“I used to think that they were all abnormal. And I was the normal one”: conceptualizing mental health and mental health treatment under Improving Access to Psychological Therapies (IAPT)

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT programme impacted on patients’ understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyse six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologising those who are dependent on people and services requires further commentary and action. Declaration of interest: The first author was employed by the same organisation that delivered the IAPT service, although through a separate staffing and management line.

Alcohol gel ingestion amongst homeless Eastern and Central Europeans in London: assessing the effects on cognitive functioning and psychological health

Background: Intentional consumption of alcohol based hand gels has been reported especially amongst non-UK national, alcohol dependent, homeless individuals in London. Whilst alcohol misuse is known to be associated with impaired cognitive functioning and mental health problems, the effects of additional ingestion of alcohol gel are unknown. Objectives: To explore cognitive and psychological functioning in users who intentionally ingest alcohol gel compared with ethyl-alcohol only misusers and controls. Methods: Male, Central and Eastern European alcohol only misusers, (n=14; mean age 39 years), alcohol gel users (n=14; mean age 43 years) and controls (n=12; mean age 31 years) were recruited from a London Homeless Service during 2013/14. Alcohol misusers, alcohol gel users and controls were compared on the Forwards and Backwards Digit Span Test; Block Design test; Retrospective and Prospective Memory Questionnaire (PRMQ) and the Hospital and Anxiety Depression Scale (HADS). Results: Alcohol gel users performed significantly worse on the Block Design task (p<0.01) and PRMQ (p<0.01) relative to both alcohol only and control groups, and significantly worse on the digit span relative to controls (p=0.01). Both alcohol misusing groups scored comparatively on digit span backwards (p<0.01), with both groups performing significantly worse than controls. The alcohol gel group reported significantly higher levels of anxiety relative to controls (p=0.02). Conclusions: Whilst there could be constitutional differences between alcohol misusers who additionally abuse alcohol gel, the findings suggest that alcohol gel ingestion may have a greater impact on psychological functioning than traditional alcohol misuse.