Mind Archives - CBT Watch

Mental Health Bewareness Week

the deeply unpopular sibling of Mental Health Awareness Week, who can be found muttering in the corner, that only the tip of the iceberg of those who receive routine Talking Therapy recover, (see link, https://connection.sagepub.com/blog/psychology/2018/02/07/on-sage-insight-improving-access-to-psychological-therapies-iapt-the-need-for-radical-reform/). Whilst his sibling proclaims a new dawn awaits us if Society would just provide more funds for the UK Government Improving Access to Psychological Treatment (IAPT) service, secondary care and MIND. This increased funding would she believes help in the colonisation of more and more areas of human suffering from Birth Trauma (see CBT Today May 2020) to long term conditions, with IAPT recovery rates of 50% already for depression and the anxiety disorders.

The focus of this year’s Mental Health Bewareness Week, might well be on the absence of any publicly funded independent evaluation of routine psychological treatment despite over £4billion of the taxpayer’s money being spent on IAPT. In the dire financial circumstances that the UK government finds itself in the questions for this week are:

‘What is the evidence that this money has been well spent?
‘If we consider a period before such expenditure, is there convincing evidence that the funding of IAPT for the last decade has constituted an added value?’
‘Is it appropriate to continue to fund agencies who have only ever marked their own homework?

Unfortunately the devotees of Mental Health Awareness Week are blissfully unaware that there is another story, of clients having been failed for the past decade with little prospect of getting a service that they would consider would return them to their normal (or best functioning).

Dr Mike Scott

Health Anxiety, Covid-19 and Overwhelming Services

great article in the Journal of Anxiety Disorders by Asmundson and Taylor just published on this https://doi.org/10.1016/j.janxdis.2020.102211. The authors remind us that we can have too little health anxiety, for example leading a person to ignore requests for social ill distancing, but also too much for example panic buying sanitisers. The article reflects that there may be an overall increase in health anxiety as a consequence of the pandemic. This will likely lead to an increase in referrals.

If everybody with a current health concern were invited to book a telephone assessment with IAPT or ring Mind, ( I hear that the Government have given £5million to Mind) the services would be overwhelmed. But not only this, what direction would people be signposted to, and on what basis? The DSM-5 uses the term ‘Illness Anxiety Disorder’ , rather than ‘health anxiety’, its criteria help decide on whether a person is a ‘suitable case for treatment’ or a member of the ‘worried well’. Helpfully it offers signposts, implying a ‘wait and see’ approach in our current situation with its criteria that an illness anxiety disorder’ label should not be applied unless the ‘illness-related preoccupation has been present for at least 6months’ implying a normality of upsetting responses before this. Another of the criteria is that ‘there needs to be ‘a preoccupation with a having or acquiring a serious illness’ [in the DIAMOND interview for DSM-5 https://giving.hartfordhospital.org/tolin-diamond-training-video this is operationalised as an hour or more a day as being clinically significant]. A further requirement is that there should be significant functional impairment in domestic or work roles as a consequence of the health preoccupation. The criteria help stop the pathologising of normality and make for a better use of scarce mental health resources.

But though CBT is recommended for health anxiety I could find no study in which clients had been independently evaluated to see if they were no longer suffering from what has been termed variously ‘hypochondriasis’, “health anxiety’ and now ‘illness anxiety disorder’ at the end of treatment, much less at follow up. So some humility is called for when, as is likely, CBT is vociferously advocated as a response to this pandemic. But the prospect of increased funding is likely to be too attractive to agencies.

Regards

Dr Mike Scott