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Purpose -The purpose of this paper is to establish that social determinants are vital contributing factors to mental health difficulties and that, similar to physical health, mental health follows a social gradient. Despite this acknowledgement, there is a rhetoric/reality gap found in social determinants of mental health (SDMH). It will be argued in this paper that this rhetoric/reality gap is located on a number of levels, including theoretical, methodological, practical, political and policy based, which are proposed here to be interrelated. Design/methodology/approach -The approach is a conceptual analysis of the rhetoric/reality gap found in SDMH using a critical perspective. It draws on a wide variety of theories in order to provide an analysis of the issues outlined. Findings -The paper's central finding is that there is a dissonance between the dominant ontological, epistemological and methodological, or axiomatic, focus in contemporary mental health theory and practice and SDMH. This dissonance has led to a form of "analysis paralysis" on all levels, and the initiatives required to tackle SDMH have been marginalised in favour of a narrow interpretation of evidence-based research and its accompanying ideology centring on the individual, which has established itself as a primary position on what constitutes valid knowledge to the detriment of other views. Originality/value -The paper offers a critical perspective on an area of SDMH which is often alluded to but never explicitly explored, and questions the underlying assumptions inherent to mental health theory and practice. The paper's value is that it draws attention to this particular dilemma on a wider scale, including on a political and policy-based level, which is often neglected in mental health theory, and it makes some recommendations on how to move forward.

Purpose The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally.

Objectives: The diagnosis of schizophrenia does not feature prominently in counselling psychology literature, and there is a distinct lack of empirical research pertaining to how counselling psychologists construct this diagnosis, as well as accounts of their experiences of working with this client group. This study aimed to explore how counselling psychologists in working with schizophrenia, experience the work and construct the diagnosis. Design: A social constructionist branch of discourse analysis known as critical discursive psychology was adopted as the researchers were interested in the organisation of talk, as well as the social and culturally resonant interpretative resources the participants draw upon in research. Method: A version of discourse analysis known as 'critical discursive psychology' is used to analyse how eight counselling psychologists talk about and around the diagnosis of schizophrenia in semi-structured interviews. Results: Three main interpretative repertoires will be expanded on in relation to the analysis; Relating to the Individual's Experience; The Therapeutic Relationship -The Contrarian Subject Position and Normalising the Experience -The Egalitarian Subject Position. Conclusion: These findings suggest that although counselling psychologists construct their experiences of working with individuals diagnosed with schizophrenia in a 'relational' way (e.g. through relating to the individual's experience and normalising the experience), the dangers of using language that pathologises is always present. This paper concludes with noting the inroads that have been made into an area where counselling psychology has been traditionally underrepresented, and what type of influence this will have on counselling psychology in the future.

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