“Hello there, it’s Stephen Fry, I’m sorry I can’t be at the launch of this fantastic new initiative, but I just wanted to show my support for it.
“It seems rather odd that an audit should be important in the world of psychotherapy and mental health, but actually of course without the knowledge that these audits give it’s very, very difficult to formulate proper policy and to get the treatment to where it’s most needed. So, any inequalities in service, and any problems that people have, and any needs that they foresee, or imagine, in the field need to be pulled together, and the Royal College of Psychiatrists, of which I have the honour to be an honorary fellow, is putting this together with its usual expertise and commitment. So I hope everyone can support this.
“Mental Health, as I’m sure you all know, is one of the biggest problems facing Britain at the moment. You can’t have general health without mental health, and without general health you can’t have any kind of prosperity.
"So, em, thank you very much indeed [vigorous nod of the head] for helping to support this great initiative, and I’m proud to be doing the same myself. Many thanks.”
Within the Royal College of Psychiatrists is something called the CC QI – a centre for quality improvement – the which has been carrying out national audits for … yes, the last 10 years.
The flimsy ground for this trivial pursuit is covered up by the names of no less than 15 corporate bodies, which lend their credibility to the project. But, the list also shows signs of self-replication in so far as at least one of them (The New Savoy Partnership) is itself a corporation made up of almost all of the others already on the list. In what precise practical ways the BACP, the UKCP and the BPC are partners in developing this particular audit is left unremarked. But it is worth noting that the first Savoy Partnership conference (Nov 2007) saw Prof David Clark unveiling his dream of data collection with the new IAPT (increasing access to psychological therapies) scheme. This plan involved questionnaires at the beginning and end of every session whereby what he called ‘evidence’ could be collected and entered onto a national database whence a cunning algorithm would ascertain where people were achieving their government’s quality targets for happiness
Perhaps there is a quotient of intelligence lying behind the choice of Stephen Fry to launch this project. Writing about his own QI show Fry says “There’s not been anything quite like it before. The questions are designed to be impossible to answer, so points are awarded for interesting answers rather than correct ones and points are taken away for dull or obvious blather …”
What points would the psychiatrists and economists win or lose? Their CCQI proudly displays its political correctness and thus the central characteristic of its programme – it is reaching all demographic areas, rich and poor, black and white, old and young, etc. This is not about the specifics of anguish, nor the dynamics of humour, but about the mental hygiene of the general population.
But what are psychological therapies? Although Fry mentions Psychotherapy in his podcast, this word is completely absent in the rest of the blurb. Instead we have inter alia computerised CBT, IAPT (which is a government spending programme, not a practice), Art Therapy, and group therapy, all lumped together as ‘services’ which have been ‘invited’ to participate in this audit.
IAPT is not a bright new idea of a hardworking practitioner, but a political expedient fed by centralised planners. Here's what they say: “People referred to psychological therapies for depression and anxiety should be assessed and treated promptly by a therapist, who delivers appropriate therapies in an acceptable manner and achieves an outcome that compares favourably with those of other comparable therapists”. The process is depicted in the literature as a never ending circle: establish standards, collect data on practice, compare this to the pre-written standards, plan necessary change, implement change and then … re-audit!
The questionnaires that are being administered reveal what is thought necessary to inform the national policy makers, on this vital work:
1 Thinking about your current treatment, how long approximately did you have to wait for your talking treatment to start? (ie referred by your GP)
2 I feel the waiting time for my treatment to start was reasonable. Y/N
3 I was given an option about different days/times available when scheduling my appointment. Y/N
4 I was able to get to my appointment location without too much difficulty. Y/N
5 I received enough information about my talking treatment before it began. Y/N
The second questionnaire asks
Thinking about today’s meeting, please circle your answer to each statement.
1 This talking treatment helps me to understand my problem. Y/N
2 I feel that I am getting the right kind of help. Y/N
3 If I have similar difficulties in the future, I would take up this talking treatment again. Y/N
4 I believe this talking treatment helps me to cope with my problem. Y/N
A third questionnaire asks practitioners to give details of their professional background and their qualifications – thus by-passing the role of local management, and ignoring the importance of experienced supervision.
There are also fourth, fifth, and sixth questionnaires but …
In case anyone would accuse the questionnaire designers of bias, carelessness, or anything at all, they declare quite openly that they didn’t actually design them themselves but used focus groups – of course they did – to come up with these ‘rigorous analytic tools’.
There is a confusion between admin and, well, science. What is the thinking behind offering these new ‘talking therapies’ as a cure? Reading these questionnaires the idea seems to be that punctuality, promptness and neat data entry is a cure for anxiety and depression. A bonus point from Stephen Fry and the QI team?
The politicians have not noticed they are perpetrating a joke. Lord Layard does not realise that he has been cast as the jester. We need to return to his 2006 Depression Report and read it with this new insight; we need to see if that's the way to relieve some of these symptoms.
If all the word were a stage, and all the men and women merely players, then Lord Layard and Prof Clark must be two characters in search of a half way decent author…
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