After two and a half years of searching and a number of false starts I have finally found an experienced CBT-p practitioner. CBT-p stands for Cognitive Behaviour Therapy for Psychosis. It appears to be a promising non drug based intervention for psychotic mental health problems like bipolar disorder and schizophrenia. Ordinary CBT practitioners are readily available but the “P” word for those willing and able to deal with psychosis seems to be the stumbling block. There seems to be very few practitioners in Australia with these skills and experience.
I had my first session last Friday and found it challenging. By the end of the session I had about as much as I could take and was glad when it came to an end. We spent a fair bit of time looking at techniques for acknowledging thoughts and feelings, connecting with physical sensations in the body and then anchoring oneself and returning to the task or situation at hand after experiencing a triggering situation.
It sounds easy enough but will probably take a lot of practice to get to the point where it becomes a natural part of everyday functioning. From what I have read about CBT-p, my first experience was pretty much as expected. I would rate my first session as “so far so good”. For the time being I will continue to use meds sparingly but maybe, just maybe...
Why are there so few CBT-p practitioners in Australia? In the UK, I believe that almost anyone who wants it can get free treatment via their National Health System. There appears to be similar programs in a number of European countries. Even the US, which is not well known for its socialised medical services seems to have a network that covers most of the East Coast of America.
My CBT-p sessions are not exactly cheap. Even after the Medicare rebate I am still out of pocket $95.50 for each session. I have elected to undertake fortnightly sessions but even so it is still a significant bite out of my retirement income and Medicare rebates for psychology are limited to a number of sessions. I have known quite a few people with schizophrenia who would be unable to afford this amount despite being desperate to reduce their dependence on anti-psychotic medication.
In Australia all health services, including mental health, are shared by the federal and state governments. This arrangement has evolved over time. Generally, the federal government gives money to the states who are responsible for the the delivery of services. Over the years the federal government has created a number of important mental health initiatives. Not the least of these is the ability to claim Medicare rebates for psychology. This gives at least some help to those who wish to explore alternative options to treatment with drugs.
One of the criticisms of CBT-p is that it can require quite a bit of effort for a relatively prolonged period of time to become effective. Many people, particularly when heavily medicated can’t muster or sustain this effort and find it easier to just take pills.
I have no argument with those who are satisfied with their drug based treatment providing the risks and pitfalls of these treatments are openly made known to them. In my experience this is often not the case. Many of us however, for various reasons, are not happy with a drug based approach and there are some very good reasons for this dissatisfaction.
On the 30th Dec 2021 the Mental Health Authorities of the Victorian Government (MHA) forced their way into my home with the help of police. They claimed that I was a danger to the public. There was no reasonable basis whatsoever for this claim but apparently it is a common excuse used to get around the law that would otherwise make forced entry illegal.
It appears that the MHA’s agenda was to sedate me and take me to the Peter James psychiatric aged care facility. I understand that the conditions there are appalling and once you get put in there it is very difficult to ever get out again. Obviously I wasn’t too thrilled about their plan so they proceeded to harass and bully me for some hours. I assume this was to try and trigger me into reacting which would then justify them using force. When that didn’t work they tried to talk me into allowing them to inject me with a slow release anti-psychotic medication. Given my age and general health, this type of treatment would have been extremely dangerous and possibly fatal. In the end I negotiated with them to undertake a course of CBT-p which of course I had been wanting to do anyway but had not been able to find a suitable practitioner. After raiding my medical cupboard and taking an inventory of all my medication, including a lot of non psychiatric stuff, they left.
Later that afternoon someone from the Peter James Centre rang me. They put me in touch with Eastern Melbourne Primary Health Network, a federal government organisation, who were supposed to be able to arrange a CBT-p practitioner for me. Several weeks later, after a lot of messing around, they were unable to find anyone.
I have since made a complaint to the Victorian Mental Health Complaints Commissioner about the forced entry to my home etc. The complaint was quickly fobbed off with a bunch of procedural excuses as to why it could not be considered. This matter is still far from being resolved to my satisfaction. I plan to escalate it.
