Information: Research into the National Institute for Health and Care Excellence guidelines for ADHD and Depression being adhered too?
Primary Researcher: Ciara McKay
The National Institute for Health and Care Excellence (NICE) creates and updates health guidelines to improve the quality of health and care services. These guidelines have become increasing influential to those within medical professions and the health and social care practitioners; they are not mandatory but have shown a provided guide to treatments for developmental disorders. Researchers have found a common prevalence of depression and ADHD through all ages of a lifespan. The aim of this study is to investigate whether the NICE Guidelines are being adhered to within Depression and ADHD and whether people are receiving the appropriate treatments for their disorder.
Those of you who wish to take part in this study will be assigned to one or two questionnaires based on your condition. Participants will be asked to answer a series of multiple-choice questions as well as open-ended questions that will enable you to elaborate on your answer. Questionnaires will be available on The Bristol Online Survey (2018) and will take no longer than 20 minutes in total. There is no follow up for this study.
The information collected from this study will be shared only between Ciara McKay, Dr M. Thomas and internal/external marking moderators. Data from this study will be stored until the dissertation is complete and then be deleted destroyed. Anonymity and confidentiality is very important within this study, you will not be asked any personal information, for instance your name or to identify yourself in any noticeable way. If you wish to review the findings of this study, it will be available on request on once the study is completed.
To take part in this study you must have or have had ADHD and/or Depression. The purpose for this requirement is because the questionnaire is based around your specific treatment and management of these two conditions. Any gender and 18+ can take part in this study. You must not attend Bath Spa University.
You can complete the survey by following the link below:
If you have any questions about the study, you can contact Ciara at: firstname.lastname@example.org or her supervisor Dr Marie Thomas at: email@example.com.
Update to our email below: On Monday, 14th January we received an email from the Governance Manager of the British Psychological Society letting us know that a Director of the Society has been appointed to investigate the issues we have raised and that the investigation will take 4 weeks to complete.
On Sunday, 9th December 2018, we sent the following email to the Chief Executive and Trustees of the British Psychological Society (BPS):
Dear Mr Bajwa and Trustees of the British Psychological Society,
I would like to bring to your attention the harmful manner in which Attention Deficit Hyperactivity Disorder is referenced in the document titled ‘Power Threat Meaning Framework’ (PTMFramework).
Lucy Johnstone, lead author, on 30 November 2018 told us on Twitter that all discussions of ADHD had been specifically excluded from the PTM Framework (see attached: ‘Tweets September to 30 November 2018’). But to date, the uncorrected version of the PTM Framework ( i.e. the version containing 16 references to ADHD, all of which are stigmatising and harmful) is still on the British Psychological Society’s website here https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework
If you are able, please could you provide us with a copy of the amended version of the Framework and ensure that the uncorrected copy is replaced?
If it has not been amended, please could you discuss this matter with the Trustees as to whether or not the Framework meets the requirements of the BPS Royal Charter.
Sadly, we have some doubts as to whether the Framework has been amended as Lucy Johnstone and her fellow authors are adamantly opposed to psychiatric diagnoses as illustrated in one of the attached tweets as well as in the following quote from the 3rd paragraph on page 314 of the PTM Framework:
At the same time as affirming people’s right to describe their difficulties as they wish, we affirm the equally important principle that professionals, researchers, trainers, lecturers, charities, policy-makers and others involved in the mental health field should use language and concepts that have some claim to be descriptively accurate and evidence-based. Because psychiatric diagnosis does not meet these standards, it follows that it can no longer be considered professionally, scientifically or ethically justifiable to present psychiatric diagnoses as if they were valid statements about people and their difficulties. To draw an analogy from psychiatric history, once it becomes clear that terms like ‘wandering womb’ are mistaken, no professional should be offering – let alone imposing – them.
For your information here is some background:
In January 2018, the launch of the Power Threat Meaning Framework was heavily promoted on Twitter under #PTMFramework and as part of the launch it was also advertised as being available on the British Psychological Society’s website. As a result of this we, Adult Attention Deficit Disorder-UK (AADD-UK), became aware of the published document so we downloaded the full version (414 pages) and read it.
There are 16 specific references to Attention Deficit Hyperactivity Disorder (ADHD) in the framework (see attached document) which are in themselves incorrect and when read in the context of the framework as seen in the quote above.
We’ve given our feedback to the authors many times since the launch of the PTM Framework, but until 30th November 2018 it has been consistently ignored. Please note that while Lucy Johnstone says she won’t engage in a debate about the framework, she is still actively promoting it on Twitter.
