Would you like fries with your diagnosis and drugs? 

I have worked in the mental (ill) health industry for several decades in various roles. I now work in an IAPT service, meaning Improving Access to Psychological Therapies or as I sometimes think of it, Integrating Austerity with Psychological Therapy. However, this blog is not about IAPT.

The main focus of the blog is to briefly talk about a new service that will no doubt increase the psychiatric medicalisation of human distress and escalate prescribed drug use. Linked to this I also have an idea for exposing this to the public to raise awareness.

For a few months now I’ve met people accessing an IAPT service who have told me that they have recently been diagnosed with ‘ADHD’. When using our screening tool, we are forced to ask people if they have been diagnosed with a ‘neuro-developmental disorder’ either ‘ADHD’ or ‘autism’. This question is asked this way despite there being no proven brain abnormality or actual objective tests to diagnose either. Not to mention a great deal of thoughtful criticism and challenges to these ideas from within the industry.

When I have enquired about the details around these newly labelled people I have been told about an online service called Psychiatry UK.

In the ‘fees explained’ section on the site they state:

‘In the majority of cases, you will need a full one-hour assessment. This will cost you £360.00 which is payable in advance. This cost will include a written opinion or assessment letter and/or a suggested treatment plan and a formal diagnosis where indicated.

There may be additional fees payable after the assessment, for which you will receive an invoice: for example, for the costs for prescribing medication agreed between you and the psychiatrist at the time of assessment.’

So you get a one hour online ‘consultation’ with a ‘telepsychiatrist’ They go on to state that they ‘supply a fast, discreet and economic means to get medical diagnoses and treatment recommendations for all mental health conditions through our own secure video portal all from the comfort of your own home.’

Under another section they state ‘Usually the doctor will be pretty certain within the first few minutes of the consultation starting whether you have ADHD.’

They also state that they ‘treat a wide range of mental health issues including ADHD in both adults and children, ASD in both adults and children, stress, anxiety, Bipolar Disorder, Depression and many more.’

In the service update section they state:
“Our phone lines are extremely busy and we regret that you may be on hold for some time.

ADHD Services:
Due to the popularity of this service, we have received large numbers of referrals for our adult ADHD service. We thank you for your patience while we work through our waiting list.

Waiting list update August 2022:
We are currently booking in patients who have been referred for an ADHD assessment and the current wait time for an appointment is approximately 6 months.

We sincerely apologise for the delays which have arisen due to the popularity of this service. We are doing everything we can to ensure patients are seen as soon as possible and that includes continuing to recruit more consultant psychiatrists and prescribers.

Titration:
After your initial assessment, your Consultant may refer you to our Titration Team to obtain a prescription for medication and titration. “

So, it seems like they are being inundated with people actively seeking a diagnosis and drugs. I find this a very disturbing development. It will surely further expand and normalise the medicalisation of distress and the idea of ‘lifelong brain disorders’ and promote the drugging of people long term.

It’s like a fast-food drive-through for ‘mental illnesses’ and prescribed drugs. I actually thought this was some sort of scam when I first heard about it but the service is linked to the NHS Right to Choose and is rated as ‘good’ by the CQC.

This got me thinking about the Rosenhan experiment and the paper Being Sane in Insane Places that came from it. The study was essentially to test if mental health professionals could distinguish between psychologically well people and ‘mentally ill’ people. Rosenhan sent eight collaborators to mental hospitals and all eight were hospitalised and received a psychiatric diagnosis. I know this experiment has recently been pulled apart in the book ‘The Great Pretender’ but I wonder if we might have an opportunity to do something similar today.

Rather than having to present to a mental hospital faking mental illness to try and get a diagnosis, participants would simply sit in front of a webcam from the comfort of their own homes and hit ‘Record’ on a camera.

A small amount of funding would be needed for the online consultation and a handful of people as fake clients to learn the ‘symptoms’ of ‘ADHD’ or ‘bipolar’ etc and then upload the results online for all to see. Given the obvious issues with diagnosis in mental (ill) health perhaps faking it won’t be needed and participants could just talk about general suffering and see how many get a label and drugs.

“adult human beings should be able to manage their distress in any way they like”

It could also be useful to contrast this process with an actual diagnosis being made in physical medicine. Perhaps for something like diabetes, to show all the steps involved including the actual physical objective tests enabling a diagnosis to be made and the risks involved in making the wrong diagnosis in the absence of such tests. This can then be linked to the issues with diagnosis in general within the mental (ill) health system.

On a personal note, I think adult human beings should be able to manage their distress in any way they like. If this is through drugs, then so be it. However, it seems what is of fundamental importance is the need for real informed consent and a clear detailing of the costs and benefits.

This seems to be largely missing from mental (ill) health systems at this time and with services like the one above it’s likely to get much worse.

“People are led to believe that these diagnostic constructs are reliable and valid”

People are led to believe that these diagnostic constructs are reliable and valid and that they have lifelong brain disorders and this leads to effective treatment by drugs. This is clearly not the case for many, if not most, people.

Over the decades we’ve had many examples of terribly corrupt practices causing an obscene amount of suffering in the name of safe and effective evidence- based treatment. For example, barbiturates were deemed safe and effective and then twenty years later turn out to have numerous serious problems – it was the same story with benzodiazepines, sleeping tablets, ‘antidepressants’, ‘antipsychotics’, opiates and no doubt with stimulants. In many of these cases the industry knew these drugs were a risk but pressed ahead anyway in the name of profit, power and status in a thoroughly captured and corrupted market place.

It seems to me that we are a species that has always taken drugs and presumably we always will, so how do we make this safer for people? I’d like to see a real push to get withdrawal clinics fully set up nationwide and the funding for them taken from the eye-watering profits drug companies have made over the years. The profound damage these systems and companies have created is shocking and compensation and proper support should also be provided and paid for by those responsible. I cannot believe after all of the damage done that something as irresponsible and dangerous as Psychiatry UK exists.

Refs:

Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250-258.