No Health Without Mental Health

Greetings all!

The Coalition Government has just published its initial plans on mental health - "No Health Without Mental Health": "No Health Without Mental Health"

I don't want to go into the content of the document at present or even raise the question of how mental health can be improved within a context of service cuts.

Instead, I want to draw your attention to and seek your thoughts on a key expressed assumption within the document highlighted by NHS Networks, namely that " THE GOVERNMENT [HAS THE] AIM OF ACHIEVING PARITY OF ESTEEM BETWEEN PHYSICAL AND MENTAL HEALTH". I’ve never come across such a strongly expressed statement of parity between physical and mental health in ANY government policy document before.

Now, of course, this may all be talk and that the reality may be quite different. However, my cynicism isn't quite so marked - not because of my belief in the intrinsic altruism of governments - but rather because of the financial issues currently being grappled with.

Firstly, there is the issue of the welfare budget. Forgive me if I'm teaching you to suck eggs here but for those unaware of the history of incapacity benefits let me give some brief background. Twenty years ago, Invalidity and Sickness Benefit (as it was then called) along with associated housing benefit was significantly short term in nature (six months or less) and primarily claimed by those with industrial injuries and pain problems. By 2010 this situation had radically changed whereby an increasing number of claimants were claiming for more than six months and over 50% of these were claiming for mental health problems. At estimated costs of £16 billion a year all political parties began to look seriously at the question of addressing this cost. IAPT (Increasing Access To Psychological Therapies), introduced by the last government and extended by this government by hundreds of millions of pounds, is the most visible example of how seriously central government now takes mental health. (CBT Training); (Managing Depression)

Secondly, the parity between mental health and physical health has also become apparent as a result of their interconnectedness - again from the perspective of the costs, this time associated with health costs associated with "long term conditions". The latter includes such illnesses as diabetes, cardiovascular problems, respiratory diseases and stroke. They are conditions that are often associated with repeated hospital admissions (which are costly) usually prompted by failure to maintain changes in health behaviour or because of the de-motivating effects of mental health problems such as depression. The thinking is that IF services can address depression or poor motivation in such groups, hospital re-admission rates will fall and costs reduced. (Motivational Interviewing Training); (Psychological Coping Post-Stroke)

Now this is all very understandable and laudable stuff - all industrialised countries at present are trying to contain healthcare costs, but a recognition that mental and physical health are intrinsically interconnected strikes me as a radical new framework in which to start debating this. However, it also raises difficult questions about the priorities that we we establish within this however.

• With limited money, do you agree that Depression and Degenerative Arthritis are of "parity of esteem".
• What about Panic Attacks and Palliative Care or Gall Bladder problems and Generalised Anxiety Disorder? Or do you think that we should recognise that such "parity of esteem" varies according to the type of problem.
• Should Botox continue to be funded on the NHS in certain circumstances when those with a diagnosis of borderline personality disorder still have problems finding ANY service wanting to work with them?
• Should Pancreatitis be seen as having a "parity of esteem" with PTSD or should the latter be seen as a more pressing issue.

These are difficult questions with no easy answers. However the government's express acceptance of "parity of esteem" between physical and mental health opens up this debate.

WHAT DO YOU THINK? ALL VIEWS AND IDEAS ARE GREATLY WELCOMED.

Criteria for PTSD..

"The relevancy of an individual's subjective experience in determining what constitutes a traumatic event has been a source of debate among PTSD specialists for years. The study concludes that both objective and subjective factors are relevant and that current PTSD criteria are missing several reactions that many trauma survivors experience."

"A person's response is multifaceted and may include appraisals and other thoughts, a variety of felt emotions and behaviors. It's not enough to rely on the objective qualities of an experience to determine whether it should be considered traumatic or not," said co-author Brian P. Marx, PhD, an associate professor of psychiatry at Boston University School of Medicine and psychologist at the VA National Center for PTSD.

"Trauma should be defined as the interaction between the individual and his or her environment and all parts of an individual's response should be considered."

PTSD is believed to be the result of exposure to trauma, so understanding what defines a traumatic experience is critical. The authors suggest that researchers investigate and add more appropriate examples to these criteria in order to more accurately categorize traumatic events.

