In October 2011, Derbyshire County PCT announced its plans to reduce or scrap Tier 4 Psychotherapy Services, and replace them with other therapies such as Cognitive Behaviour Therapy (CBT). This was an attempt to save money. The Mental Health Action Group became aware of this plan from two sources; service receivers currently in the Tier 4 programme, and through Derbyshire Voice who had been engaged in consultation on the issue.
However, the plan was criticised by Councils in Derbyshire as insufficient consultation with stakeholders had been carried out. The PCT and Hardwick Clinical Commissioning Group quickly arranged for consultation sessions to be provided on 4 dates across the County, and despite a slow start these duly took place. There was a great deal of debate from attendees, who included service receivers past and present, medical professionals and carers as well as PCT facilitators.
There was a great deal of anger at what was seen as a “done deal”, and many people who had experienced Tier 4 Psychotherapy gave testimony about how it had benefited them and aided their recovery. They felt that CBT was an unrealistic option as it was nowhere near as thorough or effective as Tier 4 (or “Psychodynamic) psychotherapy.
The result of the consultations was that the whole plan had to be referred for more high-level consultation, and Derby City Council held a meeting for stakeholders to discuss the key issues. They recommended that not only should Tier 4 continue to be provided, but that it should be made available in the North of Derbyshire where there was currently no provision. We await further decisions.
What is “Psychodynamic Psychotherapy”?
Psychodynamic Psychotherapy, or “Tier 4” as it is known, is designed for people with severe and enduring mental illness or personality disorder. It is a long-term treatment carried out by specialist practitioners, and involves intensive one-to-one and group therapy sessions several times a week over months or years.
The length of treatment depends on individual needs and recovery rates, and the underlying causes of the illness. Current programmes are conducted in specialist units in Derby, but the north of the County has no provision, making referral difficult (although not impossible). Part of the PCT’s intent to discontinue Tier 4 was based on this inequality of provision.
Although CBT (Cognitive Behaviour Therapy) is a very effective tool for people with mild or medium mental health problems such as anxiety disorder or depression, it is not seen by medical practitioners as being effective for more serious conditions. The loss of Tier 4 would leave dozens of severely ill people with no effective treatment and little hope of recovery.