Threat to psychotherapy services run from Guy's and St. Thomas's Hospitals
Open letter soliciting support: 15th November 1996
21st November 1996
Dear ...
Re: THREATENED CLOSURE OF ALL PSYCHOTHERAPY SERVICES WITHIN THE NHS
IN LAMBETH HEALTHCARE TRUST
At a meeting of Lambeth, Southwark and Lewisham Health Authority
on 5th November 1996, a proposal was made to cut all psychotherapy
provision within Lambeth Healthcare Trust and Bethlem and Maudsley
Trust. Psychotherapy provision in Lewisham & Guys Mental Health
Trust will also be reduced.
In Lambeth Healthcare Trust this proposal would close Shanti Women's
Intercultural Psychotherapy Service and the Psychotherapy Unit
at St Thomas' Hospital.
This would mean that Lambeth residents would have no access to
psychotherapy within the NHS. According to the Department of Environment
Index of Local Conditions, the area that Lambeth, Southwark and
Lewisham serves is the second most deprived in the Country, containing
a wide range of risk factors that predispose mental illness. It
is unacceptable that access to psychotherapy provision is to be
denied in this way to Lambeth Residents and to this area of South
London.
We would like to draw the following points to your attention:-
- It is a common belief that psychotherapy services do not treat
the severely mentally ill. This is inaccurate. The clinical range
of mental health problems treated by the department covers a range
of severely complex mental health problems including patients
with a history of psychosis or psychotic episodes, bipolar disorders,
personality disorders, severe disabling neurosis such as recurrent,
long-standing depression and anxiety, and acute adjustment disorders.
Patients often present with multiple pathology which may include
dual diagnosis and such things as substance abuse, eating disorders,
severe somatic disturbances, deliberate self-harm (self-mutilation
and suicide attempts) and violence. The unit also sees a high
number of patients who have a history of severe emotional and
physical deprivation, including many survivors of violence and
sexual abuse.
- Another common belief is that psychotherapy provision is uneconomic
and ineffective. This is also inaccurate. ' Psychotherapies have
been more studied than many other health interventions'.
(4.1.2) (1)
An overview of this research
is about to be published commissioned by the
NHS Executive of the Department of Health.
(2) The Psychotherapy Unit at
St Thomas' is one of the most cost effective in the country. It
provides a range of five psychotherapy interventions on a yearly
budget of £130,000. This is possible because 95% of the service
is carried out by unpaid trainees, closely supervised by senior
qualified psychotherapists. The Unit offers a major contribution
to 'Care in the Community', through direct patient intervention
and through the supervision of other mental health professionals
within the Trust.
- If the service is cut 37 trainees will lose their clinical
placement, placing their training in jeopardy. In addition to
this the Unit is one of the main national training bases for Cognitive
Analytic Therapy (C.A.T.). This is a psychotherapy intervention
which is time-limited, focused, open to research, economic and
effective. It is accessible to a wide range of people with diverse
mental health problems and acknowledged as one of the most appropriate
psychological interventions in the NHS. Closure of St Thomas'
Unit would therefore impede the national development of Cognitive
Analytic Therapy.
- The Department of Health has just published a National Strategic
Review of Psychotherapy Services, which identifies three frameworks
for the provision of psychotherapy within the NHS. It acknowledges
that 'well conducted psychological therapies are an important
part of mainstream mental health care' (1.1). The Psychotherapy
Unit at St Thomas' provides a service within all three of these
frameworks and is therefore in a primary position to implement
the strategy put forward in this document. This is further supported
by the recent
Kings Fund Review of Psychotherapy Services at Claybury
Hospital (3).
- It is inconceivable and utterly premature that St Thomas'
Psychotherapy Unit should be cut at the same time as the Department
of Health publishes a National Strategy for the Provision of Psychotherapy
Services in the NHS.
May we invite you to give this matter your serious consideration
and urge you to support us in our conviction that such an action
would remove a vital part of mental health provision for patients
within Lambeth and consultation for other mental health professionals
within the Trust. Most of all it would deeply affect the mental
health of the people whom we treat, for whom there is no alternative
option. We would greatly appreciate the use of the resources available
to you in your professional capacity to actively intervene on
our behalf.
For your information the Chief Executive of Lambeth, Lewisham
& Southwark Health Authority is Mr Martin Roberts. He is contactable
at:-
Lambeth, Southwark & Lewisham Heath Authority
1 Lower Marsh
London SE1
Tel: 0171-716-7000
Fax: 0171-716-7039
The Chief Executive of Lambeth Healthcare NHS Trust is Mr Erville
Millar. He is contactable at:-
Reay House
108 Landor Road
London SW9 9NT
Tel: 0171-346-5400 Ext 5422
Fax: 0171-346-5423
Yours sincerely
Ian Simpson
Senior Adult Psychotherapist
Head of Psychotherapy Services
Hilary A. Beard
Adult Psychotherapist
Chair - Association of Cognitive Analytic Therapists (A.C.A.T.)
References
(1)
NHS Psychotherapy Services in England-Review
of Strategic Policy - NHS Executive
Department of Health, (1996). See
reference to the NHS Strategic Review of Psychotherapy Services published by the Department of Health NHS Executive (September 1996)
(2)
Roth, A.D., & Fonagy, P. (1996)
What Works for Whom? A Critical Review of Psychotherapy Research.
New York: Guildford Press.
(3)
Paranoia or Adaptation? The Implications of a Kings Fund Review on a
Psychotherapy Department
A Garelick & J Wiener - Psychoanalytic Psychotherapy (1996) Vol.10 No. 3.