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NHS Talking Therapies -Blatant Marketing

NHS Talking Therapies use two psychometric tests to monitor outcome, the PHQ-9, a measure of the severity of depression and GAD-7, a measure of the severity of generalised anxiety disorder. But nevertheless proclaim a 50% recovery rate, (IAPT Manual, February 2023 ) across a heterogenuous set of disorders. Depression and GAD are but two of the multitude of disorders that present to the Service. An assessment of clientele by Hepgul et al (2016) using a diagnostic interview, covering 16 disorders, found that just over a third, 37%, fell into the depression or GAD category. Thus the Service has pontificated on outcome for the two thirds of its population that it has not used a disorder specific measure for. Matters are even worse in that specific phobia, body dysmorphic disorder and illness anxiety disorder were not assessed by Hepgul et al (2016). Making the spectrum of disorders even broader. NHS Talking Therapies is telling more than it can possibly know, this is blatant marketing.

But Hepgul et al (2016)  showed how misleading the two tests used in isolation could be. 72% of the sample scored over 10 on the PHQ-9 but only 52% were found to be currently suffering from depression by the diagnostic interview. Sole reliance on the PHQ-9 would mean 1 in 3 people treated unnecessarily for depression.Whilst 78% of the sample scored over 8  on the GAD-7 only 66% were found to have GAD, still an overdiagnosis resulting in overtreatment, albeit not as glaring as for depression.

The fallacies of using a psychometric test in lieu of diagnosis are elaborated in detail in Clinical Psychology Science and Practice ( 2023). Bovin and Marx (2023) highlight that this reification of a psychometric tests leads to both a missing of those with a disorder and the unnecessary treatment of those without a disorder.

Though their focus was on another test, the PCL-5, used with those who have been traumatised, their findings were that cut-offs varied with the particular population addressed and the prevalence of the disorder in the particular community. Without attention to these details, clients will be misdirected.

Listening is the way forward 

Bovin and Marx (2023) suggest that a test should only be used as an adjunct and involve a discussion with the client as to the meaning of each item. But this is highly likely to introduce extra bias in the UK, as clinicians are penalised if they do not achieve 50% of patients falling below caseness. They further point out that an essential part of a diagnostic interview is the assessment of social and occupational impairment, a psychometric test cannot do this. Use of a diagnostic interview involves taking the time to listen to the client, if this does not happen treatment will likely be built on sand. 

A psychometric test takes a photograph of an individuals functioning over typically the last 2 weeks, but most disorders naturally take a fluctuating course. A ‘video’ of how they have been functioning over say the last 8 weeks is likely to be much more informative about their real-world functioning. But the distillation of this video with the client, takes prolonged listening. This has become anathema in the UK & US, targets have become everything with nobody questioning whether they are meaningful. Speed has become everything but without any understanding of where you are heading – headless chickens suggest themselves. The name of the game is apparently to take a photograph of the client as soon as they hit a better patch, claim success and reimbursement and close the case. In the DSM-5-TR the diagnostic criteria specify a 6 month timeframe for GAD, social anxiety disorder and illness anxiety disorder.

Dr Mike Scott

68 replies on “NHS Talking Therapies -Blatant Marketing”

The ward im on now has been really good Alnmouth the staff have been excellent I can honestly say we have even had laughs about stuff and have done sport ( within my limits) though I’ve got a gut bug so on a ban atm. But they treat us like humans haven’t seen a lot of my specific dr but the nurses and other drs do listen. Honestly they have the right recipe on here in Morpeth. Main worry is going home and gettting bad aftercare again but in here I can’t really fault them much

‘Listening is the way forward’ so true and no need for any voted into existence, self limiting and dangerous ‘disorders’ required.

What is needed is to get community functioning off line, people’s support needs met . I ended up with another bought of h pylori , athletes foot and a breast infection but the community fun and games ( genuine fun, silly games and hard honest talk from both sides ) and yes listening. The DWP took me through a maze of checks and hung up on me before I got an operator when I did everything . The nurse witnessed it too. So I’ve had to ask for help dealing with the psyops suicide DWP creators . They need jailed for using psyops and likely cyberwarfare on own countries civillians, they undo a lot of good people do do in mh and it was right before I had my needs meeting too. We all know this gov wants to cull over 50s to save money for their corporate mates they sold uk too. Again thankyou for being a voice in the wilderness . I’m going home tomorrow after a meeting.

I have been incapacitated by M. E. since the mid 1980s, and house or hospital bound since 2009, because I once made some notes to remind me what to try to explain to a psychiatrist who was the only ‘diagnostic’ service my GP would send me. He was in my house for less than 5 minutes and did not listen to me try to explain my signs and symptoms. He just wrote me off as a hypochondriac on the grounds that I had made notes about my health.

After that I was treated as scum every time I tried to get help for years, until the illness got so bad that I could not look after myself, and I begged the authorities to send me to an inpatient neurological fatigue unit, where I was sure that I would at last be observed and the true nature of my incapacity be seen by the medical profession.

My local NHS Trust refused to send me out of area, and said I had to try everything they had first. All they had was the same psychiatric ‘service’ that had branded me an untouchable and made my life hell, but I had no choice but to obey. I eventually lost 3 1/2y of my life (and my girlfriend) in psych units, as they tried to browbeat me into pretending I wasn’t really ill, even though I was able to do less and less every week. It was cruel and degrading treatment that would be torture under the Human Rights conventions, but they, eventually gave up on me, and sent me home, where I have been on my own ever since.

I had pleaded with them to honour their promise to send me to the Romford fatigue unit, but they had ignored me until discharge, when they gave me the address to write to for the unit (which I had already been offered a bed by the lead researcher years before) but the unit had been shut down by then!

I did, eventually get sent an appointment to see the neurologist who had worked in the unit. I had to wait eight months more, but the secretary promised I would be given a double appointment and the doctor was ‘very kind and thorough’. Once more, I sent a detailed account of my illness in hope of keeping them fully informed and not waste any more time.

Imagine how I felt, when, after suffering decades of hellish mistreatment and disrespect, I arrived for my ‘double appointment’, only to find that three other patients had been booked the same time slot, and all I was given was a huge pile of nonsensical questioonaires on which there was nowhere to explain my illness. They had no bearing on my illness whatever, yet they wasted all my time until I complained and demanded to be seen. Once actually in front of this famed ‘expert’ surrounded by apprentice observers, I was told I had to choose just one symptom that was troubling me right that minute, and i only had 5 minutes. I was fighting back the tears by then, and left afyer waiting years and years to see someone who was supposed to know what he was doing.

As a final nail in my coffin, his ‘report’ to my GP was just the same hypochondria garbage that he got straight off my record without doing any work himself, and he wrote across the letter that it must not be shown to me, even though this is a right!

Questionnaires ought to be banned: their only purpose is to avoid making any effort at a proper diagnostic procedure.

I am still at home and mostly in bed, and have not left the house all year.
I am losing the will to keep going.

All thanks to one word from a psychiatrist nearly half a century ago, when a proper diagnostic procedure could very well have identified the cause, and stopped it getting any worse.

Keep up your exposing of the charlatans.

Many thanks

That is truly awful. One of my Supervisee’s Joan Crawford is heavily involved in the ME Support Group, don’t know whether you’ve tried them. But will pass on your post to her. Take good care.
Mike

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