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Interview The left must challenge the state’s reduction of mental health to market agendas

Psychotherapist Paul Atkinson talks to Richard House about being a mental wellbeing activist and the daily difficulties faced by those on the therapeutical front line

Richard House (RH): Paul, activism takes many forms — including “psy activism” (my term) in the realm of mental health and you’re one of the most committed psy activists I know. Can you say something, first, about what you see as the key commitments of a psy activist who also works professionally in the mental health field?

Paul Atkinson (PA): For me as a psychotherapist, the key commitment is an ongoing awareness of the inevitable and complex power relationship between psy professionals and clients/service users. This applies to activism and also to the consulting room itself.

Psy professionals often claim an apolitical neutrality and an enhanced empathic sensitivity in their relationships with other people. Unless we’re willing to continually pay attention to the limits of our assumptions and experience, and keep learning from the people we’re working with, we’re likely to be projecting subtle and not-so-subtle messages of knowing more than we know, of being a little (or a lot) more important than we are and protecting ourselves with a whiff of authority that’s overbearing or condescending.  

One of the particular characteristics of mental health politics, of course, is that what we call “mental ill-health” is very likely to be a response to the abuse or misuse of others’ power over us at different periods and settings in our lives.

So the fact that so much mental health provision is top-down — in the form of the politics of commissioning and funding, as well as the diagnostic and treatment decisions of psy professionals — is a fundamental issue for mental health activism.

As far as possible, political activism around mental health must be shaped and led by service users and survivors. For psy professionals, trust can only be earned over time through action, alongside and in support of survivors.

Obviously we professionals have plenty of political issues within our own working remits, around which we can take the lead. But we’re so much more powerful in our campaigns if we have allies campaigning with us who are on the receiving end of the dysfunctionality of the psy professions.

RH: There’s a lot there. Can you tell us how far away current mental health provision is from the “bottom-up” approach you’re advocating here? — and whether you think a radical left government could really make a difference to that — and if so, how? Imagine you’re the new minister for mental health and you have five years...

PA: I think there are fantastic examples of grassroots activity among service users. I’m thinking of people I’ve met from the Mental Health Resistance Network, Disabled People Against Cuts (DPAC — regularly featured in the Morning Star, of course), Recovery in the Bin, Friends of East London Loonies, the National Survivor User Network, Kindred Minds, the Survivor Researcher Network and Making Waves, as well as hundreds of small user, refuser and survivor-run groups involved in peer support, political campaigning, the creative arts, in manifold ways of sharing and valuing each other’s lived experience.

But the culture-gap that exists between these forms of local “activism” and mainstream top-down mental health services provided by the NHS, or by some of the big mental health charities like Mind, can be enormous, and often very toxic for people suffering psychological distress.

Do I think a radical left government could really make a difference? The political transformation required to rethink mental ill-health as a function of society’s ill-health is profound. In a way, mental-health politics is at the heart of any real questioning of what kind of society we want to live in, how we want to relate and be related to, what and whom society’s for.

The first three jobs of a radical minister for mental health should be:

  • To ask user groups and individuals all over the country what “mental illness” means to them and what would be of help to them. Mean it, listen and then carry on listening. If the Labour Party were serious about any kind of radical transformation of mental health policy, it should be doing this right now. Are they?
  • Give people the material resources to support their basic needs without condition.
  • Ban all forms of coercion in the name of “treating” people’s psychological suffering/distress.

RH: That’s a resoundingly clear statement — and challenge — to Labour’s shadow health team. Let’s hope they’re open to listening, both to your conspectus here and to the experience of those who desperately need to be listened to — and who, to date, rarely have been by the Establishment.

I really like how you place your emphasis on political receptivity and user empowerment, rather than on top-down initiative-itis.

I assume you’re less than impressed by current state therapy provision and its top-down nature?

PA:  Well, NHS primary care therapy provision — Improving Access to Psychological Therapies (or IAPT) — is seriously top-down. It’s organised as a sort of factory system or conveyor belt of mental health treatment, offering on average six or so sessions of cognitive behavioural therapy (CBT), or perhaps mindfulness, relaxation, or online self-guided exercises — aimed really at getting people suffering from depression and/or anxiety back into the everyday reality of their lives under capitalism.

What kind of therapy you get is decided for you through a diagnostic check-box interview which may be held on the phone, or even by computer.

There’s very little room for “user choice.” Out of 1.4 million people referred last year, two-thirds either never entered or failed to finish a course of IAPT treatment. They simply disappear from the statistics.

I’m afraid it’s hard not to feel that IAPT is more about providing cover for the mental ill-health of capitalism than it is responding to the psychological suffering of the people.

Beyond IAPT, I think all forms of therapy carry the danger of encouraging a way of thinking about one’s self and the world that’s imposed on clients, rather than evolving through a process of mutual exchange between a therapist and a client.  

RH: That’s sobering stuff, but I suppose we shouldn’t be too surprised when (state) capitalism creates a form of therapy that’s cast in its own image. Finally, could you say something about the once-again mooted state regulation of the psy therapies and why you think this would be harmful to the field and to the work of therapy?

PA: Obviously therapists want their work with clients to be accountable. The problem with state regulation is the state’s desire for psychotherapy. As we see in other fields like education, medicine and the law, the neoliberal state is increasingly engaged in violently undermining and taking political control of professional practice whose values and traditions conflict with the interests of the market.

Psychotherapy, especially in the independent sector, operates at its best as a sort of free association and open exploration of meaning between people, a process that fosters possibilities for individual and social transformation.

In the hands of the state, it will gradually and inevitably be reduced into the service of market agendas.

Paul Atkinson is a psychotherapist in independent practice in London, and a member of the Free Psychotherapy Network. Richard House is a Corbynista activist living in Stroud.

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