• ¿El fin de pensar en enfermedad mental?

• ‘The Division of Clinical Psychology is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations and there is thus a need for a paradigm shift in classification in relation to these diagnoses, towards one which is no longer based on a ‘disease’ model “disease”

•Tony Wainwright• The end of Mental Illness thinking? Int Journal of Clinical and Health Psychology Vol 14

Sept- Dec 2014

• Tony Wainwright University of Exeter

•

• Poor performance of Mental Health Services - not just a financial issue but is conceptual one

• Nothing about us without us rhetoric starting to take hold

• Advances in our understanding of the Psychological, Social and Physical mechanisms that underpin psychological wellbeing and mental distress, need to urgently lead to the replacement disease based thinking and service models.

• Innovative research in genetics, neuroscience, psychological and social theory provide the platform for changing the way we conceptualise, formulate and respond to psychological distress at both community and individual levels.

A powerful movement is in train - the status quo doesn't wash

Introductory commentsThe UK contextThe house of psychologyEleanor LongdenThe classification statementFinish by outlining theoretical and practical ways forwardJo Hemmingfield response

• Westminster London

• Holyrood Edinburgh

• Stormont Belfast

• Welsh Assembly Cardiff

• 3

• l

•3

•Austerity Psychology

•Richard Pemberton, Chair British Psychological Society, Division of•Clinical Psychology dcpukchair@gmail.com

• richardpemberton wordpress• @socratext @dcpinfo

• The UK context• • ‘Liberation’ of the NHS in England

• Deep cuts to Mental Health and Social Care Services

• Parity of Esteem

•‘Nothing about us without us’

• Improving Access to Psychological Therapies Programme

• Time of significant change and opportunity

• 2

• The ‘Liberation’ of the NHS - NHS as a business or a social movement

• 1• Clinical Psychology Crisis or opportunity?

• Strategic Intent

•F

•Future search

•Creates strength•through coherence•of Design

•Coordinated Policies

•and Actions

•Shifts in thinking•and paradigm

•Bad Strategy

•Incoherence

•of Design

•Multiple

•Good Strategy

• objectives.

• Service users response to distress has been to get involved, become empowered to support each other, and to have our say about what works for us -

• - Individually - In services

• - policy

•

• This is to make things better for ourselves. The system has found it very challenging, often finding it does not understand our language and ideas it could be argued when it does it is resistant.

• Positive Psychology and the Rotten to the Core Dogma

• Martin E. P. Seligman University of Pennsylvania

• ‘20th Century Psychology is half baked’

European Community Psychology Association task force on austerity and mental health

Carl WalkerUniversity of Brighton

• The Spirit Level: Why More Equal Societies Almost Always Do Better Kate Pickett and Richard Wilkinson

• John Clements ‘our increased preoccupation with the psychological therapies has been associated with declining relevance to disempowered and marginalised groups’

• Transforming the understanding and treatment of mental illnesses.

• The National Institute of Mental Health: www.nimh.nih.gov

•Director’s Blog: Re-Thinking Classification of Mental Disorders

• Robert Whitaker The anatomy of an epidemic

• Psychiatry's scientific reboot gets under way

• Stephen Maier ‘We need to get rid of current categories as they do not inform us on the best way to treat people

• Secondary Mental Health Services• Lack of Outcome measures

Adrian P. Bird..we study animal models of the debilitating autism spectrum disorder Rett Syndrome to better understand the origin and potential reversal of this condition.

• Good Practice Guidelines on the use of psychological formulation

• Classifying what psychotherapists do: A first step

The absence of a common language for psychotherapy (clp) procedures leads different therapists to use different terms to describe the same procedure and/or the same term to describe different procedures. This often confuses professionals and patients. A shared language would reduce confusion and speed psychotherapy’s evolution into a science. An international clp Task Force is therefore developing a common language for psychotherapy procedures that is widely acceptable.

ATICLE

Psychology Should List Empirically Supported Principles of Change (ESPs) and Not Credential Trademarked Therapies or Other Treatment PackagesGERALD M. ROSEN

University of Washington

GERALD C. DAVISON

• Division of Academics, Researchers and Teachers in Psychology• Division of Clinical Psychology• Division of Counselling Psychology• Division of Educational and Child Psychology• Division of Forensic Psychology• Division of Health Psychology• Division of Neuropsychology• Division of Occupational Psychology• Division of Sport and Exercise Psychology• Scottish Division of Educational Psychology

APA President Nadine J. Kaslow, has diagnosed psychology with a serious problem: fragmentation.

• • Addiction• • Children, Young People and their Families• • Clinical Health Psychology• • Eating Disorders• • Forensic Clinical Psychology• • Holistic Psychology• • Leadership and Management• • Intellectual Disabilities• • Oncology and Palliative Care• • Perinatal Psychology• • Psychosis and Complex Mental Health• • Psychology of Older People• • HIV and Sexual Health

• Carving nature at its joints

• Improving Access to the Psychological Therapies • The first million patients

• Originally launched in 2008, the Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to significantly increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders, within NHS-commissioned services in England.

