Current attempts to treat mental health issues on a mass scale creates opportunity for lots of own goals. For example, we tend to believe that providing more counselling or clinical psychologist slots will mean more people being treated. In practice there are great limitations to providing mental health support in the NHS and I propose a radically simple alternative which could be trialled in some localities to test for efficacy. Large organisations suffer from the requirement to be managed in a way which meets targets that can become inadvertently counterproductive. In trying to offer more sessions of therapy to patients, we end up routinely offering people 4 sessions. In four sessions you can certainly reduce suicidality, but for the most commonly present issues of anxiety and depression you typically need 14 sessions, and some times many more to be compliant with the evidence based practice. This creates a skewed service which doesn't achieve positive endings or outcomes and is incentivised to discharge patients too soon. This creates a atmosphere of dispair among patients and practitioners who are already at risk of burn out. A rational solution to this is to provide community counselling services which operate in a model similar to dental practices. To attract and fund mental health workers it needs to be meaningfully true that people seeking support and offering support get the resources they need to actually achieve good outcomes. I would suggest that the service be partially paid for by the state and means tested for adults based on ability to pay. The others reason general counselling practices are a constructive approach is that it addresses the unhelpful race to the bottom funding approach politician's face. Do you fund counselling for young people in schools or for cancer patients? Do you fund victims of sexual assault or addiction services? The only answer is that they all deserve support and a well resourced counselling centres with well established training programmes can allow counsellors and psychologists to support a wide range of presenting issues. At the moment, mental health providers are inadvertently left competing against each other which means they have to reduce sessions to be competitive. An mhs could also offer mental health risk assessment services for work places and community organisations, creating meaningful preventative measures.
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