An excellent piece in the Guardian again today on one of the most insidious practices common in most NHS regions. Patient’s mental health status being manipulated so that a manager sat in an office, likely with no background or direct experience working in mental health, can manipulate their figures and get a bonus/promotion to bolster their reputation and standing. Or off-rolling to you and me.
This in turn makes a group of NHS bureaucrats look clever and competent in front of a bunch of politicians who can then go on to produce a report that says that everything in the NHS is fine, because they have all managed to meet a target somewhere.
This practice is as old as mental health services themselves, but more prevalent in an austerity ravaged NHS that is slowly consuming itself through the slowly atrophying, deluded and toxic layers of increasingly incompetent management who put themselves and their ambitions before patients.
The three ways most commonly used to fudge the figures are:
- discharging people before their allotted number of sessions have been completed because they are not likely to achieve sufficient progress. That way the figures look great as the counselling ended early (an indication of success), but the patient will be further demoralised as they are likely to feel abandoned and potentially re-traumatised by the experience.
- diagnosing someone with a personality disorder. When I first started out in this field fifteen years ago, the diagnosis of choice for this second form of off-rolling was schizophrenia. Nowadays, if you have someone who is using up a lot of resources, they can be given a diagnosis of personality disorder (most often borderline personality disorder) and their behaviours can now be written off as ‘attention seeking’ and you can withdraw those expensive resources that you were paying for. Impact on the patient to the sudden loss of support and input, well, devastating obviously, but hey, the figures are starting to look great…
- another great way to push your problem somewhere else, send the really expensive, complex cases out of area and into another NHS region. Of course, you have to put these patients into ‘for profit’ organisations as successive governments have closed down all the NHS treatment centres that used to be used, so everything is really, really expensive now, but hey, out of sight, out of mind.
The article I refer to by a clinical psychologist explains it better than I do, so please check it out by clicking the link below. I do not apologise for my tone here though. The main reason I have never worked for the NHS is because I know I would be asked to work in a way I find personally and professionally unethical.
I have heard many things from good, solid, ethical, caring counsellors who work or have worked in the NHS and it is soul destroying for them to have weeks, sometimes months of hard work undone in a moment by a manager who is more worried about their figures than helping people recover. The NHS and those managers get away with this because the NHS’s organisational expectations over-rule the counsellors governing bodies and their code of ethics. In effect the organisation, in this case the NHS insists that its employees be unethical and if they refuse, they will be in breach of their contract and fired.
Honestly, that is what happens. The vital code of ethics written by the BACP and which has been developed over thirty or forty years of practice and experience can be nullified and bypassed by any organisation which writes its own code of ethics or rules of best practice and links adherence to this to an employee’s continuing employment within the organisation.
Until there are root and branch changes in the way people with mental health issues are treated in the NHS, things are only going to get worse. It doesn’t have to be this way though. If people with experience, understanding and insight into mental health were put into the management positions to explain properly to the senior managers and government why things aren’t working at the moment, then there may be a chance to turn things around.
In fifteen years, I have not seen any positive move forward on this front though. If anything, things are getting worse.
The link to the article mentioned is below: