All Party Parliamentary Group for Mental Health

Notes of meeting: March 2002

Tuesday 12th March 2002

Speaker: Lord Alderdice

Members present: Dr Lynne Jones MP, Virginia Bottomley MP, Dr Evan Harris MP, Earl Howe, Baroness Linklater, Earl of Listowel, Lord Rea.

In attendance: Martin Ball (MACA), Simon Denegri (Sainsbury Centre for Mental Health), Philip Dixon-Phillips (MACA), Dr Roger Freeman (Royal College of Psychiatrists), Deborah Hart (Royal College of Psychiatrists), Peter Kinderman (British Psychological Society), Winston McCartney (Northern Ireland Assoction for Mental Health), Tracey Maher (Young Minds Magazine), Shenée Parfoot (MACA), John Penrose (Mind), John Ricketts (Lilly), Lola Soremekon (SIRI Behavioural Health) and Lucy Windenka (National Schizophrenia Fellowship). 

Lord Alderdice had been invited to talk to the Group on ‘The Need for Psychotherapy Registration’. He was a practising NHS consultant psychotherapist as well as Speaker of the NI Assembly. For many years psychotherapists and the Government have recognised that the professional of psychotherapy, like others in health care, needs to be regulated for the protection of the public and the proper conduct of professional development.   A series of conferences involving many organisations with an interest in this field led some years ago to the establishment of an UK Standing Conference on Psychotherapy.  An attempt to consolidate this into the UK Council on Psychotherapy (UKCP) was only partially successful, however, since most of the substantial psychoanalytic organisations, unhappy with what was proposed, established a separate British Confederation of Psychotherapists (BCP).  The Government, although keen to see statutory registration, had been hesitant to become involved when there was such a division within the profession, not only on structures but on training, qualifications and even professional standards.

Recent years have seen a heightened demand from the public for professional standards in healthcare to be monitored and maintained more rigorously.  Even statutory bodies, such as the General Medical Council, have been judged to be inadequate in their current form.  The complete absence of any statutory requirements or structures for psychotherapy is clearly unacceptable and sooner or later a number of cases will emerge where unsatisfactory practice will result in a strident public demand for something to be put in place.   The most obvious response by the Government is to turn to the Health Professions Council established under the Health Act 1999.   This is likely to be unsatisfactory since psychotherapy is not a unitary profession like chiropody or physiotherapy.  It is hard to conceive how it could be represented under the current simple mechanism.  It is also different from most other healthcare professions since its members work very largely outside the NHS.  The lack of unity, the likely public demand for a statutory system and the inadequacy of the current options have led to an attempt to construct an alternative.

A number of the main stakeholder organisations in this field including both the UKCP and the BCP had been meeting regularly with Lord Alderdice for the last two years to address these problems.  The mechanism of a Private Members Bill in the House of Lords (which he introduced in both sessions of parliament in 2000) had given a focus to these discussions, as well as providing a process though which progress could be made. The Government signalled its interest in the process at an early stage, but initially indicated that it would prefer that psychotherapy simply fit in with the other healthcare professions catered for under current legislation.  This seemed unlikely to work.

As it proceeded through the House of Lords, the proposed measures in the Psychotherapy Bill were refined so that they commanded substantial support from the diverse strands within the profession of psychotherapy as well as satisfying the reasonable expectations of the public and the Government.  The Government also moved to indicate that it might be prepared to consider new arrangements to enable Psychotherapy, Psychology and Counselling to be managed together in a new Council set up under the Health Act 1999. There was also an acceptance that this need not await the full readiness of all three components, since counselling in particular may not yet be ready for this development.

Until now the group had been chosen by Lord Alderdice to be advise him on the progress of the Bill.  The Bill process was now over but, at the start of the new parliament, the stakeholder organisations met again and decided to establish themselves as a more formal and representative group.   They asked Lord Alderdice to chair this group and to explore whether it is possible to agree on representative structures based on the proposals in the Bill.  These more refined proposals would identify in detail how the different strands of psychotherapy would be represented and demonstrate that such a structure is workable in practice.

After some months of discussion, he felt that they were close to agreement on a representative composition of the group and new administrative arrangements for its servicing.  This will make it possible to proceed with the more substantive task of mapping out a new structure based on the principles laid out in the Bill as it was after Committee Stage.  If this can be achieved it seems likely that it will be possible to persuade the Government to proceed with agreed arrangements for psychotherapy.

The alternative to this painstaking process is to wait to be bounced by scandals and the ensuing public demand that ‘something be done immediately’.  That ‘something’ might well be built on a less considered and appropriate foundation.”

Further background comments made by Lord Alderdice:

Lord Alderdice became concerned about this issue when working in Northern Ireland as a psychotherapist. He became aware of the deeply damaging experiences which people can have with therapists who were inadequately training or qualified.

When this issue was first discussed in the early 1980s, a series of conferences were organised in Rugby which brought together a wide range of organisations.  At that time, the Royal College of Psychiatrists decided to retain observer status to the UK Standing Conference on Psychotherapy although a number of organisations at that time choose to withdraw.

