Anonymous Letters

Anonymous, 2012. Anonymous Letters. Reformulation, Winter, pp.22-23.


ANONYMOUS LETTER

Dear Reformulation,

Thoughts on CAT and the NHS:  As a retired psychiatrist and someone who has worked extensively with CAT, predominantly in older patients, I am extremely concerned about what Glenys Parry rightly calls the ‘industrialisation’ of NHS psychological therapies. This industrialisation is a simplistic, knee-jerk, political response to the real problems of access to psychological therapies within the NHS. There is a presumption that everything, except possibly a short course of CBT, is off limits because of expense and time.  A perceived ‘quick fix’ is therefore being applied, and failure to comply with this will be equated to possessing attitudes of ‘non-modernisation’.

For several years I have been all too aware of the politicisation of CBT as a one- size- fits- all therapy, even to reductionist ideas of digitally based DIY, CBT- based therapy in GP surgeries. This is not a statement against CBT, but it is a comment about the apparent lack of understanding of people as individuals and of the very important process of selection of the right therapies for the right people at the right time.  

Another concern is that of training. I am worried that undertrained staff could, not through their own fault, make matters worse for the individual by rote application of a unified therapy model, where another therapy or no therapy may be more appropriate. 

In my view, it is part of the general role and responsibility of any health professional to develop the skills of listening to, and more importantly, hearing the patient who is with them.  ‘Being with’ the patient in this way has great time saving, therapy saving and bed saving potential as well as being generally therapeutic in itself.

From a CAT point of view, there is a perception amongst mental health care workers that CAT, if they have heard of it, is only useful in people with borderline personality disorder. Primary and secondary health care workers have rarely heard of CAT.  I am sure that I am not the only person who has been asked ‘CAT, what’s that? Is it CBT?’  Almost all staff are aware of CBT and Counselling.  I am not sure where the root of this lack of awareness of CAT lies, but it does seem a long way from Tony Ryle’s original vision.  I would hope it is not too late to address this with results from time-limited CAT outcome studies and discussions on patient choice, as this is the ‘political’ language which the NHS will listen to and hear.  

Over a 20 year period, I have had a very positive experience of using CAT in elderly patients.  CAT is a truly conjoint therapy, and it is often the first time that the older person has experienced this way of working.  After an understandable initial nervousness, older people find working together extremely enlightening and welcome ‘good enough’ outcomes.  I have seen a wide range of patients with acute functional and early organic problems, as well as those with more chronic difficulty.  I have also found ‘CAT-style’ process to be helpful in work with couples. It is my opinion that CAT is a particularly effective therapy to use with people whose mental health problems have generated from previously undisclosed abuse in childhood or from long term PTSD.

I have experienced no difficulty with older people understanding the therapy itself. This is a point which I feel is sometimes cited as rendering them unsuitable for CAT.  It is our responsibility to adjust what we present to the person that is with us. I do not feel this is age or diagnosis dependant, nor does appropriate flexibility diminish the CAT process in any way. 

I realise that this is a personal view, but wanted to add my own contribution. I shall be very interested to see the views of others.

ANONYMOUS LETTER

Health service management will often make cuts or other changes without subjecting them to public consultation of any kind. In one Trust, staff have been forbidden to discuss the proposed changes. It is important for us to know that this contravenes current legislation, and can therefore be challenged. In particular[1]:

NHS Act 2006 – Section 242: Public involvement and consultation

  1. This section applies to—
    (a) Strategic Health Authorities,
    (b) Primary Care Trusts,
    (c) NHS trusts, and
    (d) NHS foundation trusts.
  2. Each body to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on—
    (a) the planning of the provision of those services,
    (b) the development and consideration of proposals for changes in the way those services are provided, and
    (c) decisions to be made by that body affecting the operation of those services.

The Health & Social Care Act 2012 amended Section 242 of NHS Act, so that it no longer applies to Strategic Health Authorities or to Primary Care Trusts2. Therefore it still applies to NHS Trusts and NHS Foundation Trusts.

The ACAT Ethics Committee are exploring the situation of Trusts keeping their cuts or other changes secret and will put on record their views in due course. 

[1]. All quotes in Italics have been downloaded, unamended, from government websites which contain the Acts in full

[2]. HEALTH AND SOCIAL CARE ACT 2012: PUBLIC INVOLVEMENT AND SCRUTINY

126(1)Section 242 (public involvement and consultation) is amended as follows.(2)In subsection (1A)—
(a)omit paragraph (a), and
(b)omit paragraph (b).

Full Reference

Anonymous, 2012. Anonymous Letters. Reformulation, Winter, pp.22-23.

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