We are bringing this to your attention as well as the attention of the trustees not only because Lucy Johnstone directed us to the BPS but also because the presence of the BPS Logo on the Framework lends credence and validity to statements which stigmatise people with ADHD.
If you have any questions, please do not hesitate to contact me. I’m very willing to help.
Today, Wednesday, 2nd January 2019 we received the following reply from the Governance Manager at BPS:
Your complaint as set out below has been forwarded to me for attention. I am very sorry to learn of your concerns
I am making enquiries into the matters which you raise and I will be in touch as soon as my enquiries are complete
Finally, it looks as if some progress is being made by the BPS and we’re hoping this means that at last someone is taking our complaint seriously. We’ll keep you updated and in the meantime our fingers are tightly crossed.
Here is a link to the copy of some tweets we sent to the BPS, Tweets September to 30 November 2018
And here is a link to a list of the statements in the Power Threat Meaning Framework that we sent to the BPS, Quotes from PTMF for Letter
And finally, if anyone is interested in reading more, here is a link to the 414 page version of the Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis
Thursday, 7th June, We’ve just learnt that it looks as if the Power Threat Meaning Framework has been adopted as policy by the Division of Clinical Psychologists at the British Psychological Society. An email has been received by other psychologists which says “Statements of Interest are invited to join the DCP Power Threat Meaning Framework (PTM) Working Group, that reports directly to the DCP Committee.”
We have been working hard on our report about the PTMFramework and are now compiling the results into a coherent whole so that it can be presented along with our letter of complaint. This has not been easy and has taken a while as the Framework itself is a poorly researched and poorly written mishmash of outdated ideas as well as being unintelligible in sections.
As of today, Monday, 30th April, we’ve still not had any kind of a reply from the British Psychological Society regarding their stigmatising and discriminatory attitude towards people with ADHD. We sent the BPS & authors of the Power Threat Meaning Framework a note today, via Twitter, to say that unless they promise by Friday, 4th May, in writing, that ADHD will be deleted from the PTMFramework we will be taking further action.
FYI, work on this further action is well underway!
In the meantime, we note that Lucy Johnstone, a consultant clinical psychologist and one of the two lead authors of the framework, tweeted at 5:10 pm on Tuesday, 24th April the following:
As you see, Lucy Johnstone declares that all diagnoses lack validity even if people actually find them to be helpful. And she says, psychologists should be honest and tell us that our diagnoses are invalid. That is an arrogant and harmful statement that devalues the experience of service users.
And before any of the authors think about contacting us to claim that the PTMframework is an alternative option to the DSM (Diagnostic and Statistical Manual of Mental Disorders), we will state right here and now that we are not fooled! At the same time they tell everyone that their framework is an alternative option, they also deny the validity of the DSM. No options allowed!
Basically, in the PTMframework the authors claim that the symptoms we experience (ADHD included) are expressions of emotional distress caused by “relational and social adversities” such as poverty, discrimination, inequality, violence and abuse. Furthermore, they state that there are no ” consistent associations between functional psychiatric diagnoses [e.g. ADHD] and any biological pathology or impairment, and nor have any biomarkers been identified” (Johnstone, 2018, 7). In short, the authors dismiss the results of genetic and screening research. The framework is not backed by reliable research and the authors lack the depth of knowledge and experience of the DSM authors.
While the framework may be helpful for those people whose distress has been solely caused by relational and societal adversities (although they will still need the utility of the DSM), it will not help those whose distress results from the impact of complex interactions between genetic and environmental influences amplified by relational and societal adversities. In fact, in these instances the framework will only serve to disempower people by denying the validity of their experiences. It will increase feelings of failure and despair.
Unlike the PTMFramework, the DSM is designed as a classification system that provides cross-border mental health professionals with a common diagnostic language that is useful for both treatment and research efforts. While some of the DSM authors recognise that it is a flawed system, in part because knowledge about mental ill health is evolving and changing, they also acknowledge that the DSM contains much practical information and experience and is better than anything else currently available (and when used properly does a good job).
The two main criticisms levelled against the DSM (and psychiatry in general) are first, that it medicalises normal behaviours and turns them into illnesses and disorders to be treated with drugs and secondly, that the DSM’s authors (and psychiatrists in general) have conflicts of interest because they have links with the pharmaceutical industry.
