England has a mental health crisis, and the incidence of depression has doubled since the beginning of the COVID pandemic. “Outspoken” strategies, mindfulness classes at work, and national “happiness” campaigns are touted as effective ways to solve mental health problems at work, but the therapist doesn’t believe it.
But what about mental health services provided by the state? This is also unconvincing. In the past ten years or so, mental health services in England have undergone a process of “Uberization”. This refers to how services are effectively viewed as goods marketed through online platforms, changing the way they are delivered and making the work of the people who deliver them more erratic—similar to the impact of taxi-hailing apps on taxi drivers .
Specifically, this is achieved by introducing a standardized and digital therapy model called Increased Access to Psychotherapy (IAPT). This Uberization seems to be leading to a mental health crisis in the treatment industry itself.
IAPT was launched in 2008 and provides psychotherapy for depression and anxiety to more than 1 million people every year-the largest NHS program in England. It uses a cognitive behavioral therapy model—consisting of short-term interventions of 4 to 12 sessions—using techniques such as relaxation exercises to encourage positive emotions and behaviors.
Due to the pandemic, these meetings are mainly provided online, and are usually conducted in a guided, self-service manner, without contact with clinicians, and increasingly using artificial intelligence technologies such as chatbots.
Due to this model, face-to-face treatment has been downgraded. The use of digital technology (accelerated during the pandemic) and the emergence of digital providers and online treatment platforms means that the trend is towards treatment mechanization.
In a survey I conducted with 650 NHS IAPT staff in 2019, 68% of respondents experienced depression or anxiety – or both – due to work, while 70% experienced Burnout. As a therapist working at IAPT said: “I have never seen such a depressed professional in my life.”
The reason this is important may be obvious: when your therapist suffers from their own mental health problems, their ability to deal with your pain may be reduced. Coupled with remote work, the number of cases has increased, and the employment contract is unsafe, and the therapist has been directly hit financially and psychologically.
Due to the extremely high levels of depression and anxiety among therapists, people have overlooked a real issue regarding patient safety. If the mental health model itself is broken, will the service deepen the mental health crisis instead of solving it?
Most worryingly, there are more and more questions about IAPT performance data, including the controversial claim that 50% of people recover from access to IAPT services. My survey found that 41% of the therapists working for IAPT were asked to manipulate data about the patient’s progress. This includes their manager encouraging the therapist to guide the patient to respond positively to the questionnaire after each treatment. And they were asked to repeat the questionnaire until they got a positive answer.
There is a real and growing problem with patients’ confidence in the credibility and validity of the IAPT model. This can be seen in the lobbying of more and more “unrecovered” activists-such as the Mental Health Resistance Network and Pennsylvania Rehabilitation-who call for a boycott of public mental health services and the development of alternative peer-led mental health care models. .
In the post-pandemic world, the emergence of digital services and digital employers will continue to severely affect mental health services. We can foresee the growth of large and new digital providers and online platforms in NHS mental health services, and an increasing number of therapists working for them on the basis of self-employment and unsafe contracts. Fundamentally, this continuous Uberization service is a downgrade for all of us, and both therapists and patients will suffer.
We need to return to the principle of treatment, based on a people-oriented approach, treatment is determined by the specific needs of patients, and the therapist has the ability to respond to them. Uber-chemotherapy contrasts sharply with these principles, in which automated, standardized, and digital interventions drive our response to the mental health crisis.