Keynote presented on the 15th Nov 2014 in Seville

1. •1
•¿El fin de pensar en enfermedad mental?

2. •2
• ‘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”

3. •3
Tony Wainwright University of Exeter
•T•Thoen eyn Wd oafin Mwernigthalt Illness thinking? Int
Journal of Clinical and Health
Psychology Vol 14 Sept- Dec 2014

4. •4
A powerful movement is in train - the status quo doesn't
wash
• 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.

5. Introductory comments
The UK context
The house of psychology
Eleanor Longden
The classification statement
Finish by outlining theoretical and practical ways forward
Jo Hemmingfield response
•5

6. •6

7. •7
•Westminster London
•Stormont Belfast
•Holyrood Edinburgh
•Welsh Assembly Cardiff

8. •3
•l
•3
•Austerity Psychology
•Richard Pemberton, Chair
British Psychological Society,
Division of
•Clinical Psychology
dcpukchair@gmail.com
•richardpemberton wordpress
•@socratext @dcpinfo

9. •9

10. • 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

11. •The ‘Liberation’ of the NHS - NHS as a business or a social movement
•2

12. •1
• Clinical Psychology Crisis or opportunity?

13. •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.

14. •14
•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

15. •Positive Psychology and the Rotten to the Core Dogma
•‘20th Century Psychology is half baked’
• Martin E. P. Seligman University of Pennsylvania
•15

16. •16
European
Community
Psychology
Association
task force on
austerity and
mental health
Carl Walker
University of
Brighton

17. •The Spirit Level: Why More Equal Societies
Almost Always Do Better Kate Pickett and Richard
Wilkinson
•John Clements ‘our increased preoccupation with the psychological •17

18. •18

19. •Transforming the understanding and treatment of mental illnesses.
•The National Institute of Mental Health: www.nimh.nih.gov
•Director’s Blog: Re-Thinking Classification •Robert Whitaker The anatomy of an epidemic
•19

20. •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
•2
0

21. •21
•Secondary Mental Health Services
•Lack of Outcome measures

22. 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
22
condition.

23. •Good Practice Guidelines on the
use of psychological formulation
•2
3

24. • Classifying what psychotherapists do: A first step
The absence of a common language for psychotherapy (clp) procedures leads ATICLE
•24
Psychology Should List
Empirically Supported
Principles of Change (ESPs)
and Not Credential
Trademarked Therapies or
Other Treatment Packages
GERALD M. ROSEN
University of Washington
GERALD C. DAVISON

25. •2
5
APA President Nadine J. Kaslow,
has diagnosed psychology with a
serious problem: fragmentation.
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

26. •2
6
•Carving nature at its joints
• 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

27. •Improving Access to the Psychological Therapies
•The first million patients
•27

28. •2
8
•IAPT - No Health with Mental Health
• 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

29. •29
•David Clark University of Oxford
•IAPTImproving Access to Psychological Therapies

30. •30
•IAPT -Evidence based 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

31. •3
1
•IAPT - data
• 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

32. •32
•I played the first ten minutes of this great
•presentation at this point

33. 3
3
‘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

34. •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

36. •3
6
Classification statement
•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’.

37. •3
7
Classification statement - diagnostic positives
•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

38. •38

39. •39
Classification statement - Concepts and models
•Interpretation presented as objective fact
•Limitations in validity and reliability
•Restrictions in clinical utility and functions
•Biological dominance
•Decontextualisation
•Ethnocentric bias

40. •40
Classification statement Impact on service users
•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

41. •41
Classification statement Recommendations
•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.

42. •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

44. •44
:
Classification statement what instead - the way
forward?
•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.

45. 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.
•45

46. •We already have alternatives.
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

47. •47
•The Integrative Power of
Cognitive Therapy
•Aaron T. Beck
•Global DX 1

48. •4
8
•A Prescription for Psychiatry
•Why We Need a Whole New Approach to Mental
Health and Wellbeing
•Peter Kinderman

49. •4
9
•The Kinderman Prescription
1. Change from disease based to
psychosocial model
2. Drop the language of disorder
3. Sharply reduce our reliance on medication
4. Create holistic psychological services
5. Create new crisis care provision
6. Democratic multidisciplinary teams
7. Move Mental Health into Social Care

50. EFPA states great significance of psychology in the
promoting of tolerance
•50
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.

51. •51
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

52. •52
‘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 need to call it as it is
We needs to get out national and European
houses of psychology in better order