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When Ideology Replaces Knowledge: How the UK Mental Health Sector Lost Its Way


Contents


  1. Introduction: Ideology vs Knowledge and Skills Setting the frame: how dogma displaces competence in mental health.

  2. When Ideology Replaces Knowledge: Lessons from the Soviet Dictatorship My lived experience of how Marxism–Leninism displaced expertise and weaponised psychiatry.

  3. How Postmodern Ideology Undermined Western Mental Health and Universities My lived experience of retraining in the UK, where postmodernism and “empathy culture” sidelined clinical skills.

  4. When Ideology Crossed Borders: From Soviet Communism to Western Postmodernism How intellectual ideas migrated across systems and reshaped Western psychology.

  5. Twelve Ways Ideology Replaced Skills in UK Mental Health Systemic and practical examples, from MHFA to “trauma-informed” slogans.

  6. Conclusion: Restoring Competence, Evidence, and Courage Steps to rebalance values with evidence-based skills and structural reform.


1. Introduction: Ideology vs Knowledge and Skills

In this article, I offer an analysis of the roots of the current mental health sector crisis in the UK. Any complex problem has many different causes, but if I had to prioritise the main one, I would choose ideology — ideology that has spun out of control and replaced the knowledge and skills so urgently needed in mental health.

In mental health, ideology refers to fixed dogmas that can function more like propaganda than genuine help — offering rhetorical or ideological reassurance rather than treatment. Knowledge, by contrast, is the evidence-based understanding of trauma, crisis, and recovery, grounded in research and science. Skills are the practical tools clinicians apply — from assessing risk to stabilising clients and delivering effective interventions.

While values and guiding principles do have a place, the current crisis in the UK sector stems from ideology taking the lead, often replacing knowledge and skills with slogans, theories, and fashionable narratives. These may sound progressive or compassionate, but without grounding in evidence and practice they risk leaving people without effective, real-world support (see link1 + link2 ). Of course, not every practitioner or service falls into this trap, but systemic patterns are clear.

I will be finalising this article by arguing that the mental health sector is failing clients as it relies heavily on, and mainly offers, ideological support instead of skills and solutions based on knowledge (see link 3 + link 4)

In making this argument, I will also be drawing on my own lived experience, comparing two ideological systems that I have lived under: communist/socialist ideology and neoliberal ideology. If ideology goes out of control, it always ends up the same — it destroys the knowledge and practical skills that we humans rely on. I will use the current mental health sector crisis to demonstrate this point, but it applies equally to any other sector where ideology has managed to creep in and cripple the system from within.


2. When Ideology Replaces Knowledge: Lessons from the Soviet Dictatorship

As a person, I grew up under a communist ideology where the Soviet Union was a clear example of a dictatorship. Any dictatorship requires an ideology to sustain itself: to control, to direct, and to manage people. In the Soviet case this was Marxism-Leninism, but the pattern is universal. Left-wing socialist and communist ideology was compulsory in schools, colleges, universities, and even in workplaces. If you did not wish to study it, there was no way to escape—it was woven into every aspect of life.

The consequence was that knowledge and skills were gradually replaced by ideological dogma. Critical thought, technical competence, and innovation were stifled in favour of repeating what the ideology demanded. Lifton’s classic Thought Reform and the Psychology of Totalism documents how ideological systems use coercive persuasion to suppress critical thinking in institutional contexts - see Link 5.


Ordinary people like me found it very hard to access competent professionals or services. We were constantly hunting for foreign-made goods, which were in huge demand. Anything produced or offered from outside the dictatorship’s ideological system was automatically valued as better. Even people who had been thoroughly brainwashed by left-wing ideology could see that it did nothing to improve their quality of life.

To cut a long story short, this was one of the key reasons why the Soviet dictatorship, like other authoritarian systems, eventually collapsed: the quality of services and goods was shockingly poor and simply nearly all sectors bankrupted. Economic studies of command economies demonstrate how centralised ideological control often results in chronic inefficiencies and poor-quality outputs (see Link 6)


I write about it because I actually lived, studied, and worked as a medic in the Soviet Union — and later studied and worked as a psychologist in the post-Soviet world. I still remember being forced to study Marxism–Leninism in secondary school like every other child, and later communist philosophy in medical college and then at another university, deeper than you can imagine. I can assure you that if you failed the ideological exams, you could not qualify as a medic or psychologist at that time. So when I eventually developed a critical way of thinking, the only way forward for me was to escape this system.

