“If you only have a hammer you can only afford to recognise nails”
Abbreviated from Mark Twain
I have long been interested in how the scarcity of resources shapes policy; it is here that we get most bent out of shape. The impact is all pervasive on our mind set and consequently the services we design.
Our National Strategy for mental health ‘No Health without Mental Health’ should be applauded for taking a broad view recognising the importance of promotion and prevention, but alas at a time when resources are being scaled back, resulting in longer waiting lists and elevated threshold criteria, significantly undermining the notion of prevention.
A case in point (and in desperate need of an analogy) is the use of Cognitive Behavioural Therapy (CBT) as a panacea for all ills. CBT’s elevation to the talking therapy’s treatment of choice was due to NICE approval largely on the back of efficacy in treating depression and anxiety which the Improved Access to Psychological Therapies (IAPT) services were then based on. However it also offered the highly desirable quality of representing a finite and quantifiable impact on scarce resources to those paying for services. Having opened the door via IAPT people are now waiting months to receive intervention.
Is anxiety and depression somewhat of a catch all; would a GP see anxiety within PTSD or abuse, depression within relationships soured by acrimony and domestic violence?
Does CBT offer a model with much to commend it? Indeed it does. But should it be the only approach available regardless of the issues a person or family group is facing?
Back room support and employee assistance programmes for front line services such as fire, ambulance and police are becoming increasingly rare. One result has been that some services are further limiting the support sessions available to their staff to three sessions for work related issues only, regardless of what they have had to face in the line of duty.
UPDATE: Figures released today help to underline this issue; Police long term sick has increased by a third over the last five years
The favouring of CBT serves to marginalise other available therapeutic approaches, which in turn help us to only recognise nails.
Has CBT become the little blue pill for all ills and further, in times of scarce resource, is it now being offered late and below the therapeutic dose?