I’ve seen a lot of these letters flying around recently between various services that work with vulnerable people and their families, probably due to the pressures of austerity. Since we’re all constrained for time, feel free to copy and paste this for future use.
Dear Professional from Another Service
Our service has discussed this client in our team meeting which we didn’t invite you to. Our service is currently under strain due to service cutbacks. Naturally, any suggestion that your service has similar problems would be ridiculous!
Our service decision is that the client fits your referral criteria, which we haven’t read, and that you should engage the client with the resources that we haven’t checked if you’ve got. We have concluded that it is the role of your service to fire a magic wand out of your backsides and sort everything out.
We do not look forward to hearing from you, as it’s your problem now.
Department of Buck-Passing
I hope this template will be useful to you in your inter-agency correspondence. But do please note that if you send one to me you’ll be getting a letter back suggesting a joint meeting.
Yesterday I posted about how the Association for Christian Counselling has banned so-called “conversion” or “reparative” therapies that aim to turn gay people straight – (this has also been reported in the Guardian). Lesley Pilkington, a counsellor who practices reparative therapy, had previously joined the ACC after being struck off by the British Association for Counselling and Psychotherapy over the issue.
I’d speculated that this decision may be linked to the ACC’s application to become an “accredited voluntary register” with the Professional Standards Authority. Today, the PSA contacted me to confirm that this is indeed the case.
“The Professional Standards Authority believes gay conversion therapy is inconsistent with our obligations under the Equality Act. As part of the process of assessing its application for accreditation, we raised the issue of conversion therapy and its implications for public protection with the Association of Christian Counsellors. We were pleased to see the unequivocal statement from the Association of Christian Counsellors rejecting conversion therapy. This is an example of the Accredited Voluntary Registers scheme improving standards without the need for regulation.”
In addition, Lesley Pilkington has confirmed to me that her membership of the ACC has been revoked over the issue.
Personally, I agree with the PSA that AVR is driving up standards in counselling and psychotherapy – but only up to a point. AVR forced the UK Council for Psychotherapy to radically overhaul their complaints procedures, and now it’s prompted the ACC to ban gay conversion therapy.
But we’re talking about voluntary rather than statutory registers. “Counsellor” and “psychotherapist” are not protected titles. Ms Pilkington can still practice and advertise her services as a counsellor, even though she’s been expelled from two organisations.
She’s also advertising herself as a “conscious channel for the Archangel Gabriel”, though to be fair, I doubt there’ll be much call to make that a protected title.
On 24th January there’s a second reading for Geraint Davies MP’s private members bill to bring in statutory regulation of psychotherapy. Personally, I think all counsellors and psychotherapists should support it. The use of AVR has already done a lot to drive up standards in the professional bodies – to the point that I suspect state regulation might not make much difference to the practice of someone registered with the BACP, UKCP or ACC. But giving these professions a statutory backbone would mean that when someone says they’re a counsellor or psychotherapist, then that means something. That has to be good both for the counselling and psychotherapy professions and for the public.
As regular readers will know, I’ve covered the UK Council for Psychotherapy’s journey towards being accredited by the Professional Standards Authority. The professions of counselling and psychotherapy have no statutory regulator, though a private members bill by Geraint Davies MP, which calls for state regulation, is approaching its second reading in Parliament. Voluntary registers do exist, such as the the UKCP and the British Association for Counselling and Psychotherapy, and the PSA has introduced a system of “Assured Voluntary Registration” where they will accredit these registers if they meet certain standards. Several counselling and psychotherapy organisations, including the UKCP and BACP, are now accredited.
I recently discovered that another organisation, the Association for Christian Counselling, is applying for accreditation. I then discovered that on their register is a counsellor by the name of Lesley Pilkington, who was struck off by the BACP for offering so-called “reparative therapy”, which aims to turn gay people straight.
Reparative therapy, also known as conversion therapy, is controversial, to put it mildly. The UKCP, the BACP, the British Psychological Society, the British Psychoanalytic Council, the Royal College of Psychiatrists and the Department of Health have all condemned it. They all view it as both unethical and harmful, and argue in favour of promoting inclusivity and respect for gay people rather trying to make them change their orientation. Geraint Davies’ bill includes a clause specifically banning such therapies.
