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Is Psychiatry On Its Way Out?


With the waiting lists for mental health support being the highest they’ve ever been and the stress levels across the world rising to breaking point, choosing a therapy option that works for you has never been more important.


Whether you’re waiting for NHS interventions, can afford to go private, or are taking advantage of workplace mental health solutions, there are often a lot of options to choose from. That being said, it seems that some are definitely better than others.


Despite the domination of Freud throughout psychology courses the world over, the father of psychiatry has been proven incorrect time and time again. Increasingly, the NHS is leaning into Cognitive Behavioural Therapy (CBT) as a cost-effective and location-independent way to help people. 


The thing is that no one thing works for everyone. While CBT is great for mild-to-moderate cases or as a triage method while people are waiting to get off a waitlist, the thought pattern rewiring basis isn’t always suitable for those with severe mental health diagnoses or for neurodivergent people. Here, psychiatry can come into its own. 


But there are a lot of problems with psychiatry both in its style and its societal perception. Psychiatry appears inherently elitist. It’s the therapy style you think of when someone is lying on a couch sitting opposite a man with a beard, rounded glasses, and a jacket with elbow patches. It’s one-to-one sessions that are charged by the hour in a lavish and carefully designed brownstone in New York. That’s the vibe.


So, inherently, psychiatry becomes inaccessible to a lot of people. it’s not a form of therapy that lends itself well to online versions or group settings due to its in-depth personal and historic format. So, you need to be in a location where affordable psychiatrists are operating which is normally in large cities. With hourly rates being the norm, it’s not surprising for a session to be upwards of £60 per hour. As you need regular sessions, this quickly becomes unaffordable for a lot of people, especially when you factor in the cost of living crisis.


This is a large reason why a lot of people and organisations opt for CBT. It’s easily disseminated into group settings and for computerised versions. This higher level of accessibility helps with reducing waiting times and opens up more affordable solutions in rural areas. That being said, waiting lists are still super long and cCBT isn’t being fully utilised as a triage mechanism.


With people staying on waiting lists for up to nine months, a lot of patients are getting a lot worse while they’re waiting for support. If you think about it, your stress, anxiety, or depression is already having a big impact on your life when you’re at the stage to ask for professional help. If you have to add another nine months of white-knuckling it out to that process, you’re slowly going to be moving from a mild-to-moderate level into a more severe category.


People simply can’t afford to wait. So, whether it’s paying for private psychiatry sessions, purchasing CBT app subscriptions, like Leafyard, or checking out their workplace’s (often lacking) subsidised support, there needs to be more signposting to triage-style services. 


CBT apps are probably best placed to fill this void. They’re practical, independent, and don’t rely on location. In the case of Leafyard, they’re also anonymous and feature habit-building techniques that drive action – something that people who use NHS-backed CBT worksheets say is missing from the process. They’re designed to give you practical strategies that help you understand and reframe your negative thoughts, beliefs, and emotions.


On the flip side, psychiatry has come under criticism for focusing on the past too much, living the patient something to blame rather than working constructively. Also, studies have shown no indication of the existence of the Superego, the ID, or any of the other common psychiatric constructs in the brain.


At its core, therapeutic interventions work best when they work in tandem with principles of behaviourism, something that B.F. Skinner noticed decades ago. You have to act and make changes in the present. Psychiatry’s focus on the past, or on Freudian concepts doesn’t practically help people to move forward. 


There was a quote the team here saw the other day that said, “mental health issues are a lot like cancerous tumours, it helps to know where they come from but that’s not as important as treating it in the present”. Psychiatry helps you figure out your trigger, but behaviourism and CBT actively help you build strategies to rewire your brain and keep you moving forward.


Like any therapy, CBT is not a quick fix. One of the criticisms of CBT is that it’s a 12-week course and you can’t change behaviour in 12 weeks. Of course, you can’t. What it does do is give you the strategies to move forward and use in your life. You need to continue to implement them and put in the work after the sessions are done. 


As we contend with growing waiting lists, we need solutions that give patients the tools and techniques to help themselves, taking the strain off healthcare services to deal with more severe cases. CBT gives us that. That’s why Leafyard combines CBT, behavioural science, and tons of other wellbeing strategies and techniques to improve mental health and mental fitness in an accessible, location-independent, anonymous way.


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