Psychotherapist

There Is Another World

Neoliberalism is the predominant reality in contemporary society. It dictates the material conditions we live within. Yet a peculiarity of neoliberalism is that despite the way it affects each of our lives – and for more and more people this means adversely – few of us could really define what it is. Its anonymity, its shrouds and its ‘commonsense’ are possibly its greatest weapon.

‘The market’ sounds like a natural system that might bear upon us all in equal measure, as natural as the air we breathe. It is the way the world is, the way things are. Only it’s not. It is neither natural nor inevitable. It is not ‘commonsense’. It is only the way it is because human history has shaped the world in this way. It is maintained because it is hiding in plain sight.

The philosophy around neoliberalism arose as a conscious attempt to reshape human life and shift the locus of power. Although the exact beginnings are impossible to pinpoint, a number of key figures emerged around the time of the Second World War (including Friedrich Hayek, and his vastly influential book The Road To Serfdom) and a significant acceleration of neoliberal ideology occurred from the 1980’s onwards under Reagan and Thatcher.

The policies of Reaganomics and Thatcherism initiated included huge tax cuts for the wealthy, the stripping away of trade unions together with deregulation, privatisation, outsourcing and competition in public services. This continued all the way up to the recent financial crisis of 2008 and the austerity economics that followed afterwards, with policies crippling many of the UK’s public services, including the NHS and the tremendous healthcare it has long provided.

The NHS is anachronistic to neoliberalism because neoliberalism sets us against one another, creating adversarial social interactions amidst hierarchical, unequal societal structures. It reduces the social and the cooperative. Though both competition and cooperation are a part of the human endowment, under neoliberal regimes the former dominates. This dehumanises us all. It is the very antithesis of the NHS – the supportive, responsive, caring human face of healthcare in the UK.

The lack of challenge to neoliberalism’s reach is now keenly felt across the landscape of mental healthcare in the UK (and beyond). This is demonstrable in a number of ways. Instead of a system which makes care the primary objective of a health service, we have an NHS being operated according to (and dismantled because of) the whims of the unforgiving market-place where competition is seen as a defining principle within human relations, where people are consumers, where buying and selling decides everything.

Neoliberalism is premised on the assumption that the market place can somehow replace the state as the ultimate arbiter of logic. The value we place on relationships between people is mediated by the de-personalising market place. Health is merely business. And so, the NHS is in grave danger because of the cuts being made. In my area, it is suffering because of the forms of mental healthcare that have become increasingly utilised since the advent of the Improving Access to Psychological Therapies (IAPT) programme.

Mental health services are now dominated by IAPT, which focuses exclusively on ‘evidence-based’ and short-term interventions for clients with particular diagnoses – chiefly depression and anxiety disorders. IAPT fits well within the neoliberal matrix. Ostensibly, a programme devised to increase the availability of ‘talking therapies’ on the NHS, it has become clear that what was actually meant by ‘talking therapies’ was the domination of evidence-based, manualised, short-term interventions. Furthermore, the financial pressure on services is such that many workers in IAPT services are minimally-trained psychological wellbeing practitioners offering ‘low-intensity’ interventions over few sessions.

CBT is a valuable therapy that works for many people. And of course there many wonderful, compassionate people working in the NHS, often stuck within a system they dislike. Until we can see neoliberalism and its effects, and beyond it, everyone will speak in a language that is utterly alien to the core values that led to the setting up of the NHS in the first place. Limiting the options of mental healthcare to time-limited work leaves no space for the types of relational, deep, facilitative work that many people who access mental health services need. In addition to this, because of the financial pressures on services little time is left for therapists to reflect on their practice or for the adequate supervision of therapists who work at the coal-face day after day.

Services are structured the way they are because of their because of the ‘economic’ fit, and not according to the needs of the population. This comes at the expense of other much-needed therapies. The many good people working in mental healthcare in the NHS are suffering because of the way the NHS has re-structured in recent years. If the professionals are suffering, this means patients are too. Human interests have become conflated with narrow economic outcomes. It seems increasingly clear that the implementation of IAPT was less about the provision of therapy to help people suffering and more and more about the dismantling of the NHS to meet ideologically-designed targets.

A most dangerous phrase is ‘we’ve always done it this way’ – we haven’t. But it’s hard to know how to fight against it. The opponent is hard to define, it is scattered and viewed as inevitable somehow. The language of the market permeates all of our lives, including our health system. The health of a country’s citizens shouldn’t be anywhere near so reduced to the vagaries of the market. How we look after people ought to be above this. But without strong opposition the status quo cannot be mobilised against properly. And yet, neoliberalism is an ideology, no more. If it was constructed by humans, it can be deconstructed. As a way of organising society it is not on a path anywhere productive. Actually, the way it structures our society is making us ill.

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