The Industrialisation of Care

Since 2008, the government’s Improving Access to Psychological Therapies (IAPT) programme has been rolled out across England and Wales. In the 10 years of its existence it has transformed primary care mental health services and changed the landscape of counselling and psychotherapy across the UK. While IAPT services provide therapy to thousands of people experiencing depression and anxiety, they also absorb millions of pounds in government funding. This has resulted in wholesale cuts to numerous voluntary sector and GP-attached counselling services run by qualified and experienced counsellors and psychotherapists. Current plans to expand the reach of IAPT to 25% of need (NHS Five-Year Forward Plan) rely on an economic model of treatment that has more in common with the principles of Henry Ford than with those of either Rogers or Freud. This book, with chapters written by experienced therapists, psychiatrists and academics, unravels and exposes the neoliberal roots from which the IAPT programme sprang. It scrutinises the tightly regulated, manualised and medicalised therapies offered in IAPT, the constant surveillance under which its practitioners work and the dehumanising effects of this on clients and therapists alike. It also offers an in-depth cost-benefit analysis of IAPT’s published outcomes, challenging the well-publicised claim that IAPT pays for itself by cutting the national welfare benefits bill and returning depressed and anxious people to work. Meanwhile, with therapists working on performance-rated, short-term and self-employed contracts, often in professional isolation with inadequate management and supervision support, the book exposes the difficulties, frustrations and hardships experienced by those on the front line of mental health services. Together, the contributors question whether and to what extent the IAPT `factory’ system of care, driven by psychiatric diagnosis, fast through-put and quick-win `outcomes’, can really provide a solution to Britain’s growing mental health crisis.