In mental health, the Soviet system did not encourage individual psychology at all. There was almost no demand for therapists, because the ideology itself claimed to provide the answers to every human problem. People were expected to conform to the “collective,” not to explore private feelings or personal struggles. Privacy was suspicious. In schools and workplaces, everything was organised in groups where behaviour was visible, monitored, and corrected by party loyalty. If someone showed distress or disagreement, it was not seen as a personal psychological issue but as a political or ideological failure. At its most extreme, psychiatry was weaponised: “sluggish schizophrenia” was a diagnosis used against dissidents who disagreed with the party line. In such an environment, there was no need for individual psychologists — the state ideology itself claimed to be the cure.


3. How Postmodern Ideology Undermined Western Mental Health and Universities

It may not surprise you when I say that I had to retrain completely in the UK, as none of my Soviet qualifications were considered compatible with Western ideology. During my retraining as a psychotherapist at a British university, it became very clear that in order to pass exams I had to do more than demonstrate competence. I also had to show that I had absorbed the “new” ideology and could apply it in practice with my clients.

What did shock me, however, was realising that no one was teaching me liberal ideology — the foundation of any capitalist system. Instead, I discovered that the UK mental health sector had quietly denied liberal principles and embraced something very different: a sophisticated, twisted version of Marxist left ideology, still mixed with a bit of liberalism, of course. I quickly learned the 'new,' a bit updated, left ideology names for what were, to me, very familiar ideas: poststructuralism and postmodernism.


Later, I found that most university mental health courses had submitted to this ideology, with little choice in the matter, and I believe this remains true today. I do not mean every lecturer or student — but the overall training culture was shaped by these trends. Let me give you a flavour of what this ideology looked like in practice. Its influence was everywhere, and it translated into beliefs such as (there are many, but I will share just some):

· Outcome does not matter — Recovery goals were dismissed as “too medical” or “too controlling.” For example, I saw services where clients could attend therapy groups for years without any expectation of progress. Simply “being heard” was presented as sufficient, while the real distress or dysfunction remained untouched.

· Truth is negotiable — Instead of working with recognised trauma patterns, everything became a “story” or “one version of their narrative,” rather than a treatable trauma response. The professional’s task was not to intervene, but to validate every story equally, regardless of clinical evidence.

· Skills are secondary to language — Students and clinicians were rewarded for using the correct ideological vocabulary — terms like “empowerment,” “narratives,” or “lived experience” — rather than for demonstrating practical competence such as assessment, risk management, or stabilisation techniques. In supervision, you could pass simply by showing you had mastered the right language, even if your practice skills were weak.

· Lived experience replaces expertise — People with personal stories of distress are elevated as “experts” equal to, or even above, trained clinicians. While lived experience can offer valuable insight, turning it into a qualification in itself dilutes professional standards and risks confusing narrative authority with clinical competence.

· Responsibility is dissolved — Professionals were discouraged from giving direction or structure.

· Empathy is reduced to performance — Genuine human empathy, which should be grounded in presence and skill, was replaced by surface-level displays of “validation.” For instance, a therapist could repeat back a client’s words in the correct empathetic tone, but without offering containment, safety, or direction. The appearance of empathy became more important than its effectiveness. Clients often left sessions feeling “listened to” but not actually helped, because empathy without action or skill does not lead to recovery.

Just as in the Soviet Union ideological exams replaced real competence, in the UK I found that ideological language often replaced clinical skill. The result is clients without direction and professionals without the tools to deliver meaningful change.


The UK mental health sector has been increasingly dominated by postmodern frameworks and poststructuralist ideologies that displaced core clinical skills— ideas that, beneath their progressive language, share direct roots with the same socialist and communist thinking I once tried so hard to escape. Where Marxism dissolved competence into slogans about equality and collective struggle, postmodernism dissolves competence into slogans about identity, inclusion, and narratives. Both elevate ideology above evidence. Both punish dissent. And both replace the demand for results with the demand for correct language.


4. When Ideology Crossed Borders: From Soviet Communism to Western Postmodernism

After the Second World War, Western societies entered a kind of “honeymoon” period following the defeat of Nazism. Soon, the Soviet Union emerged as the next threat, openly organised and driven by ideological principles. By the 1960s and 70s, Western politicians recognised that people needed to be diverted away from communist ideology, and liberalism seemed to offer the needed guidance.

