All Party Parliamentary Group for Mental Health

Notes of meeting: April 2003

Tuesday 1^st April 2003

Members present: Dr Lynne Jones MP (Chair), Liz Blackman MP, Sandra Gidley MP

In attendance: Martin Aaron (JAMI), (Rethink), Rosanna Cavallo (Justice for Patients), Paul Corry (Rethink), Adrian Delemore (Justice for Patients), Philip Dixon-Phillips (UK Federation of Smaller Mental Health Agencies), Richard Egan, Roger Freeman (RCPsych), Dr Lynne Friedli, Shazia Ghani (Outward Housing and Care and Support Services), Helen Lord (Lilly), Joan Penrose (Rethink), David Tombs, Agnes Wheatcroft (RCPsych), Matthew Williams (APG for Integrated and Complementary Healthcare)

Alternative and Complementary Treatments in Mental Health

Jan Scott, Professor of Psychological Treatments Research, Institute of Psychiatry - Cognitive Behavioural Therapy

Jan Scott began by explaining the principles behind cognitive therapy saying that it is based on a model of emotional disorder. This is broken down into four strands, cognition, emotion, behaviour and biological – all combined with environmental factors. Events in childhood shape beliefs and determine how people are affected by certain triggers. These beliefs mould day to day behaviours by affecting how we process information. Cognitive therapy provides a normalising model to change the automatic thoughts we learned in childhood, which act like a prejudice to guide our adult behaviour.

Jan Scott then spoke about when beliefs can cause problems and how they can be changed. The model, ‘event, thought, feeling, belief’ works for most people. For example a student who is worried about their exams may feel that if they do badly this will lead to poor job prospects, unemployment and failure. They may focus on negative thoughts because this is the way they are used to dealing with stressful situations. The therapy empowers people by providing them with tools to solve their own problems. She noted that cognitive therapy works best alongside anti-depressants but continues to work after the drugs programme has ended. The cost of 20 sessions is £1,200 including support. The treatment is highly cost-effective under NICE criteria, costing only around £12.50 per day.

Copies of Jan Scott’s slide presentation are available on request from Agnes Wheatcroft.

Lara Ellen Dose, Chair, National Network for the Arts in Health – Arts and Drama Therapy

Lara Ellen Dose began by referring to two documents produced by NHS Estates (Improving Patient Experiences) and the Arts Council (Directory) which were both sent to every NHS Trust. These documents show the importance of the arts in health both in terms of the nature of the built environment and the use of art therapy. Art therapy is often used with psychotherapy, as a treatment in itself and as a complement to other treatments.

Lara Ellen Dose described a case study from a treatment centre ‘Seven Acres’ where the level of violence and attacks on staff fell dramatically following improvements to the design specification of the building. Staff, users and visitors all felt that the changes lowered stress levels.

Ms Dose stressed the importance of the community setting for arts projects where the arts can be used to communicate issues. People usually access these services by referring themselves or via their GP, they can be especially useful in helping tackle social isolation and stress. Art therapy offers a proactive, creative approach to well being.

The National Network for the Arts in Health is an umbrella organisation with around 500 members who are involved in many different art forms. Their funding comes from the Kings Fund, PPP, Nuffield and the Arts Council and is secured for three years.

Discussion:

Following the two presentations the meeting Lynne Jones MP opened the discussion by asking about the uses and benefits of the two therapies. Jan Scott explained that cognitive therapy could be used to treat anxiety, depression, panic, obsessive compulsive disorder and social phobia. Six to twelve sessions are recommended following referral from primary care. The therapy can also be used in severe mental illness, alongside medication, for schizophrenia and manic depression. It has helped people who have been in hospital for years to leave and live in the community. Cognitive therapy can also be used to treat self-harm and personality disorder because of its normalising effects. Lara Ellen Dose reported that art therapy could also be used for a wide range of disorders including social isolation, anger and violence.

A question was raised about what training is needed to provide cognitive therapy. Jan Scott reported that the qualifications needed must reach a European standard, training must be undertaken from a recognised course and the practitioner must also practise for two years. Following this they must take part in continued professional development and have individual supervision every two weeks. She noted that because so few people are training in the therapy it is hard to secure a psychotherapy post when one becomes available. The Royal College of Psychiatrists is incorporating it into their training. Jan Scott reported that there are not enough people trained in this area. Many areas do not fund a cognitive therapist, though by creating a waiting list, funding can be found. She was asked whether the therapy would benefit from the establishment of one professional body. Jan Scott replied that though in some ways that could be useful, the current position when a number of different professions are involved is beneficial in giving breadth to the application of the therapy.

Funding for both therapies was highlighted as being a problem. It was noted that organisations such as the Wellcome Trust have been having financial problems which has impacted on organisations who rely on their funding. It is also difficult for individuals and organisations who chose not to engage in work with pharmaceutical companies as that excludes another possible revenue stream.

The speakers were asked whether their therapies could be used in promoting good mental health. Jan Scott said that while she usually meets people after disorders have appeared it is possible to use cognitive therapy in teaching and also to promote good parenting. A programme in Australia has proved effective in helping children with low self-esteem. Lara Ellen Dose noted that professionals can predict and advise on future problems for example with children at risk from exclusion from school.

It was also noted that these therapies do not work for everyone and that different therapies suit different people. Jan Scott explained that it can be hard to tell at the start of cognitive therapy whether it will work for the individual, however, it is often successful because it gives people the tools to help themselves. She also noted that it is important to look at the physical and mental aspects of illness rather than focusing on one and disregarding the other.

Both speakers were thanked for their time and quality of their presentations.

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