"Knowing exactly what trauma is can help us to better know who is a trauma survivor and who is not," said Marx. "It is critical that we know this for the purposes of understanding the disorder as well as being better able to help those who are survivors of trauma."

It seems to me that the main problem with PTSD, as stated above, is that there is no concrete way of defining an event or experience as 'traumatic.' Indeed, although there may be events that we generally consider 'traumatic,' for example a bad car accident, it doesn't mean that any one individual suffering an event will become traumatised, or indeed, suffer from PTSD.

So if it's not an objective event that generates the trauma, then it is the perception or the thought process within a person that makes the event traumatic. So, logically, if this though process is generated through any event, even one that isn't considered traumatic - for example, realising you hadn't turned the plug on, symptoms and problems assocaited with PTSD could still manifest, and would it really be fair to claim that this individual wasn't suffering with PTSD just because we don't consider the event 'traumatic?'

Okay, maybe that example was a little far-fetched, but it makes you think, who am I to judge whether an event should or should not make you feel traumatised?

Original Article

Dopamine and Individual Styles of Response

Contrary to popular belief, researchers have found that the differences in individuals' styles of response to environmental cues can influence chemical reward patterns in the brain. This has a great impact for future treatment and prevention of a number of compulsive behaviours.

The age old question: to what extent is the dopamine released by the rat's brain related to the lever's ability to accurately predict the food. They concluded that it depends on your style!

An example the researchers used: "Some people will see a sign for an ice cream shop and for them it's simply that, an indicator that ice cream is available nearby. But other people will have a stronger reaction to the sign -- the tantalizing association between the sign and ice cream is so powerful, they can already taste the treat and often hurry to buy some."

Similar reactions could be said to occur when people are addicted to harmful substances, not just food.

Using a technique called 'fast-scan cyclic voltammetry,' researchers measured the dopamine responses in the rats' brains - Analysis showed that the rats that were fixated on the environmental cue (the lever) got a jolt of happiness just from the lever, while the other rats did not. This desire for the lever continued even after the food reward was removed - showing how the environmental cue was enough for some rats to be rewarded, but not for others.

So it seems that although maybe we all seem the same on the outside, inside we could all have vastly different chemical processes occuring, based upon our reaction to the world around us..

Journal Article

Stress and the Unknown Stressor

We all try and avoid stress if we can. But sometimes Stress is unavoidable, especially if the stress is just the waiting.

Researchers recently found that not knowing your diagnosis is a very serious stressor - and can be worse (in terms of stress) than knowing you have a serious illness!

In this study 214 women scheduled to undergo different diagnostic and treatment procedures ahd their stress levels checked. About half were awaiting breast biopsy to check a suspicious lump in their chest, whilst the others were undergoing treatment for cancer or uterine myoma or benign fibroids.

Breast biopsy patients reported significantly higher levels of anxiety/stress, compared to the group undergoing treatment.

The researcher running the study, Dr Lang, said: "These results really drive the point home that the distress of not knowing your diagnosis is serious." It seems that the emotional and psychological effect is far worse when you don't know what the problem is, compared to knowing about a serious illness under treatment.

Similar results were found in a 2008 study by Jacob Hirsh and Michael Inzlicht. They found that, with neurotic individuals, participants experienced immediate and uncomfortable response to uncertainty, even more so than when they are faced with clear negative information.

“Uncertainty can be very stressful,” said Hirsh.

So enough of umm-ing and ahh-ing, whoever you are! People need to know one way or another, because to not know is just stressful!

Article 1

Article 2

Gambling away your health..

Although just a correlation, a recent study has found that Pathological Gamblers are at risk of Mental Health Disorders - they are 3 times more likely to commit suicisde than non-gamblers.

"..Pathological gamblers account for five percent of all suicides. These staggering statistics motivated us to study the difference between gamblers and non-gamblers," says study co-author, Richard Boyer.

The study examined 122 suicides between 2006 and 2009 and found that 49 (40%) were pathological gamblers.

