The uberization of mental health

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There is a mental health crisis in England, with rates of depression doubling since the start of the Covid-19 pandemic. “Talk” strategies, mindfulness sessions at work, and national “happiness” campaigns have been touted as an effective approach to tackling mental health in the workplace, but therapists are not convinced.

But what about state mental health services? It was equally unconvincing. Over the past decade, mental health services in England have undergone a process of ‘uberization’. This refers to how services are effectively treated as products marketed through online platforms, changing the way they are delivered and making the jobs of the people who provide them more insecure, much like ridesharing apps. about taxi drivers.

Specifically, this happened through the introduction of a standardized and digitized therapy model called Increased Access to Psychological Therapies (IAPT). This uberization seems to contribute to a mental health crisis within the profession of therapist.

The IAPT, which was introduced in 2008, offers psychotherapy for depression and anxiety to over a million people each year, the NHS ‘largest program in England. He uses a cognitive behavioral therapy model – consisting of short-term interventions of four to 12 sessions – that use techniques, such as relaxation exercises, to encourage positive mood and behavior.

These sessions were primarily delivered online due to the pandemic, and often in the form of guided self-help, without contact with clinicians and increasingly using artificial intelligence technologies, such as chatbots.

As a result of this model, face-to-face therapy was downgraded. The use of digital technologies – accelerated during the pandemic – and the emergence of digital providers and online therapy platforms mean the trend is towards the mechanization of therapy.

In a 2019 online survey of 650 NHS IAPT workers, 68% of people said they had suffered from depression or anxiety – or both – as a result of their work and 70% said they had suffered from depression or anxiety. burnout. As one therapist working at IAPT put it, “I have never seen a more discouraged group of professionals in my life.

The reason why this is important is probably obvious: When your therapist is living with their own mental health issues, their abilities to deal with your distress are likely to be reduced. Add to this the remote work with an increased workload and precarious employment contracts, therapists suffer a direct blow, financially and psychologically.

With these extremely high levels of depression and anxiety among therapists, there is a real issue of patient safety that is being overlooked. If the model of mental health itself is broken, do services make the mental health crisis worse instead of solving it?

More worryingly, the data on IAPT’s performance is raising more and more questions, including the much contested claim that 50% of people recover by accessing IAPT services. My survey of therapists working for IAPT found that 41% said they were asked to manipulate data on patient progress. This included therapists allegedly encouraged by their managers to coach patients to give positive responses to questionnaires taken after each session. And, they said, they were asked to repeat the questionnaires until a positive response was obtained.

Alternative models

There is a real and growing problem of patient confidence in the credibility and effectiveness of the IAPT model. This is seen in the growing lobby of ‘no recovery’ activists – such as the Mental Health Resistance Network and Recovery in the Bin – who are calling for a boycott of public mental health services and the development of alternative models of mental health care. peer-led mental health.

In the post-pandemic world, mental health services will continue to be strongly shaped by the emergence of digital services and digital employers. We can anticipate the growth of large and new digital providers and online platforms in NHS mental health services and a growing number of therapists working for them on an independent and insecure contract basis. Fundamentally, this continued uberization of services is a downgrade for all of us where therapists and patients have everything to lose.

We need to go back to the principles of therapy, based on a person-centered approach, where therapy is shaped by the specific needs of the patient with a therapist who has the capacity to meet them. Uberized therapy contrasts sharply with these principles, where automated, standardized and digitized interventions guide our response to the mental health crisis.


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