The importance of listening and talking
The British Psychological Society is actively engaged in several important policy issues, but two are particularly contentious. They are technically complex and they are personally challenging.
A recent government consultation asked how to implement the replacement of bursaries for nursing and other healthcare students with an expanded system of loans. This change raises complex issues for our discipline.
Our response stressed that “the proposed reform to healthcare education funding falls short of the long-term holistic workforce strategy necessary to achieve the government’s goal of delivering high quality integrated physical and mental health care.”
Given that clinical psychology trainees receive both fees and salaries from Health Education England, any move towards loans as opposed to bursaries would constitute a major threat to our profession. Thus we stated clearly that this support “is vital and must continue”. But this support does not cover all applied psychology, and, as we said in our response “is not sufficient to deliver the progress needed to achieve the government’s goal of significantly improving the psychological health and wellbeing of the population.”
We need to enter into substantive discussions with the Department of Health and Health Education England about the future shape of our professional training. We know that our profession is under review. There are many options – from the discussions held under the New Ways of Working programme, suggestions I have previously made and the opportunities offered by the existing Clinical Scientists route.
One thing that psychologists are good at – trained in – is grappling with difficult issues and forging coherent consensus. In this response we expressed a clear message on behalf of the whole profession that takes us forward with authority. But on a personal level, this was a difficult issue. It was challenging to balance the well-argued concerns of colleagues over the commissioning of clinical psychology training with the opportunity for other applied Divisions to boost the psychological workforce and begin to address structural inequity if they were at least able to access loans to meet their training costs.
One of the reasons I love my profession is that we didn’t just put our head in the sands. We took the bull by the horns, and developed a coherent and authoritative position, which we will develop further in the coming months. Armed with this, we are ready to sit down at the table and try to influence the course of events.
I had to confront a second personal and professional dilemma this past week as on Friday I met with colleagues in the Department for Work and Pensions. Many of my friends have aired grave concerns about DWP policies, arguing that they inappropriately ‘psychologise’ unemployment and locate the problem within the unemployed person.
The BPS and other organisations have also raised concerns that the DWP considers employment as a clinical outcome, and that the underpinning rationale for these policies was not improving health, but for ideological purposes. We are concerned that people would be coerced into therapy or face sanctions on their unemployment benefit payments if they refused consent.
We continue to scrutinise these policies and insist on the appropriate, ethical, use of psychological theory at all times. The British Psychological Society has argued that staff must not be involved in coercion and must maintain their professional independence as therapists. Claimants’ rights to autonomy and freely-given consent (to, for instance, participation in research trials or therapy) are non-negotiable.
Moreover, employment is not a universally positive outcome for everybody. There must be a clear commitment to appropriate work that includes long-term tailored support or there is a real risk of jeopardising recovery or worsening of mental health problems. Personally I’d go further and argue that employment should only be an outcome if that’s what the client wants.
I have my own opinions, which are guided by my understanding of psychological science, by my professional training and by my values, and which I know I share with my colleagues. Last year, I spoke out about the misuse of such policies but a principled stance is not necessarily the same as simple opposition.
The most important discussions are not easy. They aren't conceptually easy and they aren’t emotionally easy. But they are necessary - we have an obligation to engage and discuss such contentious and difficult issues, not avoid them.