Those committing suicide were found to be twice as likely to be suffering from Specific Mental Disorders than other suicide cases, suggesting that the personality disorder is a significant flag towards increased suicide risk.

Boyer reported that there are three elements generally recognised: depression, alcohol or drug consumption and a personality disorder. They believed that it was the interaction between these problems that led ultimately to suicide.

But they didn't stop there. The study also found that gamblers who committed suicide were three times less likely to have seen the doctor the year preceding their death.

Boyer believes this is because they see their financial or alcohol/drug problems as a result of their gambling addiciton and seek help for that rather than get help for their other issues.

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Do you know anybody in your life with a gambling problem? It could affect anybody! Just keep an eye out for the warning signs and remember that gambling may not be their only problem!

Link to Article

Marijuana use and its cognitive effects

Although recent papers have been released suggesting that it is Alcohol and not Marijuana that is the most harmful drug, this study by Staci Gruber highlights the risks that are still present in long term, young-starting marijuana use.

Cognitive flexibility - the ability to switch behavioural responses according to feedback from your surroundings, was found to be highly affected after long-term marijuana use.

Using a Wisconsin Card Sorting Task, the participants are shown four cards that differ in color, symbol, and value. The participants are asked to sort the cards, but not told what the rules are, leaving them to work out what the rules must be when receiving 'correct' or 'incorrect' feedback. Half way through the rules are changed and the participant must change their behaviour accordingly. This is an indicator of how strong a participant's cognitive flexibility is.

But what did they find?

Habitual marijuana users made more repeated errors than those that started after 16 and who did not habitually use marijuana and also had difficulty maintaining rules once they were set.


I guess it's not particularly new, and kind of obvious - but the study concluded that the younger you start, and the more you use, the greater effect Marijuana has on your cognitive functioning.

Those that claim Marijuana has no long term on them be warned! You may be killing your brain without even knowing it!

Link to Article

Patient Personality Can Hinder Detection of Depression

"Friends and family members of a person who is highly outgoing and fun-loving and who is likely to experience happiness and excitement often miss the signs that indicate the person is depressed."

"When a person who has enjoyed socializing and whose mood normally is positive becomes depressed, friends and family often don't recognize it. Depression is inconsistent with the expectations that people have," said Paul R. Duberstein.

When the research began, researchers hypothesized that friends and family would miss depression in a person who is introverted.

"But our research showed the opposite to be true," Duberstein said. "We found the signs of depression were more likely to be missed in people with an outgoing, extraverted personality."

The researchers also found that friends and family missed signs of depression in a person characterized as "agreeable," someone who is more trusting and more altruistic or who might be considered a conformist.

"It is important for people to understand that people who are highly extraverted and highly agreeable can become depressed and that the signs of depression for these people are more likely to be missed or detected by friends and family," Duberstein said "Don't assume that because someone is outgoing or agreeable that they are not vulnerable to becoming depressed."

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But surely you'd think we'd be more likely to notice if our usually outgoing friend was depressed? Apparently not! But why is this? Perhaps because we're not looking for it, we're just refusing to see it. If somebody is very happy and outgoing, this is the image we have of them in our head, even if they have not been acting this way recently. Perhaps it is just our selective attention that is the problem!

Link to Article

Talking yourself into Control

Much like the post yesterday - it seems our ability to verbalise thought affect more of our behaviour than we realise.

Yesterday was Self-regulation and today is self-control:

"New research shows that using your inner voice plays an important role in controlling impulsive behaviour.

"We give ourselves messages all the time with the intent of controlling ourselves -- whether that's telling ourselves to keep running when we're tired, to stop eating even though we want one more slice of cake, or to refrain from blowing up on someone in an argument," says Alexa Tullett, PhD Candidate and lead author on the study. "We wanted to find out whether talking to ourselves in this 'inner voice' actually helps."

Through a series of tests they found that people acted more impulsively when they couldn't use their inner voice or talk themselves through the tasks. It's always been known that people have internal dialogues with themselves, but until now, we've never known what an important function they serve "This study shows that talking to ourselves in this 'inner voice' actually helps us exercise self control and prevents us from making impulsive decisions."

