‘Complex’ clients tend to gravitate to Specialist Units, but their focus is overwhelmingly on the disorder that they were set up for, recommending anything else outside its’ remit is dealt with elsewhere. The problem is it doesn’t actually work! I recently saw a client with a 10 year history of bulimia, alcohol abuse/dependence. The file was enormous as the Specialist Units had each made their contributions as the client went at greater speed through the revolving door.
In fairness there was one letter from the alcohol Unit that suggested that the ‘underlying cause’ for these problems should be sought, now there is a novel idea! But neither of the Specialist Units took this responsibility. IAPT sent a letter asking the client to telephone to arrange an assessment which was not acted upon and promptly discharged the client. When I saw the client I found that the underlying problem was social anxiety disorder, which pre-dated all the other problems. The records did mention in passing that the client was anxious in social situations, but this had never been a therapeutic focus. The client readily appreciated that there had to be a comprehensive/holistic treatment approach and not the piece-meal approach followed by the agencies. Changing their modus operandi is a monumental task, as there are so many vested interests. But a starting points is to insist on independent audit of recovery rates along the lines that I have pursued re: IAPT.
Dr Mike Scott