The ‘Uberisation’ of mental health services is a threat to our wellbeing

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TeaHere’s the mental health crisis in England with the rate of depression doubling Ever since the covid pandemic started. strategies of “Speak”mindfulness sessions at work, and National “Happiness” Campaign touted as an effective approach to dealing with mental health at work, but therapists disagree.

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But what about state-provided mental health services? It has been equally disjointed. Over the past decade, mental health services in England have been going through a process of “Uberisation”. It refers to how services are effectively treated as goods marketed through online platforms, the way they are delivered as well as making people’s jobs more precarious. – Similar to the effect of ride-hailing apps on taxi drivers.

Notably, this has happened through the introduction of a standardized and digital model of medicine called increased access to psychological therapies (IAPT). This Uberization appears to be contributing to the mental health crisis within the medical profession itself.


The IAPT, which was introduced in 2008, provides psychotherapy for depression and anxiety to over one million people each year – the largest NHS program in England. It uses a model of cognitive behavioral therapy—composed of short-term interventions of four to 12 sessions—that uses techniques, such as: relaxation exercisesTo encourage positive mood and behavior.

These sessions were mainly delivered online due to the pandemic, and often in the form of guided self-help, without contact with physicians and increasingly using artificial intelligence technologies, such as chatbots.

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As a result of this model, face-to-face therapy has been downgraded. The use of digital technologies – intensified during the pandemic – and the emergence of digital providers and online therapy platforms mean that the trend is towards mechanization of medicine.

one online. In I surveyed 650 NHS IAPT workers in 2019, 68 percent of respondents claimed they experienced depression or anxiety as a result of their work – or both – and 70 percent experienced burnout. As one physician working at the IAPT put it: “I have never in my life seen a more frustrated group of professionals.”

In a post-pandemic world, mental health services will continue to be heavily shaped by the emergence of digital services and digital employers

The reason why this matters is probably obvious: When your therapist is living with their mental health problems, their ability to manage your distress is likely to diminish. Add to this working remotely with it increased case load And insecure contracts of employment, physicians are taking a direct hit financially and psychologically.

With these extremely high levels of depression and anxiety among physicians, there is a real question about patient safety that is being overlooked. If the mental health model itself is broken, are services deepening the mental health crisis rather than solving it?

Most worryingly, there are growing questions about IAPT performance data, including the highly disputed claim that 50% of people recover As a result of accessing IAPT services. My survey of therapists working for the IAPT found that 41 percent claimed they had been asked to manipulate data about patients’ progress. In this, physicians were reportedly being encouraged to train patients to respond positively to questionnaires taken by their managers after each session. And, he said, he was asked to repeat the questionnaire until a positive response was received.

alternative model

There is a real and growing problem with patient confidence in the reliability and effectiveness of the IAPT model. This is seen in a growing lobby of “un-recovery” campaigners – such as the Mental Health Resistance Network and Recovery in the Bin – who call for boycotting public mental health services and developing alternative peer-led models of mental health care. .

In a post-pandemic world, mental health services will continue to be heavily shaped by the emergence of digital services and digital employers. We can anticipate the growth of larger and newer digital providers and online platforms in NHS mental health services and an increasing number of clinicians working for them on a self-employed and unsecured contract basis. Basically, this continuous uberization of services is a downgrade for all of us where both the physician and the patient have to suffer.

We need to return to the principles of medicine based on a person-centred approach, where therapy is shaped according to the specific needs of the patient with a physician who has the ability to be responsive to them. Uberized therapy contrasts with these principles, where automated, standardized and digital interventions drive our response to a mental health crisis.

Elizabeth Cotton is a Senior Lecturer at Cardiff Metropolitan University. This article first appeared in Conversation


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