Participants performed a test on a computer. If they saw a particular symbol appear on the screen, they were told to press a button. If they saw a different symbol, they were told to refrain from pushing the button. In order to block their "inner voice," participants were told to repeat one word over and over as they performed the test. This prevented them from talking to themselves."

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The study yesterday talked about how vocabulary helped boys self-regulate, and today talking ourselves through a task has been shown to help us self-control. It seems that a lot of our actions can be enhanced or reduced by talking to ourselves about it.

The knowledge of this can be applied to such things as anger therapy or mild eating disorders, showing how patients could talk themself out of the negative, impulsive actions.

This principle could also be applied to other aspects of our lives, such self-esteem, happiness, mild compulsive disorders, panic attack or phobias.

Link to Article

Rumination on violence increases aggressoin

"Playing a violent video game can increase aggression, and when a player keeps thinking about the game, the potential for aggression can last for as long as 24 hours.

This study shows that (for men) ruminating about the game can increase the game's tendency to lead to aggression long after the game has been turned off.

The researchers randomly assigned college students to play one of six different video games for 20 minutes. Half the games were violent (e.g., Mortal Kombat) and half were not (e.g., Guitar Hero).

After 24 hours:
Men who didn't think about the game: the violent video game players tested no more aggressive than men who had played non-violent games.

Men who did think about the game: More aggressive than the other groups.

The researchers also found that women who played the violent video games and thought about the games did not experience increased aggression 24 hours later."

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This study is interesting as it supports the basis of Brief Solution Focused Therapy. When the participants were not thinking about violence (i.e. the violent game) they were no more violent than those who were thinking about non-violence (i.e. the non-violent game.)

But when they were thinking about violence, they themselves became more violent.

To me this just supports the view of BSFT that ruminating on behaviour will encourage that behaviour. For example, those with depression who ruminate on their problem are going to feel worse than those ruminating on the solution (what their life could be like without depression.)

It also makes me wonder if those that play money-making video games are more likely to be better at business than their peers?

Link to Article

Prejudice and Mental Health

A decade into the 21st Century and the prejudice towards mental illness is decreasing, at least - that's what we'd hope:

"A joint study by Indiana University and Columbia University researchers found no change in prejudice and discrimination toward people with serious mental illness or substance abuse problems despite a greater embrace by the public of neurobiological explanations for these illnesses."

The "disease like any other" approach, supported by medicine and mental health advocates, had been seen as the primary way to reduce widespread stigma in the United States but 'Prejudice and discrimination in the U.S. aren't moving,' said IU sociologist Bernice Pescosolido.

But more alarmingly: "In fact, in some cases, it may be increasing. It's time to stand back and rethink our approach."

Stigma can produce discrimination in employment, housing, medical care and social relationships, and negatively impact the quality of life for these individuals, their families and friends.

Some key findings include:

2006: 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996.

Holding a belief in neurobiological causes for these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.

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This study amazed me. I'm not naive enough to think that all people had dropped their prejudices toward those with mental illnesses, but I find it incredible that this number may actually be increasing.

This is another case that shows how increased public knowledge of a topic does not necessarily mean increased public intelligence.

Link to Article

The Pain of Discrimination

"In a new study, researchers found that adolescents from Latin American and Asian backgrounds experienced more discrimination than their peers from European backgrounds and that the discrimination came not only from other adolescents but from adults as well. The level of discrimination also impacted these teens' grade-point averages and their health and was associated with depression, distress and lower levels of self-esteem.

601 Teens (equal males and females) kept a daily diary for 2 weeks to record any discriminatory events or comments they experienced. They were also asked to separately record on a four-point scale any physical symptoms, such as headaches, stomach-aches or general pain.

Among the teens in the study, nearly 60% reported experiencing discrimination from other teens, and 63% reported discrimination from adults; 12% reported experiencing discrimination on a daily basis.

The researchers found that teens who reported higher levels of peer or adult discrimination also reported more aches, pains and other symptoms, as well as a lower overall grade-point average. Thus, discrimination may not only tax adolescents' physical and psychological resources but may also affect their ability to achieve in school, the researchers said.