The UKCP pulled together a number of organisations and improved the ethical and training standards, as did the BCP. However, at the time, there was no real meeting of minds between these two organisations.

In drafting his Bill, Lord Alderdice consulted with many organisations including the UKCP, the British Association of Psychotherapists, the Royal College of Psychiatrists, the Association of Child Psychotherapists, the British Psychological Society amongst many others. This Bill had its Second Reading and went to Committee Stage in the Lords in the last Parliament.  It defined the principles for registration as a psychotherapist as well as the establishment of a Council and an Ethics Committee of which membership was based not on the organisations involved but on the modalities of psychotherapy. The Bill generated much debate and was largely accepted.  Government was keen, however, that it should also include psychology and counselling and it preferred to regulate through the Health Act 1999. It was not therefore possible to take the Bill further.

This Bill enabled those organisations involved to build on its proposals and these have now been taken back to the UKCP and the BCP for consideration.

Questions and Issues Raised

There is shortage of psychotherapists in the NHS, and in particular child psychotherapists.  They are unevenly distributed throughout the UK – there is good representation in the South East and Scotland, but less so in other areas.  They also have many different approaches from behavioural, analytical to group, family or individual centered psychotherapy.

Lord Alderdice reported that the Royal College of Psychiatrists’ training programme was moving towards making psychotherapy training mandatory as part of core training for psychiatrists. There were however issues related to the quality and intensity of training and the numbers of psychotherapists available to do it.

Virginia Bottomley MP expressed her support for this bill and the amount of groundwork which had already taken place.  She hoped that the profession would be able to find a way forward.

The question was asked whether Lord Alderdice felt that there was a role for psychotherapy in the treatment of severe mental illness as a substitute to medication. He reported that a whole range of treatment approaches should be available to patients and that an assessment for psychotherapy was important, although research in this area was still in its infancy.  He acknowledged that this was a very complicated area but that there was a need for a psychologically informed approach to the treatment of psychosis which should inform its management. Medication, however, should not be dismissed out of hand if a patient is very distressed.  The individual’s medical response is as complicated in physical treatments as it is for psychotherapy.  It was important to ensure some quality control. Some psychotherapeutic approaches are not appropriate for everything.  It was essential therefore that healthcare staff work together to ensure on-going management of a person’s disorder.

The Bill suggested that representation on the proposed Education Committee would be based on modalities and would be a near federal organisation.

Although the British Psychological Society (BPS) had been involved from the beginning, they will not be going for Statutory Registration within the framework of Lord Alderdice’s Bill. The BPS already had a robust professional register and disciplinary procedures in relation to malpractice.

With the new Primary Care Mental Health Workers, the Group wondered whether they would be opening the door to more talking therapies in primary care. They also wondered what training and background these workers would have.  It was agreed that this was not very clear, but supervision and monitoring to allow for growth, support and professional development was essential.

In building up multidisciplinary service and care plans, Lord Alderdice pointed out that there was a need for professionals to trust each other and share tasks and principles.

The Group agreed that the majority of users would prefer talking treatments to medication. However the current shortage of psychotherapists had meant that the NHS is employing professionals from other nationalities. This had led to misunderstandings between the therapist and patient because of language problems and cultural differences.

Lord Alderdice reported that it was proposed that the Council would include lay people, although it was not yet clear whom these will be, but not necessarily the great and the good.

Lord Alderdice reported that most psychotherapists do not work in the NHS but often in the private sector.  The Group wondered how the shortage of mental health workers was to be addressed generally.  Lord Alderdice agreed that this was a bigger issue with many professionals wanting to leave the NHS or take early retirement. However professionals from Europe for instance who wish to work in the UK will have to be registered as it is essential to ensure some quality control.

It was reported that the People’s Parliament, which had met that afternoon, had discussed the fear that users feel about the mental health regime and the need for more art, drama, and music therapies.  Users from black minority ethnic groups fear accessing NHS mental health services although in desperate need, yet the cost of psychotherapy in the private sector is prohibitively expensive.  There is a need for multicultural representation, supervision and counselling in schools. Problems in schools reflect those in the community and in families and it is difficult to deal with children’s and staff problems without dealing with the community. Lord Alderdice agreed that psychotherapists could have a calming influence in schools, but that very few posts were funded to do this kind of work.

Lord Alderdice felt that the music, art and drama therapies had evolved through the Occupational Therapists’ route and that he would not be against it coming through the psychotherapy route.  He agreed that there was a need to develop cultural diversity, not just in terms of black minority ethnic groups, but all minority groups such as the Irish for instance in North London.  In order to do this however a structure would need to be in place and a number of hurdles, including opposition from some organisations, crossed.

Lord Alderdice felt that it was important to do more research into the efficacy of psychotherapy which is very difficult to do in a climate when evidence-based research is all the rage. 

March 2002

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