I have always known it: hospitals are deadly places. In the news last week that there are many hospitals that are dirty, with careless staff, using single-use equipment more than once etc. resulting in avoidable deaths of patients. Makes you think of suggesting a change in name from NHS to NDS (National Death Service). I am certain, I know that there are many caring and hardworking professionals in the NHS who are just as abhorred by these stories as I am. It does not change the fact that there is something endemically wrong with the national health service in the UK.
In my own work I regularly have contact with mental health professionals working in the front-line of mental health care. From them I learn first hand of ‘management initiatives’ that lead to the situation as described above: institutionalised procedures aimed at ‘making the numbers’ while ignoring quality of treatment. I work in the psychological therapy side of health care, so hygiene plays less of a role in my work. There are however a few things we know about how to do effective and efficient psychological therapies.
What is recommended is to work in a quiet room with little distractions; the reality of is that the psychological therapists often work in very noisy rooms (in gp surgeries), with hardly any soundproofing (I regularly listen to recorded therapy sessions and sometimes can’t hear what is being said because of the background noise).
What is recommended is to have a room with certain basic facilities: some tissues to help a client deal with tears, a whiteboard or flipchart to help the therapist explain certain topics; the reality is that rooms are rarely equipped with any of these.
What is recommended is that psychological therapists, especially beginning or student psychological therapists have preparation time before each session and processing time after each session; the reality too often is that even student psychological therapists have to rush from one session to the next without any time for reflection.
What is recommended is that psychological therapists first do a detailed assessment of their client’s problems and compose a treatment plan based on that assessment. Subsequently this treatment plan is discussed and agreed with the client before it is put in practice (a process that takes between 2-4 sessions). In too many situations the psychological therapists are told by their managers that the maximum amount of sessions is 8 and that they have to discharge their patients after 8 sessions.
What is recommended is to organise the frequency of sessions based on client’s problems, preference and motivation. This means that for some clients the frequency could be once per week, while for other clients the clinical need (especially with exposure programmes for anxiety problems and severe depression) is to meet up with clients more than once per week and for other clients it may be sensible to offer sessions every fortnight. The reality however is that many services demand that the therapists only offer sessions every two or three weeks.
I wonder how long it will be before we read similar stories about psychological therapy services, how many avoidable deaths will it take for the management to realise that numbers are not people?