"Discrimination significantly predicted lower GPAs, higher levels of depression, higher levels of distress, lower self-esteem and more physical complaints," Fuligni said. "So the bottom line? Discrimination is harmful."

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This interesting study highlights the link between the personal world, i.e. one's own wellbeing and health, and the social world. This link can be good, in terms of positive interactions and suppport, but, as this study shows, negativity in the social world can create bad results in the personal world.

Although people may think the discrimination is only small, it can mount up on a single individual, much like in the story 'An Inspector Calls' by J.B Preistley, and can manifest itself in a number of physical and psychological problems.

The modern world already seems to be accelerating the number of people that are being diagnosed with depression and ADHD and personality disorders etc, and people are quick to blame the fast paced life and music and videogames. This study is an interesting wake-up call that shows how our interactions with each other, although seemingly harmless, may be commiting more pain than we realise.

Link to article

Portion Control: is it all a matter of perception?

Research suggests that the key to losing weight could lie in manipulating our beliefs about how filling we think food will be before we eat it, suggesting that portion control is all a matter of perception.

Test subjects were more satisfied for longer periods of time after consuming varying quantities of food for which they were led to believe that portion sizes were larger than they actually were.

Memories about how satisfying previous meals were also played a causal role in determining how long those meals staved off hunger. Together, these results suggest that expectations before eating and memory after eating play an important role in governing appetite and satiety.

In the first experiment, participants were shown the ingredients of a fruit smoothie. Half were shown a small portion of fruit and half were shown a large portion. They were then asked to assess the 'expected satiety' of the smoothie and to provide ratings before and three hours after consumption. Participants who were shown the large portion of fruit reported significantly greater fullness, even though all participants consumed the same smaller quantity of fruit.

In a second experiment, researchers manipulated the 'actual' and 'perceived' amount of soup that people thought that they had consumed. Using a soup bowl connected to a hidden pump beneath the bowl, the amount of soup in the bowl was increased or decreased as participants ate, without their knowledge. Three hours after the meal, it was the perceived (remembered) amount of soup in the bowl and not the actual amount of soup consumed that predicted post-meal hunger and fullness ratings.

Dr. Brunstrom: "Labels on 'light' and 'diet' foods might lead us to think we will not be satisfied by such foods, possibly leading us to eat more afterwards - One way to militate against this, and indeed accentuate potential satiety effects, might be to emphasize the satiating properties of a food using labels such as 'satisfying' or 'hunger relieving'."
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So these diet foods could actually be causing us to eat more as we still think we should be hungry? Interesting!

This study really does highlight how that aspects of our lives that we never really considered anything more than biologically driven really can be altered by our psychological state of mind!

This is an interesting situation for advertisers. Do they want to avoid using 'diet' on their labels so people don't feel like they're missing out on food? Or keep using it because the 'diet' part is the reason people keep buying it?

I know I'll be paying more attention to the fine print now!

Link to Article

DSM-5: The Future of Psychiatric Diagnosis

From the website:

"Publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review."

The new broader disorders proposed in the new DSM have got people wondering whether this is just a plow to encourage people to buy medicines from pharmaceutical companies because the DSM says that they have a mental illness.

According to Reuters: - "An updated edition of a mental health bible for doctors may include diagnoses for "disorders" such as toddler tantrums and binge eating."

The question has to be asked: "Would you buy your toddler drugs because they've thrown a tantrum?" Although the answer is obviously (hopefully) 'no,' it is a worry that members of the public may believe that this is best as the 'professionals' say that a temper tantrum is a disorder. This may not necessarily be the case, but it is the question being asked by those in the 'against' group for the DSM V revision.

Another point they bring up is that: "[the dsm v] could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder."
Show me a sane man and I will cure him for you - Carl Gustav Jung

In any case, there appears to be a lot of for and against for this revision. I guess we'll just have to see what happens in 2013.

Link to Article

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Other links: (external links do not necessarily reflect the thoughts and/or opinions of SDS or any of its staff, they are simply for interest and information on the opinions of others.)

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With a little help from your friends you can live longer

"A circle of close friends and strong family ties can boost a person's health more than exercise, losing weight or quitting cigarettes and alcohol, psychologists say.

