When help is a four-letter word: Government health/psychology interventions for benefit claimants (part 1)

In an already malign climate for those on benefits, Government interventions which are provided in the guise of “help” for claimants — but which may come with the threat of sanctions attached — deserve close scrutiny.

Firstly I look at a pilot of two ‘Nudge Unit’ psychological interventions for jobseekers. I then look at a DWP (Department of Work and Pensions) pilot which involves mandatory engagement with healthcare professionals for some of those on ESA WRAG. (By ‘mandatory’ I mean schemes which benefit claimants are pressured to engage with under threat of losing some or all of their benefit if they fail to engage. ESA is the replacement for Incapacity Benefit, WRAG refers to the ‘work-related activity’ group of ESA claimants, who may be required to perform ‘work related’ activities.)

These schemes are only two aspects of the current situation regarding “help” for claimants. I’m also waiting for more details in a case of someone being pushed towards a DWP/outsourced psychological intervention, though whether that fits in with the “barriers to work” pilot (discussed in the second half of this post) is unclear. [Update: that particular case seems to have been resolved as non-mandatory, which is good news]. And, in a late addition, at the end of this post I link to a Friedli and Stearn piece which describes more intersections of psychology and benefit claimants.

Continue reading

Posted in Psychology and benefits | Tagged , , , , , , , , , | Leave a comment

Service users and formulation

In my previous post I looked at the anti-diagnosis position statement by the British Psychological Society.

One of the position statement’s recommendations is:

Recommendation 5
For the [Division of Clinical Psychology] to continue to promote the use of psychological formulation as one response to the concerns identified in this statement.

The position statement outlines two ‘core issues’ concerning diagnosis: (1) concepts and models, and (2) impact on service users. I therefore want to look at formulation (as described by the BPS in their good practice guidelines) in those terms.

Continue reading

Posted in Clinical psychology, Diagnosis, Formulation | Tagged , , , , , , | 10 Comments

On being pro-diagnosis in anti-diagnosis places

In her interesting post The DSM5 Debates: Searching for the voices of those living under, through, and beyond psychiatric diagnoses, Felicity Callard wrote:

I am particularly keen to know from people who have received psychiatric diagnoses if there are particular arguments, ideas, and formulations regarding DSM5 and/or psychiatric diagnosis that I should endeavor to include in the paper and/or debate. Which are the points that keep on getting lost in the flurry of articles and interviews and talking heads?

I replied:

You ask: “Which are the points that keep on getting lost in the flurry of articles?” I’ve noticed that the voices of pro-diagnosis service users tend to be ignored by the anti-DSM campaigners.

For example, the recent BPS DCP position statement on classification acknowledges, but then neatly pushes aside, pro-diagnosis service users here:

“Core issue 2: Impact on service users
The needs of services users should be central to any system of classification. Service users express a wide range of views on psychiatric diagnosis and the DCP recognises the importance of being respectful of their perspectives. Some service users report that diagnosis is useful in putting a name to their distress and assisting them in the understanding and management of their difficulties, whereas for others the experience is of negativity and harm. Some of the key concerns include… ”

… and the statement proceeds to list six paragraphs of anti-diagnosis points. (The statement as a whole, of course, calls for a paradigm shift away from diagnosis, regardless of the service users who find diagnosis useful.)

Given two of the above ‘key concerns’ are “Marginalising knowledge from lived experience” and “Disempowerment”, it’s remarkable that the BPS marginalises the pro-diagnosis service users so completely.

Since then, I’ve found Peter Kinderman using a similar manoeuvre, acknowledging but then dismissing service users who are pro-diagnostic in this passage from his post So…What Happens Next?:

Of course, traditional psychiatrists, and many members of the public, say that they find a diagnosis helpful and even comforting. But the truth is that this comfort comes from knowing that your problems are recognised (in both senses of the word), understood, validated, explained (and explicable) and that the person you’re speaking to has a decent plan to help you. A problems list and a formulation can do that. Paradoxically, better than a diagnosis – since, for example, two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ might have absolutely nothing in common, not even the same ‘symptoms’, any comfort from a diagnosis is likely to be illusory.

As Keith Laws writes, (in a trenchant post on formulation Clinical Psychology- Anti or Ante-Science?”):

[I]t would be interesting to hear how Professor Kinderman delineates illusory comfort from real comfort in his patients – that would take some expertise!

At least the BPS and Kinderman give pro-diagnosis patients passing acknowledgement, before forgetting them (BPS) or explaining away their error (Kinderman).

By the time the DSM5 debate reached the Daily Mail Mental health problems should not be treated like an illness, insist leading psychologists, we were erased from existence entirely:

Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the [BPS position] statement, argues there is no scientific basis for treating ‘emotional distress’ as a physical sickness.

She said: ‘No one is denying that people suffer very extreme forms of distress. What we are saying, and in fact what some of the world’s most senior psychiatrists are saying, is that there is no evidence that this kind of breakdown is best understood as an illness, with genetic or biochemical causes.

‘On the other hand, we do have an overwhelming amount of evidence that even severe psychiatric breakdown is the end result of a complex mix of social and psychological circumstances – in other words, things that have happened to you. ‘ She said the new approach must regard mental distress as ‘people with problems, not patients with illnesses’.

This is a very long way from the BPS position statement I quoted above:

The needs of services users should be central to any system of classification. Service users express a wide range of views on psychiatric diagnosis and the DCP recognises the importance of being respectful of their perspectives.

Inconvenient as it may be for the anti-diagnostic side, some of us are indeed pro-diagnosis. I hope the BPS finds a way of incorporating our views, before its next broadside.

Posted in Diagnosis | Tagged , , , , , | Leave a comment