Karen Paradowski: How has therapy changed over the years of the NHS?

Published on: 31st July 2018

When the NHS was established in 1948, the services for mental health were for the most part provided by the Asylum services, which were established during the19th century. Many people without mental health problems were put into asylums. My grandmother had epilepsy, and as it was a very misunderstood problem at the time, she was sectioned into St John’s Hospital in Lincoln when my mother was 2 years old, and sadly she was never released, and stayed in there for 25 years until she died. However, after the NHS Act (Department of Health, 1948) all of that changed and services were provided by the medically dominated system of the NHS.

Primary care mental health services have undergone a number of changes in recent years, from psychiatrists and community psychiatric nurses being based in GP surgeries, to the growth of counselling and therapy in primary care due to the pressure for shorter-term, brief treatments and evidence-based, managed care. This enabled the patient to be offered a wider range of treatments, such as psychodynamic psychotherapy, humanistic and cognitive-behavioural approaches.

In the primary care setting, CPNs would often go out into the community supporting patients with serious mental health problems. They may also have extended their work to include counselling and brief psychotherapy with selected patients, and often appointed as practice counsellors in GP surgeries.  Along with the growth of clinical psychology in primary care, also the number of practice counsellors greatly increased, as more colleges and universities offered Diploma in Counselling courses.  

It was while I was working in a GP surgery that I saw a flyer for a counselling course at Grimsby College. I decided to attend a six-week taster course, and became hooked.  It took me another five years to go through the Diploma course to gaining my Masters degree, but then I was rewarded with a post as counsellor with LPFT at Skegness. I have seen many changes since my days at Lumley Avenue, but you know what they say “if you don’t like change, don’t get a job in the NHS”!When the NHS was established in 1948, the services for mental health were for the most part provided by the Asylum services, which were established during the19th century. Many people without mental health problems were put into asylums. My grandmother had epilepsy, and as it was a very misunderstood problem at the time, she was sectioned into St John’s Hospital in Lincoln when my mother was 2 years old, and sadly she was never released, and stayed in there for 25 years until she died. However, after the NHS Act (Department of Health, 1948) all of that changed and services were provided by the medically dominated system of the NHS.

Primary care mental health services have undergone a number of changes in recent years, from psychiatrists and community psychiatric nurses being based in GP surgeries, to the growth of counselling and therapy in primary care due to the pressure for shorter-term, brief treatments and evidence-based, managed care. This enabled the patient to be offered a wider range of treatments, such as psychodynamic psychotherapy, humanistic and cognitive-behavioural approaches.

In the primary care setting, CPNs would often go out into the community supporting patients with serious mental health problems. They may also have extended their work to include counselling and brief psychotherapy with selected patients, and often appointed as practice counsellors in GP surgeries.  Along with the growth of clinical psychology in primary care, also the number of practice counsellors greatly increased, as more colleges and universities offered Diploma in Counselling courses.  

It was while I was working in a GP surgery that I saw a flyer for a counselling course at Grimsby College. I decided to attend a six-week taster course, and became hooked.  It took me another five years to go through the Diploma course to gaining my Masters degree, but then I was rewarded with a post as counsellor with LPFT at Skegness. I have seen many changes since my days at Lumley Avenue, but you know what they say “if you don’t like change, don’t get a job in the NHS”!

The formation of Improving Access to Talking Therapies (IAPT) – beginning in 2008 - provided the hope of a new kind of therapeutic approach for the NHS which could reach more of the population, through the tools of self-help using primarily the theory of cognitive behavioural therapy (CBT), and assisted by the revolution in communication brought about by the internet. The aim was to increase the provision of evidence-based treatments for common mental health conditions.  

I was fortunate to be among one of the first IAPT trained CBT therapists with Derby University, but it was a tough schedule, cramming two years of the course into ten months! There were many times when I thought I wasn’t going to make it to the end, but with the support of my colleagues, and endless cups of coffee at Costas in the New Life Centre, Newark, I got my qualification without having a nervous breakdown!  At the same time, psychological wellbeing practitioners (PWP’s) were being trained to provide 'low intensity', or self-help, interventions. To complete the team, there were also counsellors and IPT therapists to provide treatment for more complex presentations.

Improving Access to Psychological Therapies (IAPT) services in England has transformed treatment of adult and young people’s anxiety disorders and depression, with over 900,000 people accessing these services each year. The development of adult IAPT services has demonstrated that effective ways of working can be achieved on a large scale within the NHS of the twenty first century, and this is a far cry from the days when someone with a mental health problem would either be locked away in an asylum or a workhouse, with symptoms that nowadays can be treated quickly and successfully.The formation of Improving Access to Talking Therapies (IAPT) – beginning in 2008 - provided the hope of a new kind of therapeutic approach for the NHS which could reach more of the population, through the tools of self-help using primarily the theory of cognitive behavioural therapy (CBT), and assisted by the revolution in communication brought about by the internet. The aim was to increase the provision of evidence-based treatments for common mental health conditions.  

I was fortunate to be among one of the first IAPT trained CBT therapists with Derby University, but it was a tough schedule, cramming two years of the course into ten months! There were many times when I thought I wasn’t going to make it to the end, but with the support of my colleagues, and endless cups of coffee at Costas in the New Life Centre, Newark, I got my qualification without having a nervous breakdown!  At the same time, psychological wellbeing practitioners (PWP’s) were being trained to provide 'low intensity', or self-help, interventions. To complete the team, there were also counsellors and IPT therapists to provide treatment for more complex presentations.

Improving Access to Psychological Therapies (IAPT) services in England has transformed treatment of adult and young people’s anxiety disorders and depression, with over 900,000 people accessing these services each year. The development of adult IAPT services has demonstrated that effective ways of working can be achieved on a large scale within the NHS of the twenty first century, and this is a far cry from the days when someone with a mental health problem would either be locked away in an asylum or a workhouse, with symptoms that nowadays can be treated quickly and successfully.

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