Sociable people seem to reap extra rewards from their relationships by feeling less stressed, taking better care of themselves and having less risky lifestyles than those who are more isolated, they claim.

A review of studies into the impact of relationships on health found that people had a 50% better survival rate if they belonged to a wider social group, be it friends, neighbours, relatives or a mix of these.

The striking impact of social connections on wellbeing has led researchers to call on GPs and health officials to take loneliness as seriously as other health risks, such as alcoholism and smoking.

"We take relationships for granted as humans," said Julianne Holt-Lunstad, a psychologist at Brigham Young University in Utah. "That constant interaction is not only beneficial psychologically but directly to our physical health."

Holt-Lunstad's team reviewed 148 studies that tracked the social interactions and health of 308,849 people over an average of 7.5 years. From these they worked out how death rates varied depending on how sociable a person was.

Being lonely and isolated was as bad for a person's health as smoking 15 cigarettes a day or being an alcoholic. It was as harmful as not exercising and twice as bad for the health as being obese. The study is reported in the journal Plos Medicine.

Holt-Lunstad said friends and family can improve health in numerous ways, from help in tough times to finding meaning in life. "When someone is connected to a group and feels responsibility to other people, that sense of purpose and meaning translates to taking better care of themselves and taking fewer risks."

Holt-Lunstad said there was no clear figure on how many relationships are enough to boost a person's health, but people fared better when they rarely felt lonely and were close to a group of friends, had good family contact and had someone they could rely on and confide in.

Writing in the journal, the authors point out that doctors, health educators and the media take the dangers of smoking, diet and exercise seriously, and urge them to add social relationships to the list.

A report by the Mental Health Foundation in May blamed technology and the pressures of modern life for widespread feelings of loneliness in all age groups across Britain. The survey of more than 2,200 adults found one in 10 people often felt lonely and one in three would like to move closer to their family.

Andrew McCulloch, of the Mental Health Foundation, said the latest study builds on work that links isolation to poor mental and physical health. "Trends such as increasing numbers of people living alone and the advent of new technologies, are changing the way in which we interact and are leading both the young and old to experience loneliness. It is important that individuals and policy-makers take notice of emerging evidence and of the potential health problems associated with loneliness."
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But with online social networking on the increase, does this help or hinder our mental and physical health? Although online social websites allow us to catch up with more people than ever, even on the other side of the globe, has this left us more isolated?

I guess anybody can ask questions.

No go forth and socialise! For your health!


Link to Article

Rudeness 'increases mistakes risk'

Rudeness 'increases mistakes risk'

If you are rude to colleagues, they are rude to you or you witness rudeness, mistakes are far more likely to occur, studies have shown.

Writing in the British Medical Journal (BMJ), Rhona Flin, professor of applied psychology at the University of Aberdeen, said being the victim of rudeness can impact on how people perform tasks.

Human attention "is powerfully driven by emotion", she wrote.

In one study, students who were insulted by a professor on the way to the test performed worse on a series of memory tasks than others who had not been spoken to rudely.

"This reaction is probably caused by the emotional arousal caused by the rudeness, which resulted in a switchover of cognitive capacity to deal with the required emotional processing, or it may, more simply, be caused by distraction," Prof Flin said.

In other research, a student who was late for a group experiment apologised, but was told by the person in charge: "What is it with you? You arrive late, you are irresponsible, look at you, how do you expect to hold down a job in the real world?"

The level of rudeness was not extreme and the comment was said at normal volume.

However, students who witnessed the exchange went on to perform more poorly on tasks than a control group which had not witnessed rudeness.

Prof Flin said the link between performance and rudeness was particularly worrying when it comes to healthcare, with patients potentially being put at risk.

Link to Article

Idle thoughts on ICD-10

Ive just completed a set of training days on mental health awareness for a Housing Association whose target group are homeless people in the North East of England. I know the organisation well and we have worked together on a number of projects over the years.

This has been the first time Ive provided overview introductory training on Mental Health. The training was enjoyable and well received ...but it was the nature of the discussions with people who have no background in mental health or therapy that set me thinking.....

