A few deaths may be the price we'll have to pay for saving resources

"Dear Dr Hammond,

Having skimmed over your column for some months now, I've noticed that you have an alarming tendency towards nihilism.

"In any organisation as large as the health service, you are going to get a few unproven treatments and bad decisions, some poor communication and callous disregard for human existence. There may even be some doctors who coerce their NHS patients into going private. But in 40 years as a GP I can honestly say that the scoundrels are very much in the minority. The vast majority of health care professionals are well-intentioned folk who give their all in very difficult circumstances.

"If you want to carp, have a go at the politicians and lawyers who are destroying the NHS, and not those who have to work in it.

"You may be too young to remember Bing Crosby, but you would do well to heed his lyrics: "You've got to ACCENT-TCHU-ATE the POSITIVE, Eliminate the negative." So why not drop the so-called satire and give it a try? It could well make you a nicer, happier person.

Yours sincerely,

Dr M Dingle

Swainswick

"PS And do try to reflect the public mood. If people really are as disaffected with the NHS as you suggest, why do I have 200 of the buggers coming into my waiting-room every day?"

This letter - with its invitation to try the Crosby Method - arrived on the same day as my copy of Staying Sane, Dr Raj Persaud's "passionately argued, impeccably researched, change the way you think about your mind" book.

Had it arrived the day before, I might well have saved myself pounds 17.99, because it seems to be saying much the same thing, but without the references. Raj's closest tribute to Crosby is tucked away on page 217. Found it yet? Join hands with me and repeat "To stop my daily RANTS against myself, I must kill my ANTS." (Automatic Negative Thoughts). On reflection, I think Bing's version just shades it - or rather, the version written for him and the Andrews Sisters by Arlen, Mercer and Morris. None of them were psychiatrists. They didn't even clean the floors at the Maudsley. So how could three humble songwriters develop such a sophisticated theory of staying sane 40 years in advance of Raj? Makes you think, eh?

We're straying into Francis Wheen territory here. Francis off-loaded a few of his ANTs about Raj in The Guardian - most pertinently, that he appeared to be paid a lot of money for stating the obvious - but, in my new-found positive mood, I think he was being a little unfair. Part of the reason why Raj is so ubiquitous is that he can do what most consultants can't - translate medspeak into plain English.

Anthony Clare is also very good at this, although he perhaps appeals to a slightly more sophisticated audience. And Oliver James, too, can rake in a broad audience (although his honest appraisal of "Diana-hysteria" may have knocked a chunk out of his popularity).

In short, psychiatry and clinical psychology are served with good media communicators at the moment. Less certain is whether what they say or write makes a difference.

Raj's book contains "proven ways to strengthen your mind and reduce your vulnerability to distress - for good" and I genuinely hope it does help its readers to stay sane. This isn't just because I'm discussing a deal with the same publisher, but because I find it very hard to accentuate the positive side of psychiatric services in the UK. Resources are so stretched that urgent admission to hospital seems possible only for those who are psychotic and in danger of killing themselves or others. Even then, they can't all get in. It's even been suggested that those who say they'll kill themselves shouldn't all be admitted, because few of them do. A few deaths may be a price we'll have to pay for saving resources.

For the great majority of those with less severe illness, provision is patchy to non-existent. Indeed, psychological distress is so badly handled that it's diverted to physical specialists. Sixty per cent of a neurologist's referral case load is tension headache; 50 per cent of a gynaecologist's is pelvic pain; 80 per cent of a gastroenterologist's is irritable bowel; 80 per cent of coronary artery investigations are completely normal.

Many of the sufferers have physical manifestations of psychological distress, but there isn't the training, organisation, time or resources to keep people away from the disastrous slope of unnecessary physical investigations. In essence, if you've got psychological problems in the UK, you're better off treating yourself. And Dr Raj knows it.