· Liberal ideology emphasises individual freedom, free markets, and the limitation of state power (https://plato.stanford.edu/entries/liberalism/).

· Communist ideology, by contrast, prioritises state control, collective ownership, and suppression of dissent (https://www.britannica.com/topic/communism).

Yet by the 1970s, liberal ideals were already losing their strength. The optimism of post-war liberalism gave way to a growing intellectual shift — with many academics and activists turning towards Marxist/communist frameworks that questioned, or even rejected, liberal values outright. Unfortunately, these ideas had already influenced many Western intellectuals. Some thinkers — whether through conviction or through the countercultural era — ended up advocating principles that undermined critical thinking. (Of course, some argue that socialism and communism are very different projects — yet in practice, many academics blurred the line, adopting Marxist-inspired critiques under the broader banner of “social justice” or “radical change.”)


Post-structuralism and postmodernism questioned universal truths, objective knowledge, and stable meaning. While overlapping with liberal ideals of freedom and diversity, they also destabilised liberalism by eroding the foundations of reason and evidence. 



So the pattern is visible: just as in the Soviet Union, ideology replaced knowledge and practical skills. This time, it was not Marxism-Leninism alone, but a mixture of left-wing, postmodern, and pseudo-liberal narratives that gradually entered Western universities and mental health sectors.


5. Twelve Ways Ideology Replaced Skills in UK Mental Health

The most striking example of ideology replacing skills in the UK mental health sector is the rise of Mental Health First Aid (MHFA). Promoted as the psychological equivalent of physical first aid, MHFA has become compulsory in many workplaces, universities, and public services. Yet, unlike medical first aid, MHFA does not equip participants with practical, evidence-based interventions. Instead, it focuses on awareness, destigmatisation, and “conversations” — narratives strongly shaped by postmodernist and liberal ideologies about identity, inclusion, and awareness.


Scientific reviews have repeatedly shown that MHFA does not improve long-term mental health outcomes for recipients. Instead, while it may raise knowledge or confidence in staff, there's insufficient evidence of benefit for those in crisis—indicating it's more ideological than practical. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814050/. Instead, what MHFA achieves is an ideological shift: teaching non-clinical staff to “recognise signs,” “show empathy,” and “refer on” — a cycle that creates dependency on overstretched services, mislabels ordinary distress as illness, and shifts responsibility away from systemic reform.


In this sense, MHFA perfectly mirrors the Soviet ideological trap I experienced in my youth. Skills and knowledge — crisis triage, evidence-based interventions, systemic solutions — are replaced by dogmatic scripts and slogans. Just as communist ideology eroded real competence in Soviet institutions, MHFA and similar postmodern-inspired programmes erode the competence of the mental health sector, leaving professionals unprepared to deal with genuine crises.

To make the broader pattern clearer — and to show how deeply this has become a systemic structural issue — I have outlined 12 practical examples below. These illustrate situations where people are led to believe they are receiving meaningful mental health support, but in fact what is provided is little more than ideological reinforcement. This creates the illusion of care while sidelining genuine, evidence-based mental health interventions.


1. Mental Health First Aid (MHFA) --What it is: A government-backed training programme presented as the “psychological version” of first aid. Ideology: Emphasis on awareness-raising, destigmatisation, and inclusion rather than evidence-based skills. Problem: No measurable impact on crisis outcomes or service reduction. https://pmc.ncbi.nlm.nih.gov/articles/PMC8814050/ & another link Impact: Creates dependency, over-referral to NHS, and confusion between “crisis” and “illness” — over-pathologises, medicalises, and destabilises the whole mental health system.


2. Safeguarding & Trauma Narratives in Schools - What it is: Teachers and school staff are now required to act as mental health “frontliners.” Ideology: “Every distressed child is traumatised” narrative, linked to safeguarding laws and policies. Problem: Schools are pressured to use trauma labels without adequate clinical training. Impact: Over-pathologising ordinary distress, unnecessary CAMHS referrals, eroding teacher authority , CAMHS and child mental health services have been in permanent crisis for the last 20 years.  Over-pathologising, unnecessary CAMHS referrals, eroding teacher authority. Teachers now bear mental health burdens beyond their role https://www.theguardian.com/education/article/2024/may/17/teachers-in-england-stretched-by-pupils-mental-and-family-problems-mps-say).


