dropped out or declined treatment).

It does not help my understanding to hear that Professor David Clark, a key proponent of the IAPT programme, criticised the Chester researches by pointing out that it was inappropriate to consider all people referred to the service as many would not end up being treated, while those who did not complete treatment were people who had one session of treatment and advice, ‘in many cases entirely appropriately’.

By comparison, I know where I am when the Department of Health academics who made the economic case for the IAPT programme reject the researchers’ claims as based on ‘flawed analyses’, ‘inappropriate’ calculations and ‘dubious assumptions’. This is what the political game of evidence-base is all about. It makes no differences what the numbers actually say. Statistics are essential to the political lie. In this case, in the pursuit of the familiar policy – contempt for mental health.

The truth revealed by the 2012-13 IAPT annual report is that the IAPT programme is failing –  a failure obscured by the smoke and mirrors of its statistical evidence.

Paul Atkinson

March 2014