Due to the voluntary nature of psychotherapy bodies, being struck off by one body doesn’t necessarily mean that a therapist can’t join another one – though if they were two PSA-accredited bodies, the PSA has stated that they “would expect AVRs to work in partnership to protect the public”. Until recently the Association for Christian Counselling was the only major therapy organisation not to ban conversion therapies, which perhaps makes it unsurprising that Ms Pilkington joined the ACC after being struck off by the BACP.
I e-mailed Ms Pilkington, who replied confirming that she’s still an advocate of conversion therapy.
I believe that if anyone is distressed by their unwanted same sex attraction they should have the right to help and therapy. That is the issue essentially for which I have been expelled by BACP, after a complaint was made by a gay journalist posing as a ‘client’ who told me he was distressed by his same sex attraction. It was all a lie as his stated and written intention was to close down people like me and in that he has been very successful. For the moment the agenda is very much with him and people like me form a minority (and persecuted) view. But should we not have this view in a diverse and pluralistic society. It seems not.Human rights exist for some but not for others like real clients who now are to afraid to come for therapy.
The journalist she refers to is the Independent’s Patrick Strudwick. It’s true that Strudwick used subterfuge by going to her posing as a client, though I suspect Mr Strudwick would probably respond that undercover journalism is considered ethical when investigating matters of public interest. He has reported that Pilkington suggested to him that he was sexually abused and could have been exposed to freemasonry as a child (neither of which happened to him.)
Unfortunately for Pilkington, in recent weeks the ACC has also put out a statement banning gay conversion therapies.
Members who are considering using this model of therapy should neither commence nor continue to use it and any advertising or promotional material should be replaced immediately, or at least removed from current use. This includes the ACC “Find a counsellor” facility on our website.
Such instructions are likely to affect Ms Pilkington, as can be seen from this screenshot that I took at the weekend.
Ms Pilkington doesn’t seem inclined to take it lying down. She told me, “I will be releasing my own statement soon; its all happening right now. Indeed there is a ‘fight’ going on and I will explain why and the implications.”
As well as Ms Pilkington, an evangelical group, the Core Issues Trust is also objecting to the ban. They ask the ACC to “take up with the Professional Standards Authority” their objections. I’m presuming from those words (though I’m currently awaiting confirmation from the PSA) that there’s probably been some discussions between the PSA and the ACC about conversion therapies.
I e-mailed the ACC to ask their view. They sent me the following reply.
You may like to know that over recent months ACC has been conducting a review and a statement sent to all its members last Friday and published on our website today.
The reference to a certain individual named by yourself is not on a register but a ‘find a counsellor facility’ and should at present, due to constant review at this time of year, be checked each day for accuracy. We trust this enables you to complete your article.
That struck me as a little cryptic, so I re-checked their ‘find a counsellor’ facility today. Her name no longer appears on there.
With these new developments, this means that no UK counselling or psychotherapy organisation of any significance endorses conversion therapies. The message is now clear. Praying away the gay is not a valid therapeutic intervention.
The news reports are true. Nick “Fat Hitler” Griffin of the British National Party has posted a cookery TV show online. Personally I’m not entirely comfortable with the idea of no-platforming fascists. Don’t get me wrong, I can see the argument in favour of it. Even so, when Griffin was invited on BBC Question Time, the result was a more effective anti-BNP message than years of Unite Against Fascism’s campaigning – through the simple expedient of letting him open his gob.
So, with that in mind, I’m going to review his culinary extravaganza.
The show opens with the BNP TV logo, which looks strangely like the Eurovision Song Contest logo with a Union Jack slapped over it. The screen cuts to a surprisingly posh-looking kitchen for a man who’s just been declared bankrupt. No doubt his creditors are watching the show with a calculator in hand.
On the table in front of him is some veg, including a bag clearly labelled “British White Potatoes”. Presumably Nick wanted these on display because he’s British, white and has the intellect of a potato.
