HYPERLINK FOR JUNE 28th MANCHESTER BPS (decp) CONFERENCE WITH SOME OF THE SAME SPEAKERS AND TITLE = https://www.bps.org.uk/decpjune28
House of Commons Debate on June 11th organised by the Division of Child and Educational Psychology (decp)
Speakers will include:
Professor Allen Frances, who was Chair of the DSM IV Task Force and is the author of Saving Normal. He is also Professor Emeritus at Duke University where previously he was Chair.
Summary of Presentation
He will explain that psychiatric diagnosis has gotten out of control in the US and with it excessive use of medication. Twenty five percent of Americans qualify for a diagnosis in any given year, fifty percent lifetime, and we have more deaths from prescription drugs than street drugs. DSM 5 will turn the current diagnostic inflation into hyper inflation and will exacerbate the needless use of medication in the 'worried well'. Grief becomes Major Depressive Disorder; worrying about being sick is Somatic Symptom Disorder; the forgetting of old age is Mild Neurocognitive Disorder; temper tantrums are Disruptive Mood Dysregulation Disorder; gluttony is Binge eating Disorder; and soon almost everyone will have Attention Deficit Disorder. Meanwhile, we are not doing nearly a good enough job of caring for those with real psychiatric disorders who desperately do need our help.
New diagnoses are potentially more dangerous than new drugs and need a much more careful vetting than they have received. And psychiatric diagnosis has become too important to be left in the hands of parochial psychiatric researchers who lack a public health perspective. Other suggestions are to end all drug company marketing and to reduce the close coupling of psychiatric diagnosis to decisions beyond its proper competence re school services, disability, and forensics. Great Britain has a much superior system of decision making and is protected from many but not all of the DSM 5 follies. Hopefully, GB and ICD 11 will not to follow America's reckless lead into a massive misallocation of mental health resources.
Professor Peter Kinderman, Chair in Clinical Psychology at the University of Liverpool, and an honorary Consultant Clinical Psychologist with Mersey Care NHS Trust and has twice been elected Chair of the British Psychological Society’s Division of Clinical Psychology.Professor Kinderman is Head of the Institute of Psychology, Health and Society at the University of Liverpool, comprising psychiatrists, GPs, clinical and other applied psychologists, sociologists, public health physicians, nurses, sociologists and academics.
The proposed revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5) is a prime example of the creeping medicalisation of normal life. If implemented, DSM-5 would see millions of people with a range of perfectly understandable and normal problems diagnosed with mental illnesses. The consequences could be catastrophic - especially for vulnerable populations such as children and older people. Instead of understanding distress and offering help, people will be diagnosed and medicated, and the origins and causes of social problems will be minimised and ignored as doctors look for biological explanations and medical solutions.
While DSM-5 itself should be ignored, we also need a wholesale revision of the way we think about psychological distress. We should acknowledge that such distress is a normal, not abnormal, part of human life—that humans respond to difficult circumstances by becoming distressed. It should recognise that there is no easy ‘cut-off’ between ‘normal’ experience and ‘disorder’, and that that psychosocial factors such as poverty, unemployment and trauma are the most strongly evidenced causal factors for psychological distress.
A valid and humane system for identifying, describing and responding to distress should reflect these principles.
Professor Peter Tyrer, who is the Interim Head of the Centre for Mental Health in the Division of Experimental Medicine and also Professor of Community Psychiatry. His main interests are in models of delivering community psychiatric services, the classification and treatment of common mental illnesses, particularly anxiety and health anxiety, and the classification and management of personality disorders. He also leads on research into the management of patients with intellectual disability. He is experienced in the management of those with severe mental illness, substance misuse and personality disorder and has developed a new treatment, nidotherapy, to help these people by making environmental, not personal, changes.
In his presentation Professor Tyrer will be emphasizing that ICD-11 is the real classification for use in the UK and this is a much less bothering system - and also still in the process of development (i.e can be influenced by meetings like this).
Professor Simon Wessely is Vice Dean of the Institute of Psychiatry and Chair of the Department of Psychological Medicine. He has written over 650 scientific papers on various aspects of psychiatry, chiefly the boundaries of medicine/psychiatry, unexplained symptoms/syndromes and military health. He has been a strong critic of the over medicalization of emotions, particularly in the field of traumatic stress and reactions to adversity, and his research has often emphasized the resilience of ordinary people linked to the dangers of iatrogenic damage. On the other hand, as a psychiatric epidemiologist he is also a strong advocate of the principles of classification and supports the general thinking behind DSM, even if as a European he instinctively prefers the ICD approach. He was knighted in 2013 for services to psychological medicine and military health
My main theme for the will be that most practitioners in the UK in mental health will be bemused by the fuss - our main preoccupation is ensuring that those who already have diagnoses whose existence is more than clear (except perhaps to peter kindermann) continue to receive services, in a situation in which mental health services are being drastically cut and/or retendered across the country. Claims of psychiatric "over stretch" in the literary, magazines, blogs etc etc seem to belong to a different world to that of front line psychiatrists dealing with the realities of clinical services
Vivian Hill is Director of the Doctoral Training Programme for Educational Psychologists at the Institute of Education, University of London, and Honorary consultant Educational Psychologist with Wandsworth Borough Council. She is currently a member of the British Psychological Society’s Division of Educational and Child Psychology, and Past Chair of the DECP Training Committee. She is the current Chair of the DECP Special Interest Group considering the issues relating to the medicalisation of childhood, and in particular the increasing use of psychotropic medication with children.
Vivian will outline the significant increases in the numbers of children taking prescription medications and will critique the lack of scientific validity of conditions like ADHD. This is commonly diagnosed through rather subjective checklists and the main intervention is medication. However, the profession of educational psychology acknowledges that children from a particular demographic background are most likely to receive this diagnosis, despite the very significant context variables that are also influencing their behavior: overcrowding, exposure to trauma, abuse, poor parenting and numerous family stresses.
Despite NICE guidelines recommending that medication should be supported by therapeutic or other more practical interventions, this rarely happens. The concern is the lack of alternative support available and the dangers of making within child diagnoses for complex social problems that remain unchanged. We are agreeing for a new conceptualization that recognizes all of the variables influencing behavior and adequate psychological resources to respond to these needs.
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