Mental Health for Sale: Tricks or Tips?

In recent years, the mental health landscape in the UK has witnessed a significant shift, largely driven by the growing influence of social media. An increasing number of individuals, often without any formal qualifications in psychology or counselling and psychotherapy, are marketing themselves as pseudo-therapists or coaches. And they are quite literally booming. Particularly, they are targeting people with conditions such as PTSD and complex trauma.

On one hand, the rapid growth in mental health awareness is positive. Many more people are seeking help with their problems, and for some, this is likely to have been life-saving. On the other, we have a problem, and it's growing exponentially. Although we've had issues with unqualified therapists for decades, this new age of 'coaches' are reaching vast audiences through platforms like Instagram, TikTok, and more surprisingly, LinkedIn. This trend is not only reshaping public perceptions of mental health, particularly younger people, but also raises profound questions about the efficacy and safety of mental health in the UK.

New tips, old tricks

They often hijack professionally written material from qualified clinicians, and let's face it, we literally cannot move for 'top tips' these days. Yet, amidst the hyperbole, savvy podcasts and infographics, we are witnessing techniques as old as time.

Deriving its name from the showman P.T. Barnum, the 'Barnum effect' is the human tendency for susceptibility to very vague but relatable and poignant-sounding statements. Barnum statements are generally so vague that they apply broadly across populations. When mixed with glossy graphics and somewhat convincing partial truths, this can influence people to part with their cash.

We see similar techniques employed by stage illusionists, such as Derren Brown. Don't get me wrong, who doesn't love Derren Brown? I've seen him live on stage more than once. Even as a qualified psychologist I'm often left wondering how on earth he does it. But would we trust an illusionist showman to help us resolve flashbacks to the worst days of our lives? I certainly wouldn't.

Mental health for sale

But it's not just wannabe therapists using stage show techniques disguised as informative marketing. We've also seen a rise in academically qualified psychologists dishing out clinical advice to a large social media following, despite having zero clinical training. There have also been large digital healthcare platforms enrolling swathes of bona fide registered therapists, then publishing articles using stage show strategies with fear provoking calls to action. It's safe to say that things are in a bit of a mess.

Handy tip: Black and white thinking is also common in people without a diagnosable mental health condition. Unless it's having a negative impact in your life then you do not need to see a therapist about it.

Coaching vs [self titled] 'coach'

I mean, where to begin with this! First, it's important to point out that I am not a coach, but I've personally had professional coaching and it was incredibly valuable. Some qualified therapists are also trained as coaches and offer this as part of their service. However, they clearly understand the boundaries between coaching and psychotherapy. Sadly, there is a rise in people using the term 'coach' in order to work with vulnerable client groups when they have zero recognised qualifications or training to do so.

Typically, pseudo-therapists have a self-styled title [insert mental health label of choice] 'coach'. At first glance we might give someone the benefit of the doubt, perhaps simply claiming particular knowledge in a specific area of coaching. For example, a business coach, experienced working with people in organisations. A fitness coach, employment coach, and so on. So when someone states they are a trauma coach, what expertise are they then claiming? Then, add words such as 'healing' alongside a plethora of misinformed infographics quoting diagnostic concepts, they enter the territory of pseudo-psychotherapy, misleading their followers. A lot of them!

What about expertise by experience?

Lived experience plays a very valuable role in mental health. NHS services have gained significant input from experts by experience over recent years. There are also many qualified therapists whose experience drew them to the profession. Essentially, lived mental health experience does not disqualify someone from working in the field of mental health. Nor does it restrict them from training as a therapist, but it doesn't qualify them as one either. Aside from learning core skill sets and various therapy models, professional qualification requires years of supervised practice. It also teaches you how to separate your personal experience from that of the diverse clients you work with. You also learn about professional ethics, conduct, and the importance of fitness to practice. Importantly, it also allows you to obtain indemnity insurance so that your patients have legal recourse if things go wrong.

But aren't we are all entitled to free speech and to market ourselves as we wish?

Yes! 100% correct and that is important. What is also important are the exemptions to our freedom of expression under the Human Rights Act (1998). One of those is where there is a need to protect public health. UK Trading Standards also prohibit the sale of false or misleading services or goods.

The crux of the issue

Currently in England, there is poor parity of esteem between physical and mental health. Due to very limited and poor regulation of counselling and psychotherapy, literally anyone can set themselves up in business calling themselves a therapist (yes, bonkers, I know!) There is some protection for practitioner psychologists through the Health and Care Professions Council (HCPC), but the title of 'psychologist' alone is not protected.

So, the current state of play means that my niece, who is still young and figuring out her career options, could decide she no longer wants to pursue marine biology. She can browse social media, see the trending threads: 'this [ordinary life experience] is a trauma response' and 'the 84 symptoms of ADHD your psychiatrist won't tell you about.' Decides to make her own graphics using her knowledge of dolphins and the influencer tips she got from TikTok. Following a two-week online coaching certificate, she then sets up a website: "SONAR-SOUNDS TRAUMA COACHING." Once she adds some vague and relatable-sounding nonsense about shared mammalian traits, she's in business. Potentially a very lucrative one.

Sadly, in my own practice I've come across several patients that have been contacted directly through social media by people posing as 'Trauma Coaches' (not actually a thing in England). Often, it's involved a hard sell, and one occasion they were quoting fees as high as ￡400 per session. For context, that's around 3 times the local average for a HCPC registered practitioner psychologist in private practice.

No doubt if they were using titles such as 'cardiovascular specialist' or 'brain tumour informed' coaches, the GMC would be knocking on the door of parliament at 8.30am sharp.

So what's the answer?

This post is one of many in the public domain highlighting ongoing problems with poor professional regulation, including attempts at petitioning to increase the protection of professional titles. Essentially, we are riding on a fast train that has already left the station and there is no one tall enough to pull the lever. Without better government regulation of mental healthcare in the UK, regulatory and accrediting bodies for professional therapists are limited in what they can do. All we have currently is the ability to raise public awareness.

It would be easy to conclude that the people portraying themselves as self styled experts are simply operating in blind denial, or ruthless types that will do anything for money. But I actually don't think this is the case. I genuinely believe that they think what they are doing is valuable. In some cases this being based on an 'anti-psychiatry' or 'conventional methods never worked for me' type mindset. While novel approaches can prove to be viable and some become well established therapies (e.g. EMDR began with Francine Shapiro walking through a park). The difference being, that legitimate approaches have many years of research and trials under controlled conditions that demonstrate they work. Importantly, most of these are also free at the point of access through the NHS.

So what can be done about the problem of unregulated therapy in the UK?

As far as the UK government is currently concerned, apparently nothing!

I've included 2 links in the comments:

• NHS clinical guidelines for the recognition and treatment of PTSD
• A brief 'in a nutshell' explainer video from psychiatrist Dr Tracey Marks who explains how mainstream healthcare understands trauma.

Hope it's helpful.