The Service claims recovery from mixed anxiety and depressive disorder (MAD), without a treatment protocol. But at the same time insists that it is National Institute for Health and Care Excellence (NICE) compliant. NICE specifies the disorders for which there is an evidence-based treatment, but MAD is absent from the list. It therefore not possible for the Service to be protocol driven in this domain. Yet it boasts a recovery rate for MAD comparable to that for the recognised anxiety disorders and depression. For tennis afficionados this may well evoke the John McEnroe response of ‘you cannot be serious!’
How MAD clients of the Service apparently fare, throws up an interesting conundrum: given that their recovery is on a par with other disorders (without the use of any evidence-based treatment), could it be that these other ‘successes’ are nothing to do with the alleged use of specific protocols, but are just what happen if you give anybody attention, time and present a credible rationale for treatment?. The burden of proof is on NHS Talking Therapies to demonstrate that its’ ministrations have an effect, over and above, that which would obtain from say the Citizens Advice Bureaux helping its’ distressed clients with difficulties. The Service has shown no inclination to recognise or address this credibility problem, perhaps suspecting it would be like turkeys voting for Christmas.
But the NHS Talking Therapies debacle over MAD is even more extensive. The author of the Service’s Manual dissuades clinicians from using the MAD label because it might lead to missing clients who truly have PTSD. But omits to mention that there is no way the Service can identify those who do or do not have PTSD, because its clinicians do not make diagnoses! We are at least on the border of MADness and dishonesty.
Dr Mike Scott