3 November 2008
Doctors and counsellors have accused the Government of targeting the weak and vulnerable by encouraging benefit claimants to take part in therapy sessions.
Serious concerns have been raised about the flagship £170 million programme, launched last year and based around greater access to Cognitive Behavioural Therapy.
Some in the medical and counselling professions question official claims about the long-term effectiveness of CBT, whilst benefit claimants say they feel pressurised into taking part in unsuitable and potentially damaging therapy sessions.
The Government’s programme to improve access to therapy was launched with a fanfare in 2007 but hit the wrong note almost immediately.
At the time of the launch, it was claimed the multi-million cost would be paid for out of savings that will result from 25,000 fewer people with mental health conditions claiming benefits.
However, concerns expressed at the time about the lack of trained therapists and the long-term effectiveness of CBT continue to be expressed.
Now some benefit claimants say they are feeling pressured into taking CBT.
One long-term claimant diagnosed with serious mental health issues, including social anxiety disorder, agreed to take part in a dozen sessions with a CBT therapist.
After completing the sessions, the claimant was told to attend group CBT sessions. When the claimant asked to continue with one-on-one sessions instead, they were told a “refusal to comply would have to be reported”.
“The one-on-one sessions had done nothing to address some of the issues I face, particularly my social anxiety,” explained the claimant. “Yet my therapist claimed I still had to attend the group CBT sessions.
“If I refused I would be reported for failing to comply. It was only after a fortnight of frantic worry and the intervention of my GP that I was told I didn’t have to attend the group sessions after all.”
The claimant’s GP is critical of the pressure being placed on long-term patients. “The system tends to target weak and vulnerable patients. I see many people distraught at having to go through a process which does not seem to achieve anything.
“I know some of my colleagues are increasingly concerned about this ‘one size fits all’ approach. CBT does have benefits and can help people, but equally I don’t believe it is necessarily right for all cases.
“I have a number of patients who are in a similar position and although CBT has proved beneficial to one or two of them I am concerned that it is often the only option open to them.”
The programme is based around greater access to CBT, which usually involves a course of 6-12 meetings with a trained therapist. The treatment deals with solving current problems rather than trying to discover the past causes of current feelings or behaviour.
According to the National Institute of Health and Clinical Excellence (NICE) it is as effective, but no more effective, than drug treatments for conditions such as depression and anxiety.
Yet at a recent international counselling conference, many delegates voiced concern about what they termed the "myth" of CBT being more effective than other types of therapy.
Professor Mick Cooper, an expert in counselling at the University of Strathclyde, told the conference that although he welcomed the increased funding for psychological therapies, the focus on CBT was not logical.
"It is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England,” he added.
"Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment."
Professor David Clark, a clinical advisor to the government's Improving Access to Psychological Therapies programme and professor of psychology at Kings College London said NICE had put together their guidance on the basis of the evidence available to them.
He added that NICE had also recommended some other psychological treatments where there was evidence of benefit.
The Department for Work and Pensions says the Improving Access to Psychological Therapies scheme is proving a success. These and other Fit for Work pilot projects are a central feature of the Green Paper on welfare reform.
It maintains no claimants are forced to attend sessions, but are expected to take advantage of such services and support if they are able.
At a recent House of Commons event to mark World Mental Health Day, Secretary of State for Work and Pensions James Purnell, said the Government was working closely with mental health charity Mind to provide more flexible help.
“We will make support available for people with mental health conditions either already in work and experiencing difficulty, or those about to enter employment, as well as for their employers,” he said. “Crucially, the support will be available when it is needed, waiting in reserve to respond quickly when mental health deteriorates or problems emerge.”
We would like to hear from any Benefits & Work members who have attended these CBT sessions and are willing to share their experiences – positive or otherwise.