3. Diversity, Equity, and Inclusion (DEI) Training in Mental Health Services -What it is: Mandatory training modules emphasising race, gender, and identity narratives. Ideology: Postmodern/identity politics framing — “lived experience” privileged over clinical evidence. Problem: Many large-scale reviews have shown that diversity training often has weak or no measurable effects https://pmc.ncbi.nlm.nih.gov/articles/PMC8919430/ Impact: Staff silenced, clinical judgment undermined, training hours diverted from skills to ideology 


4. Counselling in Crisis Situations (overuse of therapy) -What it is: Crisis response (e.g., disasters, refugee arrivals) dominated by immediate counselling offers. Ideology: A postmodern vulnerability ideology — the belief that everyone is fragile, everyone is traumatised, and therapy is the only valid form of response. Problem: Early trauma debriefing can worsen outcomes: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000560/full Impact: Distress medicalised, natural recovery undermined, NHS overloaded. The public was told that every asylum seeker is traumatised — destabilising not only the mental health sector but also the immigration system itself.


5. University Psychology & Counselling Courses -What it is: Training increasingly shaped by postmodernist theories (e.g., narrative therapy, social constructivism). Ideology: Privileging “storytelling” and “interpretation” over biological and systemic knowledge. Problem: MH professionals often lack core clinical assessment and crisis management skills. Impact: Service users get ideology-heavy practitioners but not competent interventions. These professionals divert blame onto the system, become political activists campaigning instead of retraining in necessary skills.


6. Wellbeing Apps & Pop Psychology in NHS Strategy- What it is: NHS endorses mindfulness apps, resilience training, and “wellbeing workshops.” Ideology: Neoliberal self-care ideology — individuals responsible for their stress and trauma. Problem: No systemic reform, only personal “resilience” narratives. Impact: Staff burnout worsens, structural issues (overwork, underfunding) ignored https://www.theguardian.com/commentisfree/2024/jan/17/work-wellness-programmes-dont-make-employees-happier-but-i-know-what-does


7. Empathic Support Ideology -What it is: The dominance of “listening and empathy” as the primary or even sole intervention in many counselling and frontline settings. Ideology: Rooted in Rogerian humanism, elevated into a universal dogma that “empathy heals everything.” Problem: In crisis or trauma contexts, empathy without containment or structured intervention can worsen outcomes. Evidence shows unstructured emotional disclosure (ventilation) increases risk of PTSD in some cases. Impact: Professionals trained to “just listen” but not to act — leading to misdiagnosis, dependency, and inappropriate referrals. Clinical skills like triage, stabilisation, and systemic intervention are sidelined in favour of ideological empathy. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1090297/full & https://onlinelibrary.wiley.com/doi/10.1002/capr.12778?af=R


8. Lived Experience as Qualification (Peer Support Workers) 8. Lived Experience as Qualification (Peer Support Workers) What it is: Hiring “peer workers” or “experts by experience” as mental health support staff based on lived experience rather than formal clinical training. Ideology: Prioritises personal experience (narrative validity) over professional competence and evidence-based skills. Impact: While peer support may offer benefits like hope and connection, systematic reviews show only some improvement in clinical outcomes—they are not reliably better than traditional services. Peer support works best when clearly defined, supervised, and not used as a substitute for professional training. Additionally, successful implementation depends heavily on clear role definitions, supervision, training, and organizational support to avoid role blurring. Reference: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03260-y


9. Adverse Childhood Experiences (ACE) Scoring - What it is: Widespread use of ACE questionnaires as a screening tool to predict long-term mental health outcomes. Ideology: Promotes a deterministic trauma narrative—suggesting that past experiences label or define current/future mental health status. Problem: While ACE scores show population-level trends, researchers note they are poor predictors at the individual level — calling for cautious interpretation and more tailored assessment methods. Impact: Professionals may rely on simplistic screening instead of performing nuanced assessments, reducing complex person profiles to a single “score.” https://www.ajpmonline.org/article/S0749-3797(21)00456-6/pdf https://www.unh.edu/ccrc/sites/default/files/media/2022-02/screening-for-adverse-childhood-experiences-aces-cautions-and-suggestions.pdf


