‘Drop the Disorder!’ – IAPT Have Already Done This and It Hasn’t Worked

‘Drop the Disorder!’ is a just published book edited by Jo Watson published by PCCS, but the contributors totally avoid any mention of the Improving Access to Psychological Treatments (IAPT) service. The latter assert that they do not make a diagnosis.  My independent assessment of IAPT has shown that only the tip of the iceberg recover https://doi.org/10.1177/1359105318755264

What is interesting in this book is that none of the contributors have come up with a framework that has allowed them to evaluate the IAPT service. Their frameworks are so nebulous, choose between Power, Threat, Meaning  or an exaggerated importance being given to formulation, that there is no risk of application to any service any time soon. Clients are the casualties of this approach.

I was just trying to imagine an Expert Witness arguing for the reliability of the application of one of these frameworks to that of a person he had to assess, the Expert Witness for the other side would have a field day, with legal reps putting their head in their hands. 

When the notion of ‘disorder’ is dropped, so too is loss of diagnostic status as an outcome measure. Without a person no longer being an instance of a disorder how can one approach determining whether the person is back to their old selves/best functioning?

This is not to say that every diagnostic label is meaningful, there is an excellent chapter in the book on schizophrenia by John Read and he cogently argues that this is not a reliable diagnostic entity. He suggests that we are better served by terms such as hallucinations and delusions. Similarly there are doubts as to whether chronic fatigue syndrome/ME are meaningful diagnostic entities. But across depression and the anxiety disorders (including PTSD) the diagnostic criteria have served us well leading to different protocols for different disorders.

Unfortunately in routine practise diagnostic criteria are not applied with rigour using standardised diagnostic interviews, which also allow for the identification of comorbid disorders (that will usually also need to be treated.)  

The authors suggest that in their communications clinicians should always put diagnostic entities like OCD in quotation marks. I can see this becoming the new political correctness. I will comment on any such missive that the quotation marks simply indicate unreliable assessment.

Dr Mike Scott

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