Nick starts talking about the impact of poverty on food budgets, and how he was at an event where people complained that “they can’t afford – their wives can’t afford to put enough decent food on the table.” Their wives? Who was he meeting with? The Stepford Racists?
He then suggests that the problem here is that a lot of people only know how to cook processed food, and don’t know how to make cheap food from raw ingredients. “Our chaps said to me, you like cooking. Why don’t you show a few examples of how cheap it is, how simple it is to cook really good food for yourself and your family.”
Wow. There actually was a BNP meeting where they decided, “You know what, Nick? See that Jack Monroe? You could do that!” Be very afraid.
1.00 Nick warns “We’ve not done this before. BNP TV does politics, not cookery, but we’ll see how it goes.” Building up the tension here until it’s almost noticeable.
1.20 Nick takes us through the ingredients, which he’s spent about £10 on. He provides the startling revelation that a good place to find reduced prices is in the the reduced section of the supermarket. I have a feeling there’s going to be a lot of this sort of revelations.
1.35 He found some stewing steak in the reduced section. Naturally it’s made from British beef. “Good stuff!” He’s got some carrots, onions, parsnips and swede. But there’s an important warning. “You can have too much swede, unless you’re a goat.” The nation’s goats breathe a sigh of relief.
2.05 There’s some condiments too – some salt, pepper and in a magnanimous gesture to Johnny Foreigner, some tabasco sauce.
3.00 He launches into a sob story about how he used to be living hand-to-mouth when he first moved to London. This doesn’t seem so much to be to empathise with the nation’s poor as to justify having a bottle of beer to hand. No doubt this would elicit more sympathy if he wasn’t a fat man standing in a very expensive kitchen.
4.15 Having bleated his poor-me history, Nick then promptly starts bragging about how nice his kitchen is, and to be fair, it is a nice kitchen with a great big Aga. Or at least it will be until the bailiffs arrive next week. However, he reassures us that in order to heat up a pot of stew you don’t need a fancy cooker, just any old burner. That’s right. Tesco Everyday Value fire is just as hot as Marks and Spencer’s fire. Well, I never.
4.25 “Different things take different times to cook, so obviously you’ve got to make sure that the things that take longest are done first of all.” Glad to hear we’re getting to grips with the concept of time.
4.40 I am now watching the leader of a political party explain how to chop an onion, while explaining that you don’t actually eat the peel. You won’t other political leaders doing that, eh? EH?
6.10 Hey up, we’re off. He’s starting to cook, though not before explaining that there are different types of cooking oil.
6.30 After explaining how time works, we now have more basic physics as we learn that a handy way to speed up the cooking is to put the pan on a hotter ring. He then grabs a wooden spoon, presumably the one he was awarded at the last election.
7.00 Sometimes meat comes ready-chopped. If this isn’t the case, Nick helpfully advises that as an alternative you can cut it up yourself.
7.40 It seems not only are there different types of cooking oil, there’s even different types of meat! “You could use pork, you could use chicken.”
8.00 Handy hint from Nick. If you buy a slow cooker, you’re getting a cooker and a pan for £12. How he hasn’t got a sponsorship deal from Russell Hobbs, I’ll never know.
9.14 Time to peel some vegetables. “You can peel with a knife.” YES YOU CAN!
10.05 According to Nick, British cooking used to be the best in Europe, but was scuppered by Ze Germans. “It became very simple after the Hanoverians came over from North Germany.” Fear not though, since “I spend a lot of time on the continent” and he now believes British cooking is becoming the best in Europe again.
10.50 Oh no! An onion has escaped the round-up. He leaps on it like it’s a fleeing immigrant.
11.30 Speaking of immigrants, “Don’t let people tell you that you need huge numbers of immigrants to have good cooking. We’ve got a Mexican restaurant in a town near here. The place isn’t swamped with Mexicans. You take the recipe, that’s really all you need.” Though to be fair, his attempts to recreate the dishes at home probably don’t include those “extra ingredients” they probably secretly slip into his food when they see him walking into their establishment.
12.20 Time to move the pot of stew onto a smaller ring. He conveniently tells those with a one-ring burner that they can get the same effect by turning the gas down.
