Consultant psychotherapists: who needs them?

“The idea of a psychotherapeutically informed psychiatry seems such a simple and obvious one and yet the divide between psychotherapy and general psychiatry – between ‘brainlessness’ and ‘mindlessness’ has, until recently, seemed unbridgeable”.The Psychotherapy section of the Royal College of Psychiatrists has the largest membership in the college. Since psychotherapy became recognised as a discipline within psychiatry in 1975 the Royal College of Psychiatrists has recommended one consultant psychotherapist for each 200,000 of the population. In Northern Ireland there are only 1.9 whole time equivalents rather than the eight expected and in the Republic of Ireland there is none. According to the recent document produced by the Royal College of Psychiatrists' Psychotherapy Faculty Executive Committee in December 1998, The development of psychological therapy services: Role of the consultant psychotherapist, there has been no net growth in the last five years in the numbers of psychotherapists in England and Wales. The future looks equally gloomy in Ireland.This is rather surprising given that recent government documents have highlighted both the importance and the effectiveness of psychological therapies. There is a growing evidence base underpinning the use of psychotherapy in the management of a wide variety of conditions including psychoses, eating disorders and severe personality disorders.Psychotherapy has high public acceptability and finds itself in the unusual position of having both government and public demanding the provision of extra psychological therapies, but not receiving the full support of psychiatry and the purchasers of healthcare.