• IAPT is central plank of the government mental health strategy

• IAPT - No Health with Mental Health

• David Clark University of Oxford• IAPTImproving Access to Psychological Therapies

• Cognitive behavioural therapy CBT

• Interpersonal Therapy IPT• Couple Therapy for Depression

• Counselling for Depression• Behavioural Family Therapy and Cognitive Family Interventions

• Eye movements Desensitisation and Reprocessing EMDR Therapy

• IAPT -Evidence based Psychological Therapies

• Over 1 million people entering treatment• 680,000 people completing treatment• Recovery rates consistently in excess of• 45% and 65% significantly improved• Over 45,000 people moving off sick pay and benefits

• Nearly 4,000 new practitioners traine• A major transformation of Child & Adolescent Mental Health Services initiated - Older peoples mental health and ‘SMI’ pilots

• IAPT - data

• I played the first ten minutes of this great • presentation at this point

‘The Division of Clinical Psychology is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations and there is thus a need for a paradigm shift in classification in relation to these diagnoses, towards one which is no longer based on a ‘disease’ model

• DCP - New thinking and practice

• Recent advances in understanding mental illness and psychotic experiences (2000)

• Understanding ‘Bipolar Disorder’ (2010)• Good Practice Guidelines for the use of

Psychological Formulation (2011)• Position Statement on the Classification of

Behaviour and Experience in relation to functional psychiatric diagnoses (2013)

• Understanding ‘Psychosis’ due November 2014• Understanding ‘Depression’ due May 2015

• The development and use of classification systems for psychological distress and behaviour has never been free of controversy. Many of the issues that arise in relation to psychiatric diagnosis stem from applying physical disease models and medical classification to the realms of thoughts, feelings and behaviours, as implied by terms such as ‘symptoms’ and ‘mental illness’ or ‘psychiatric disease’.

Classification statement

• Clinical Psychology mixed views about psychiatric classification and its implications in theory and practice.

• Current classification systems have underpinned much research and theory in the area and have shaped the structure and delivery of mental health services.

• They provide seemingly ‘tangible’ entities for use in administrative, benefits, and insurance systems.

• They are broadly accepted by most professional groups, many service users, the media and the general public.

Classification statement - diagnostic positives

• Interpretation presented as objective fact

• Limitations in validity and reliability

• Restrictions in clinical utility and functions

• Biological dominance

• Decontextualisation

• Ethnocentric bias

Classification statement - Concepts and models

• Discrimination: Can create and compound social exclusion.

• Stigmatisation and negative impact on identity: language of disorder and deficit can negatively shape a person’s outlook on life, and their identity and self-esteem

• Marginalising knowledge from lived experience

• Decision-making: Decisions about how to classify a person’s behaviour and experience are often imposed

• Disempowerment position service users as necessarily dependent on expert advice and treatment

Classification statement Impact on service users

• To promote through pre-qualification training and continuing professional development

• To open up dialogue with partner organisations, service users and carers, voluntary agencies, and other professional bodies in order to find agreed ways forward.

• To support work, in conjunction with service users, on developing a multi-factorial and contextual approach

• To ensure a psychosocial perspective and psychological work are included in the electronic health record.

• To continue to promote the use of psychological formulation.

Classification statement Recommendations

• Uk Press coverage

• ‘Lonely? Shy? Sad? Well now you’re “mentally ill” too’ Independent,

• ‘The proposals in DSM-5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness’ The Guardian,

• ‘It is hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals’ The Financial Times

• ‘Many people who are shy, bereaved, eccentric or have unconventional romantic lives will suddenly find themselves labelled as “mentally ill”. This isn’t valid, isn’t true, isn’t humane’ Peter Kinderman

• To work with experts by experience, on developing multi-factorial and contextual approaches which incorporate social, psychological and biological factors' in relation to the functional psychiatric diagnoses.

• To outline 'the essential evidence-based conceptual and theoretical foundation of a new system - illustrated with a range of examples.

• We anticipate that the conclusions will be sufficiently robust and evidence-based to justify making recommendations for intervention, service design and future research

• They will not constitute a simple one-to-one system for replacing current diagnostic categories.

:

Classification statement what instead - the way forward?

Lucy Johnstone asks 'Do you still need your psychiatric diagnosis?' This book will help you to decide. A revolution is underway in mental health. If the authors of the diagnostic manuals are admitting that psychiatric diagnoses are not supported by evidence, then no one should be forced to accept them.

• At the simplest level – ask what people’s problems are, and work with that. (work of the Hearing Voices Network.)

• At a more sophisticated level - co-construct a formulation, or evidence-based hypothesis/best guess, about the origins, meaning and function of these problems in a person’s life

• We don’t have to wait for a complete new conceptual system before abandoning one that is unevidenced and damaging. ‘The weakness is its lack of validity.’ (Insel 2013, NIMH chair)

The alternative to psychiatric diagnosis is telling your story

Instead asking what is wrong with you we need to ask

what has happened to you?

‘

• We already have alternatives.

• The Integrative Power of Cognitive Therapy

• Aaron T. Beck

• Global DX 1

•A Prescription for Psychiatry• Why We Need a Whole New Approach to Mental Health and Wellbeing

• Peter Kinderman

1. Change from disease based to psychosocial model

2. Drop the language of disorder3. Sharply reduce our reliance on medication4. Create holistic psychological services5. Create new crisis care provision6. Democratic multidisciplinary teams7. Move Mental Health into Social Care

• The Kinderman Prescription

EFPA states great significance of psychology in the promoting of tolerance

EFPA states great significance of psychology in the promoting of tolerance

Promote diversity, participation and social inclusion

Engage young people

Facilitate cultural assimilation in communities

to reduce health inequalities, strengthen public health, and ensure people-centered health systems that are universal, equitable, sustainable and of high quality.

COUNCIL OF THE EUROPEAN UNION Council conclusions on 'The European

Pact for Mental Health and Well-being: results and future action’ June 2011

Invites Member States to: Make mental health and well-

being a priority of their health policies and to develop strategies and/or action plans on mental health including depression and suicide prevention

• ‘Revolutions begin when people defined as the problem get the power to redefine the problem’

John McKnight is Co-Director of the Asset-Based Development Community Development Institute

• We needs to get out national and European• houses of psychology in better order

• We need to call it as it is