10. Psychological Safety in Organisations - What it is: Corporate and NHS teams adopting “psychological safety” workshops as mandatory culture-building exercises. Ideology: Draws from organisational buzzwords — safety framed as “everyone must feel heard and validated.” Problem: Focuses on emotional comfort over accountability and performance. Psychological safety is often reduced to avoiding “offence,” sidelining competence or evidence-based conflict resolution. Impact: Suppresses dissent and reduces critical dialogue in clinical teams; training time shifts from skills to ideological reassurance. Reference: https://knowledge.wharton.upenn.edu/article/the-downside-of-psychological-safety-in-the-workplace/


11. Trauma-Informed Care (when reduced to slogans) -What it is: “Trauma-informed” language adopted in schools, prisons, social care, and the NHS. Ideology: Repetition of mantras (“What happened to you, not what’s wrong with you”) without embedding structured, evidence-based interventions. Problem: Diluted into checklists and slogans; lacks operational clarity. Training often ideological (compassion statements, empathy exercises) rather than equipping with practical trauma skills. Impact: Confusion, inconsistent standards, and “label inflation” (everything framed as trauma). Risks policy capture by ideology over practice. https://pmc.ncbi.nlm.nih.gov/articles/PMC10685790/


12. Mindfulness in Schools and NHS Programmes - What it is: Mindfulness-based interventions rolled out widely as universal stress-prevention. Ideology: A neoliberal–postmodern wellness ideology — stress is reframed as an individual regulation failure. Problem: Evidence mixed; Cochrane reviews show small effects, limited durability, and inappropriate application to trauma. Impact: Replaces systemic reform (e.g., workload reduction, service funding) with personal responsibility. https://www.frontiersin.org/articles/10.3389/fpsyg.2014.00603/full & https://link.springer.com/article/10.1007/s12671-025-02627-3


6. Conclusion: Restoring Competence, Evidence, and Courage

The story is simple, though the consequences are devastating. Wherever ideology replaces knowledge and skills, systems collapse. I saw it in the Soviet Union, where Marxism-Leninism deliberately shaped medicine and psychology as instruments of the Party, stripping them of independence and evidence. I now see the same pattern in the UK: postmodern dogmas — framed as compassion or inclusion — displacing evidence-based practice. This drift serves universities that market ideology as education, charities that build funding bids around slogans, and bureaucracies that issue statements instead of solutions. The result? Professionals fluent in fashionable language but underprepared in crises, and the public left without the help they urgently need.

Mental health needs more than ideology. It needs competence, evidence, and courage. If we continue to prioritise language and dogma over skills and responsibility, we will repeat the same mistake that destroyed Soviet psychiatry — leaving ordinary people without the help they desperately need.


The way forward must be clear and practical. This does not mean abandoning values like dignity, respect, or inclusion — these remain essential. But they must support, not replace, the foundations of good practice.  This critique is not about dismissing compassion, dignity, or lived experience — these remain vital — but about restoring balance so that values support, rather than replace, skills:

· Audit training curricula across universities and professional bodies to ensure that evidence-based crisis and trauma skills are not being displaced by purely ideological “awareness” modules.

· Rebalance CPD requirements so that at least half of mandatory training hours focus on applied competencies (assessment, crisis response, stabilisation techniques), not only on abstract theories of power or identity.

· Strengthen regulatory oversight (e.g., by expanding NICE’s remit) so that therapies, interventions, and training must demonstrate evidence of real-world effectiveness, not just theoretical coherence.

· Separate politics from practice: professional bodies can affirm values without becoming political campaigners; their primary duty should be to uphold clinical standards, much as medicine is expected to do.

· Rebuild interdisciplinary training so that mental health professionals learn alongside paramedics, social workers, and crisis responders, breaking the bubble of academic jargon and reconnecting with real-world needs.


This is not a call to strip mental health of its values, but to restore balance. Skills and evidence must lead; values and ideology must follow. Only then can the sector avoid repeating the errors of the past and provide the competent, effective support that people in crisis deserve. Do you agree the sector has become too ideological? Or do you see value in these trends? I’d like to hear from frontline practitioners, educators, and policy makers.



👉 Competency-focused CPD workshops for professionals working with trauma.🔗 https://www.complextraumainstitute.org/cpd-workshop-info

👉 Latest Online: 7th International Complex Trauma Conference – Sharing Perspectives. 🔗 https://www.complextraumainstitute.org/conferences

👉 Annual Professional Support Membership – competency-focused, free from ideology. 🔗 https://www.complextraumainstitute.org/plans-pricing



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