Misdiagnosis Equals Mistreatment – Why Then Does NHS Talking Therapies Eskew Diagnosis?

The NHS Talking Therapies Manual (2023), p24 indicates that reliable diagnosis is not part of a ‘good assessment’. Yet paradoxically, it states that clients with PTSD or social anxiety disorder should not be offered low intensity interventions first. This begs the question, of how a clinician would know, which level of stepped-care was appropriate without making a reliable diagnosis. Its’ clinicians apparently have magical insight, in that they can determine from the ‘presenting mental health problems’, the appropriate National Institute for Health and Care Excellence (NICE) protocol.  But NICE clearly states that its’ recommendations are predicated on a reliable diagnosis. NHS Talking Therapies attempt to force a square peg into a round hole is risible.

To give a further example of the Services misdiagnosis consider the following.The Service rejects referrals with a psychosis label. It does not stop long enough to carefully consider whether the label is misplaced. Mr X was a casualty of this –  a series of mental health professionals, over a period of 7 years, declared that he was a paranoid schizophrenic, each uncritically accepting the label applied by their contemporaries. NHS talking therapies declined to treat him. Finally, he was seen by a clinician who expressed his total bewilderment at the historical diagnosis, and concluded that he was suffering from obsessive-compulsive disorder, obsessive type. He successfully treated Mr X for the OCD using a standard protocol for obsessions. The Service engages in a game of ‘pass the bomb’ when it comes to certain labels.

NHS Talking Therapies has nothing in place to protect a person against the ‘slings and arrows’ of outrageous diagnoses. The de facto missive of the British Association for Behavioural and Cognitive Therapies (BABCP the CBT Lead Organisation) is to ‘suffer’ these ‘slings and arrows’, reliable diagnosis is not part of any of its approved training courses. There is no sense of ‘taking up arms’ against misdiagnosis, even though its’ former Presidents are well aware of the importance of diagnosis. Their overriding concern, is it appears, the wider dissemination of services. Which is perfectly laudable in itself. But any good has to be contextualised, it was perfectly right in the early twentieth century to seek to redistribute wealth, but not as in Stalinist Russia, at the expense of reverence for the individual and honesty. It is difficult to escape the view that BABCP and for that matter, the British Psychological Society (BPS), are on a ‘mission’, that needs contextualising.

Dr Mike Scott