Patricia Hewitt and "Talking Therapy"

Talking therapy

Patricia Hewitt has done it again.

She has opened her mouth and inserted her foot.

Last month she perpetrated the biggest PR gaffe of this Labour administration when she said that the NHS was having its “best year ever.” She was lucky to come out alive from addressing the Royal College of Nursing, and there was surprise that she survived the Cabinet reshuffle.

Now she is attacking GPs. Again. This time it is our fault that the NHS cannot deal with depression. Back into the coconut shy.

A letter to Hilary Benn is reported in PULSE magazine:

Health Secretary Patricia Hewitt has claimed GPs are at least partly to blame for the crisis in access to depression services.

In a letter to fellow minister Hilary Benn about Pulse's campaign on depression care, she said GPs were clogging up the system by making inappropriate referrals.

Mrs Hewitt admitted access to psychological therapies could be 'problematic', but added: 'In addition, referrers sometimes lack knowledge about which treatments are appropriate.'

Strong stuff, Patricia. Where is your data?

"The Department of Health was unable to provide evidence of inappropriate GP referrals to back up Mrs Hewitt's assertion."

I see.

Let me tell you what is happening on the front line.

A large number of patients presenting to GPs are unhappy.

These people are not psychiatrically ill. They are not potty. Fifty years ago, they would not have come at all. They would have spoken to grandma. Or an aunt. Or any member of the extended family. Or their priest. They do not do that anymore. They come to their secular priest, in other words, their doctor.

When I started in my current practice, we had one and a half counselling psychologists on the premises. They were readily available to see patients at our request, and were able to see them within a week or two. Teenage girls who have split up with their boyfriend; the recently bereaved; unhappy marriages; stress at work. This is day to day general practice.

We must not medicalise these patients. They do not need medication. They do not need CBT. They need a little support. But, whilst they should not be medicalised, they must not be ignored. Teenage girls who have split up with their boyfriends take “trivial” paracetamol (Tylenol) overdoses. You can call it para-suicide if you like, but sometimes they miscalculate. They do not know the dangers of paracetamol. The para-suicide becomes a real one.

Most of these patients can be helped by three of four sessions with a sympathetic counsellor. And they used to be.

The Labour government took our counsellors away. There is now a centralised system for counselling off site. It is under funded and cannot cope. As the system is not coping, entry has to be restricted. Hewitt is doing that by saying that many referrals to the system are “inappropriate”. She is getting GP referrals “screened” by the CMHT.

We have met the CMHT before here.

A middle aged woman comes to see me because her son has been killed in a road traffic accident. I am now deemed not competent to decide what sort of help she needs. This bereaved mother has to be “screened” by someone with no medical training to see if the referral is “appropriate”. This screening is not done face to face. She is sent a questionnaire which contains questions which ask her to grade her level of distress. Is has to be done like this so that the non-trained CMHT worker can tick boxes, count numbers, refer to the protocol and measure the amount of grief.

How distressed were you by the death of your son

1. hardly distressed at all
2. mildy distressed
3. moderately distressed
4. moderately to severely distressed
5. severely distressed

Most patients fall at this hurdle and tear the questionnaire up. Two weeks later they will get a letter noting that they have not returned the questionnaire and ending “we assume that you no longer require help, and have discharged you from the system.”

That saves some money.

Meanwhile, I will do my best to put some time aside for the patient and help her myself. I have no problem doing this. It is an area of interest. But I cannot provide this service for all my patients. The demand is too great. A few go privately. One of our counsellors who was sacked provides an excellent service privately, but not many can afford £70 an hour. And that is the cheaper end of the spectrum.

PULSE reports:

Dr Nigel Watson, chief executive of Wessex LMCs and a GP in New Forest, Hampshire, said:

"It is not that we are referring to the wrong people ¬- for most people there is nothing to refer to."