After a few hours spent looking back through old postings in the SANE forum, I have come to the conclusion that my experiences were by no means unique.
The recent Royal Commission into Victoria’s Mental Health System shows that the existing system at least in Victoria is dysfunctional and toxic. I would be surprised if it is much better in other states
The state governments appear to be caught in a time warp. Their approach to mental health is based on a long outdated biomedical model which sees mental illness as an organic brain disease that can be diagnosed and “fixed” with drugs.
There is now a vast amount of research from around the world refuting these simplistic ideas as well as pointing out the extreme danger of the overuse of psychiatric medication which has been responsible for a substantial number of premature deaths. Despite all this evidence the biomedical model of mental illness is alive and thriving throughout the world. It appears to be enthusiastically supported by strong vested interests backed up by some very dubious scientific claims.
The state health authorities seem to have adopted an almost fanatical agenda to enforce this model and use “chemical incarceration” as it is sometimes called as the preferred method for dealing with serious psychotic “illnesses” like bipolar disorder and schizophrenia. Within this official mindset, non drug based treatments like CBT-p are obviously not even going to be given consideration unless a massive cultural shift takes place within government bureaucracies.
At a federal government level things appear to be somewhat better. Unlike the states they seem to take a much broader view of possible causes and solutions for mental health.
According to federal government statistics 20% of the Australian population or more than 5 million people currently experience some form of mental health problem. Only about 0.5% or 130,000 of those people experience psychotic problems although I have seen claims elsewhere that this figure is much higher.
Irrespective of the actual figures there is obviously much less demand for treatment of serious mental illness. I would suggest that people with bipolar disorder and schizophrenia have, to a large extent, become the forgotten, marginalised minority. In many cases I would also suggest that these so called illnesses and the life styles of those effected are often made substantially worse by the inappropriate treatment that they receive.
The cost to support such people, which is mostly born by the federal government is far from trivial. My back of an envelope estimate suggest that this total cost could exceed $10 billion per year.
While setting up and maintaining a CBT-p program would obviously cost quite a bit of money, it would more than likely save the federal government a considerable amount in the longer term, even if CBT-p proved to only be moderately effective. Ongoing research is also likely to result in improvements to these techniques over time.
As well as saving costs it would provide an alternative for those who are unhappy with a drug based solution and offer the hope of a substantially enhanced quality of life. CBT-p can be used either as a stand alone treatment or in conjunction with anti-psychotic drugs.
Lobbying the federal government to provide a national CBT-p program might be of some value, particularly if it is pointed out that it could save money. The absence of such a program could simply be that no one has thought of it. It is also possible that the biomedical fraction have been actively lobbying the federal government with false or misleading information, which they are reported to have done in the past.
Getting the state government mental health organisations to cease and desist from bullying and abusing people with mental health disorders is likely to be a lot more of a challenge. This includes involuntary custody without trial and involuntary treatment orders (ITO’s).
Following the Victorian Royal Commission, there is talk of new legislation and revenue raising measures to fund additional facilities. In my view all this is futile unless massive cultural changes take place within the mental health administration. Otherwise we are likely to finish up with even more of the same toxic mess.
Initially, these changes need to take place at a federal, not a state level and possibly in the form of some sort of best world practices commission for mental health that becomes incumbent on the states to adhere to. Given the nature of politics I doubt if anything like this will happen harmoniously. It seems likely that it will at the very least require new federal government legislation and changes to federal and state government powers.
Don’t hold your breath waiting for something like that to happen quickly.
Here are some links to some of my previous posts that are related to this subject
Looking for a CBT-p Therapist. Two and a half years ago
Still Looking for a CBT-p Therapist. A couple of weeks ago
Different Views Of Mental Health and Medication
Here is a link to the next post in this series
Finally Found A CBT-p Practitioner Part 2
Regards
Willy
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