Healthcare Counselling and Psychotherapy Journal, April 2019
For counsellors and psychotherapists working in healthcare

From the editor

As therapists, we are all acutely aware of the enormous pressure on NHS mental health services. Much as there is talk of parity of esteem with physical health, the reality is very different.

Counsellors and psychotherapists working in NHS-funded services face many obstacles in trying to provide the best possible service to their clients; these include lack of time, lack of resources and lack of training in mental health issues among those responsible for making referrals into the service. As a result, the pressures on counsellors and psychotherapists working in NHS settings are immense.

Arguably, nowhere is this pressure felt more acutely than in IAPT. IAPT is often criticised for being bureaucratic, target driven and high pressured. In particular, non-CBT counsellors working in the service can often feel that their work is undervalued or misunderstood. In our lead article, Gillian Proctor, Maeta Brown, Shlomo Cohen and Sue McKelvie explore how counsellors working in this environment deal with the dilemmas that inevitably ensue when trying to work in accordance with their own humanistic values and yet still comply with the demands of the system. Their article is based on research carried out at the University of Leeds, in which interviews were held with IAPT counsellors, exploring their experience of working in the service. The authors of the study have beautifully captured the words of the study participants in poems, which provide powerful, moving accounts of each counsellor’s experience in IAPT.

Mental and physical health are often addressed in separate silos – both in terms of policy and practice – and yet, as therapists, we know all too well that the two are intricately interwoven. Mental ill health often accompanies physical ill health for many patients, particularly those with long-term or life-threatening conditions, such as cancer. Nicola Swales writes about her work as a counsellor working with patients with skin cancer. She presents a clinical vignette of her work with a young pregnant woman with melanoma, in which she captures her client’s bravery in facing difficult decisions about treatment and its implications for her pregnancy. Nicola sets out a series of recommendations for other therapists who may find themselves with clients suffering from skin cancer.

We are increasingly seeing a focus on the key role of GPs’ surgeries in supporting mental health. While the trend a few years ago was to move counselling out of the GP’s surgery, new NHS guidelines now encourage its reintegration. In order for this to happen successfully, GPs need to be equipped with a thorough understanding of mental health issues and to work closely with the counsellors and psychotherapists in their practice and in other local services. Some achieve this better than others. In her article ‘Therapy or medication?’, Elen Thomas provides a critical analysis of GPs’ support for the mental wellbeing of children and young people, analysing how doctors respond to depression and anxiety in young patients. Elen laments the fact that the majority of young people presenting to GPs’ surgeries with mental health issues are not accessing talking therapies. This may be because they are given medication instead, or because mental health training and expertise among GPs often falls short, leaving some reticent to diagnose mental health issues. It is clear that more needs to be done to ensure that GPs’ surgeries are properly equipped to meet the mental health, as well as the physical health, needs of their patients.

However, it is important to highlight that there are already some examples of good practice in this field, as I discovered when I interviewed GP, Dr Emma Tiffin. As Strategic Mental Health Clinical Lead for Cambridgeshire and Peterborough Sustainability and Transformation Partnership, Emma has been instrumental in developing a mental health strategy that brings together specialist mental health, primary care and third sector services in a community-based model. Emma highlights the need for far more resources to be put into mental healthcare, as well as for new policies that support primary care mental health service provision. She is a huge advocate for the integration of specialist mental healthcare provision in primary care settings.

This is a theme that is also taken up by Elaine Davies in her column. As a counsellor working in a GP’s surgery, she is aware of many of the opportunities and challenges that this co-location of services provides. She considers the tensions that can sometimes arise in the relationships between different healthcare providers, often as a result of the lack of time for collaboration and full consideration of each patient’s needs.

If these are issues that are relevant to your own work in a healthcare setting, please do let us know your thoughts. What more needs to be done to ensure that mental health needs are properly recognised and addressed in the primary care system?

Joanna Benfield, Editor
hcpj.editorial@bacp.co.uk

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