I’ve Had 10 Diagnoses, Got This Disorder For Life

A teenager Bex’s despair at our mental health system . Twice she has been refused Hospital admission when suicidal. ( Radio 4 today full transcript on Newsbeat ‘Me and My Mind’ available on i-player.  Jeremy Hunt Health Secretary responded ‘only had Crisis Teams 3 years ..it takes time, help isn’t happening everywhere’, he might have added nor does it look like happening anytime soon.

Bex complains that she has OCD, repeatedly checks windows etc, her thoughts sometimes make her too fearful to leave home ‘all thoughts going over, no off switch, tight, chest. It is extremely unlikely that she actually has 10 disorders, but as comorbidity is the norm doubtless she has a couple of disorders. It is inecusable that these  disorders have not be reliably identified and treatment pathways for each illuminated. Making treatment available doubtless requires increased funding but just as importantly the monitoring of fidelity to evidence based treatment protocols for the identified disorders.

I’d like to think of Bex’s case as exceptional, but she reminds me of a former client of mine who unquestionably had a primary diagnoses of borderline personality disorder (BPD). I discovered yesterday that she dropped out of treatment at the behest of a drug taking boyfriend. Since she has done the rounds of local mental health services who have labelled her as having bipolar disorder and she is taking Lithium and having therapy in secondary care. To her family’s dismay she continues to create chaos, her mum has to look after her baby etc. Once again a failure to address the key problem.

 

Dr Mike Scott

Jeremy Hunt Conned on Mental Health

Today Health Secretary, Jeremy Hunt claimed ‘ we have a world-beating service for depression and the anxiety disorders that other countries are considering adopting, particularly Sweden’ [BBC One Andrew Marr Show]  but  he appears not to know that the IAPT service he cites has never been subjected to independent scrutiny and he is victim to its’ excellent marketing.  From my own work as an Expert Witness to the Court I have found a recovery rate of just 10%, ‘IAPT the Need for Radical Reform’ (In submission) which also contains testimonies of those who have gone through the system, work on a smaller sample (n=65) is summarised in ‘Towards a Mental Health System that Works’ (2017) Routledge.

Tip of Iceberg Recover

 

I presented my findings ‘Reality Checking Psychological Services’, https://files.acrobat.com/a/preview/93ed8696-b12e-44b0-a2bd-3f0646f62052 on the smaller sample at EABCT Conference in Stockholm on  September 1st 2016. Internationally countries have not rushed to adopt the IAPT approach and are much more circumspect about the IAPT results than Mr Hunt. Unfortunately in politics the bar for ‘evidence’ is set low, with evidence outstripped by enthusiasm. On October 10th 2017 Mr Hunt announced £15 million to train 1 million people in Mental Health First Aid with 1 trained member of staff in every secondary school by 2020.  He argued plausibly on You Tube that half of emotional problems are there before age 14 and if there is some early input problems could be prevented. Nice idea, but the evidence on this is lacking, arguably the monies might be better spent on what we know does work, CBT treatment with fidelity to an evidence based protocol.  Whether or not,  he anticipated the training would be online with volunteers who could thereby become less stressed, more ‘resilient’ and help others!

 

Dr Mike Scott

 

Mental Health Services Expansion Before Completion of Investigation!

On July 31st 2017, the Health Secretary, Jeremy Hunt announced funding for an extra 2,900  new therapists in Adult Mental Health talking therapy services. A week earlier the National Audit Office invited submissions for its’ investigation into IAPT, with a closing date of this Autumn. It is clearly the time of the year for the Mad Hatter’s Tea Party:

 

be careful that you don’t mutter under your breath at such gatherings that ‘evidence should precede action’, if heard it could be ‘off with your head’.

But beware, the historian High Trevor Roper wrote in the Last Days of Hitler ‘mythopoeia is a far more common characteristic of the human race than veracity’. The wholesale endorsement of IAPT by BABCP and to a lesser extent by BPS reflects mythopoeia:

 

IAPT with its low intensity modality has attempted to make therapy ‘simpler’ than simple, resulting in ineffective treatment.  When it comes to the high intensity modality it has made matters ‘simpler’ than simple, by abandoning reliable diagnosis/high specification of problem/s as a Sat Nav for treatment again often resulting in ineffective treatment.

 

Dr Mike Scott