14.05 Nick’s Handy Economy Tip! Too skint to buy meat? “Go to a butcher, and tell him you’ve got a dog. Can you have some dog bones?” Then scrape off the meat. Apparently he’s tried this himself, although your butcher may not sneak out back and wipe his bum on the dog bones first, like Nick’s presumably did before handing them to him
16.10 “With a stew, if you find you haven’t cooked if for long enough, just cook it for longer.” Amazing.
17.40 Another one of Nick’s Handy Economy Tips. Can’t afford to buy a recipe book? Just go into a shop use a camera phone to take photos of the recipes.
20.40 Brief rant about “all that green bullshit”. He really doesn’t like anything coloured.
21.20 Important advice on using stock cubes. Take the tin foil wrapper off because “tin foil really is unpleasant in your food. It’s not a good additive.”
21.50 Nick laments the fact that although you can get beef, lamb or chicken stock cubes, you can’t get pork ones. However, he has a solution. “I reckon if you put one beef one in and one chicken one in, you’ve more or less got pork.” How much time has Nick spent experimenting with mixed stock cubes?
22.05 “Food without salt is absolutely disgusting”. Between his political speeches and his salt advice, he really isn’t doing wonders for the nation’s blood pressures.
22.45 We now learn that opening a tin of tomatoes requires a tin opener “unless of course, you look for the tomatoes which have a lid with a pull-ring, and then you don’t need a tin opener.” At this stage, I’m starting to worry that watching this show is causing me to become dumber.
23:20 Nick cheerfully sloshes some rather nice-looking Hobgoblin beer into the stew, before taking a swig from the bottle. “The fact that you’re able to drink the beer as you’re cooking makes it worth cooking.” I am now regretting watching this while sober.
24.00 Nick explains how the Mexican police use tabasco sauce as a torture instrument. Perhaps in future they’ll just use his cookery shows instead.
30.20 With the stew cooking nicely, Nick puts in a request for “serious, constructive criticisms” of the show. Naturally, the online masses will hear this request as, “Troll him! TROLL LIKE YOU’VE NEVER TROLLED BEFORE!”
31.10 It’s now time for those immortal words, “Here’s one I prepared earlier”, as Nigella Hitler dishes out his stew to two old guys and a teenage girl. The girl looks embarrassed to be there.
31.30 Adolf Ramsey scoops the stew into bowls. It looks like a cowpat with carrots.
32.30 The old guys declare the stew to be “first class, delicious.” Nick doesn’t ask the girl what she thinks, probably because she’s wishing she could sneak out to the Mexican restaurant that Nick slagged off earlier.
And that’s it. Nick tells us he’ll be putting a list of the ingredients online – because nowhere on the Internet could we find a recipe for beef stew – and the show is over. This is something of a relief because if I’d had to watch any more of it then my IQ would have probably dropped to the level of Nick’s stew. Or possibly that of a BNP supporter.
Last year there was a picture meme going around on the theme of What people think I do/What I actually do. After I made some sarcastic remarks about the meme on Facebook, I was challenged to come up with one for my own role as a nurse therapist in Child and Adolescent Mental Health Services (CAMHS). Being one never to ignore a thrown-down gauntlet, I went on a trawl through Google Images, and promptly knocked together the following illustration.
A few days ago, I noticed that this graphic (which I’d probably devoted an entire half-hour to creating) was being passed around on Twitter. Since that’s the case, perhaps I should elaborate on it a little, and explain the different images. that I selected
What adult mental health services think I do.
Okay, it’s probably an exaggeration to suggest they think I work with Teletubbies. Even so, there is something of a disconnect between adult services and CAMHS. Our core client groups are palpably different, and so too are our ways of working.
We don’t work a lot with people who have psychosis. Despite the American fad for diagnosing “pediatric bipolar disorder” (which even the Americans have been backtracking on in the last couple of years), conditions such as schizophrenia and bipolar disorder are rare in children. I see maybe one psychotic young person a year, usually in their mid-to-late teens. I do work with young people who hear voices, but it tends to be at the level of pseudohallucinations rather than outright hallucinations.