ICD-10 is predominant now as THE organising structure for psychoogical problems and psychotherapy in the UK. It is the primary classification system used by the primary funders of any service - the government or insuarnce companies, and influences the theoretical and linguistic framework in which other service providers think.

ICD diagnostic classification determines whether someone has a psychological problem and who shoukld be addressing it. It assumes a number of things ranging from the the unspoken belief that psychological difficulties relate to questions of "health" through importance of differential diagnosis to an assumption of treatment cure. I'm sure we all have an opinions on this way of thinking. However....this is not what my idle thoughts are about.

What has struck me regarding my recent involvement however is how much this sytem does NOT apply or doesnt WORK for practically all of the clients this organisation is dealing with.

Firstly, arounf fifty percent of their clients have psychological problems that dont fit into ICD-10 - anger problems, general lack of motivation or interest in life (without the necessary additional features to fulfill a diagnosis of depression), general "oddness" which psychaitrists have told them they shouldnt worry about etc....except for the fact that these presentations are a cause of distress for either the clients themselves or those around them.

Secondly, a large proportion of their clients have the dreaded P.D. diagnosis which is of course the 21st century equivalent of leprosy as far as mental; health services are concerned. Despite statements from NICE on the importance of mental health services addressing P.D. needs it still remains a primary reason for many of such services tio say that it is not their business to address their needs.

Finally, about 80% of their client have dual diagnostic problems....most commonly substance misuse and psychological problems, but occasionally learning disabilities and mental health problems....and as we all know dual diagnosis brings out the worst in a jobs worth attitude in statutory services, leading to an unending merry-go-round of trying to find someone who will meet the needs of such clients.

The long and the short of it is that some of the neediest people in out society get a really lousy service for their psychological problems or don't get any service at all ! And I'm convinced that a system that has made ICD-10 SO parameount is to blame....A system based on symptoms interfering with functioing or percived indivual need or distress seems a much more logical and equitable system to base our thinking on.....

All Ive got to do now is convince the medical professiona s a whole, the pharmaceutical industry and the cuurent holders of service and research budgets....Shucks....Im sure that wont be TOO difficult :o)

Paul Grantham
Consultant Clinical Psychologist

Psychiatric Diagnosis -The corpse that wouldn't die

The criticisms of taxonomic systems in psychiatry and psychotherapy are not new - indeed Wittgenstein suggested that "The classifications made by philosophers and psychologists are like those that someone would give who tried to classify clouds by their shape" (PR #154).

Professor Ricahrd Bentall (whom I trained with in Liverpool many moons ago) has recently revisited the topic yet again in the Guardian (www.guardian.co.uk/commentisfree/2009/aug/31/psychiatry-psychosis-schizophrenia-drug-treatments). He points out that there is minimal genetic evidence supporting psychiatric diagnostic systems (compared with other fields of medicine) and that the advances that have occurred in other medical areas have noticeably failed to be replicated in psychiatry.

The flawed nature of the psychiatric diagnostic system has failed to lead to its disappearance however. Indeed, what strikes me as interesting is that despite the changing tide towards "talking therapies" a pharmaceutical classification system remains arguably more predominant than ever. Twenty years ago, criticisms of the psychiatric diagnostic system were rife as part of the tail end of the anti-psychiatry movement and within my own profession (clinical psychology). Today, such criticisms is notable by their rarity.

Why is it that such a heavily criticised model refuses to lie down and die ? The most common answer given (apart from the `the tradition one that drugs "work" , thus "proving" the validity of the diagnostic system) is that big Pharma and the medical profession are well financed and have a lot invested in maintaining the system. Jobs, careers and profits would be lost, if it wasn't so. This is true.

However, I'm struck by how this argument also applies to other professions as well. To obtain funding for research requires acceptance of the diagnostic system, to have a conversation with colleagues about a client requires acceptance of the diagnostic system, to fail to do so would lead one to be seen as a "poor team player", to obtain promotion may well require an interest in particular diagnostic categories. In other words, there is no real alternative. If this really is the case I'm not sure I expect to see a proper burial of the system any time soon.