One unfortunate consequence of this is that on those odd occasions when a psychotic child comes to a CAMHS team, they may not be as geared up to supporting them as an adult service. Conversely, adult services often aren’t as geared up towards treatment of eating disorders as CAMHS.
Another difference is that people with depression and anxiety are more likely to be seen in primary care during adulthood, and in secondary care during childhood and adolescence.
These difference tend to result in all kinds of problems when a young person turns 18. They often discover that they’re either transitioning to a very different kind of service, or they simply aren’t being offered a service at all.
It is true that use of psychiatric medication has risen in the UK in recent years, and I’d be lying if I said I’m entirely comfortable with all aspects of that. Despite this increase, it’s still fair to say that CAMHS are much more cautious in their use of medication than either their American counterparts or their colleagues in adult services.
I could count on one hand the number of medications I’m likely to come across in any given working day. If a young person is prescribed an antidepressant, 9 times out of 10 it’s likely to be fluoxetine, not least because it’s the only one licenced for under-18s. For ADHD there’s some relatively new drugs on the market, such as lisdexamfetamine aka Elvanse, but they’re not being prescribed much. The great bulk of young people with ADHD are still prescribed good old-fashioned methylphenidate (you know it as Ritalin, but it’s far more likely to be issued in various slow-release preparations such as Concerta XL, Medikinet XL or Equasym XL) with a smaller number taking atomoxetine aka Strattera. For sleep problems there’s melatonin. For highly agitated children there’s some use of low-dose antipsychotics (this has usually been risperidone, though there’s increasing use of aripiprazole instead) – and it’s this use of antipsychotics that I tend to feel uncomfortable about, even at low doses.
Outside of the higher-tier services dealing with deeply-unwell young people, that’s pretty much all the medication you’ll see. Despite the controversies about dubious use of psychiatric medications in childhood (by no means all of which are unjustified) a high proportion of the kids I work with are on no medication at all.
It’s also worth pointing out that I’ve worked with quite a few kids whose lives have been significantly improved through some judicious, well-monitored use of fluoxetine or methylphenidate.
What the Church of Scientology thinks I do.
All I have to say to this one is…If their argument is that psychiatry is superstition masquerading as therapy, and it’s all just a big scam to control people and take their money….Well, that’s a bit rich coming from the Church of Scientology.
What society thinks I do.
This image illustrates one of my major bugbears about what mental health services are perceived to be for. There’s a whole plethora of language devoted to it. “Oppositional defiant disorder.” “Conduct disorder.” “Behavioural problems.” “He has an anger problem.” “He needs anger management.” “She has difficulties with impulse control.”
All of which translates as, “Please make this child behave themselves.”
There seems to be an idea out there that all of society’s problems – unruly classrooms, chaotic family lifestyles, juvenile delinqency, crime – can be therapied away with six sessions of anger management. I can see why it would be an attractive idea to politicians, civil servants, parents, teachers, GPs, social workers – but it ain’t true. The psychiatric profession hasn’t helped itself in this regard by coming up with silly non-illnesses such as “oppositional defiant disorder”, but I don’t think mental health services should be there to get children to behave themselves, and I don’t think we generally do a good job when we try. If anything we can make the problem worse by trying to distil a wider systemic or social difficulty into a “condition” that the child has “got”. Hence why many CAMHS teams simply don’t accept referrals for ODD or conduct disorder.
What I think I do.
It would be fair to say I’ve put in quite a lot of training and studying into what I think I do. I’ve attended training on cognitive-behaviour therapy, as well as enhanced CBT for eating disorders. I’m currently paying out of my own pocket for some postgraduate study in systemic and family therapy. Over the years I’ve ploughed through a reading list of the great and the good. John Bowlby. Carl Rogers. RD Laing. Carl Jung. Paul Watzlawick.
What I actually do.
What do I do? Listen. Talk. Try to be a listener, an ally, a facilitator of reflection and problem-solving. Someone who works to build a relationship with young people and their families, and at times to help them build their relationship with each other.
When one puts it like that, perhaps what I do isn’t that complicated after all.