The critics, including the authors, using these arguments conveniently overlook the fact that researchers from both the medical field and the pharmaceutical industry need to work together in order to find and develop effective treatments. They overlook the fact that in the UK the pharmaceutical industry is heavily regulated. Additionally, as we’ve noticed with the BPS and some of their members, many of these same critics fail to declare their own financial and personal interests.
Please don’t misunderstand us. We’re not against debating the meaning and definition of illness and disorder, we’re not against improving the validity of specific diagnoses, we’re not even against changes to the classification system; so long as changes are in line with improvements in knowledge about causes of and experiences with mental ill health.
We are, however, against mental health professionals working outside their area of expertise and not declaring their lack of knowledge. We are also against the same professionals resorting to misinterpreting the conclusions of more knowledgeable colleagues and making attention-grabbing and unfounded pronouncements such as the ones they make about psychiatrists and psychiatric diagnoses. The authors allege that psychiatric diagnoses are neither descriptively accurate nor evidence-based and cannot be considered “professionally, scientifically or ethically justifiable” (Johnstone, 2018, p. 314). We are against mental health professionals attempting to enhance their own professional reputation by using these sorts of tactics to discredit the work of other colleagues.
Additionally, we think it is unethical and unprofessional, to say nothing of being harmful, for the authors of the PTMFramework to justify their own work by perpetuating distrust of psychiatry amongst people with negative experiences and by undermining the trust of those who’ve had helpful experiences.
Finally, we will point out to all those mental health professionals who feel disturbed by the implications of the PTMFramework but are staying silent, thereby implying acceptance, the framework authors’ failure to recognise their own limits, biases, prejudices, professional and power interests will not only cause harm to many service users, it will also damage the reputation of psychology as a helpful profession. And those of you who do not speak up will be seen as complicit.
There will be more on these as well as additional points later!
As of today, Tuesday, 27th March 2018 we’ve had no reply whatsoever from the British Psychological Society. Never mind; we’ve been working hard on a comprehensive follow-up which we will send to certain parties as well as publish here.
In the meantime, we note that on 1st March 2018 Lyn Romeo, Chief Social Worker for Adults, at the Department of Health not only introduced the Power Threat Meaning Framework as a “radically different perspective on mental health“ on her official government blog but also allowed Phil Wilshire, principal social worker for Avon and Wiltshire NHS Partnership Trust to write a guest blog promoting the framework.
Phil does acknowledge that some professionals and some service users have been critical of the framework so he tries to argue that the framework is an “optional conceptual resource” and that it is not anti-medication. His efforts, however, are deliberately misleading given that in the first paragraph on page 314 of the framework the authors clearly state that while they affirm “people’s right to describe their difficulties as they wish, we affirm the equally important principle that professionals, researchers, trainers, lecturers, charities, policy-makers and others involved in the mental health field should use language and concepts that have some claim to be descriptively accurate and evidence-based. Because psychiatric diagnosis does not meet these standards, it follows that it can no longer be considered professionally, scientifically or ethically justifiable to present psychiatric diagnoses as if they were valid statements about people and their difficulties.” You see; they are actually trying to take away our right to accept our ADHD diagnoses by calling them unprofessional, unscientific and unethical. What’s more they haven’t provided any valid evidence at all for this opinion.
By the way; Phil Wilshire probably should have declared his interest in the Framework as he’s listed on page 3 as having “significant input into Chapter 8” which is titled “Ways forward” and contains the following sections: 1. Public health policy. 2. Mental health policy. 3. Service principles. 4. Service design, commissioning and outcomes. 5. Access to social care, housing and welfare benefits. 6. Therapeutic interventions. 7. The legal system. 8. Research. 9. Use of language.
Mr Wilshire, of course, is advocating an eventual “collective shift towards a non-diagnostic paradigm.” (p. 264) Well . . . . good luck!!
And just in case Phil and Lyn have been chatting about how to implement the Framework, we suggest that since they both work for public bodies, they might like to ask themselves how their support for the framework complies with their public sector equality duty under the Equality Act 2010. And if they’ve overlooked their legal obligations, here’s a reminder: “those subject to the equality duty must, in the exercise of their functions, have due regard to the need to: Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act. . . etc.“!!!
On Tuesday, 16th January, AADD-UK was alerted to a furious Twitter row that began Friday, 12th January when the Division of Clinical Psychology (DCP), a Division within the British Psychological Society (BPS),* held an actively promoted launch at the Friends House, across from Euston Station, London for the Division’s recently published “Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis.”
Having no idea what this Framework was about & curious as to why there was such a ruckus, I downloaded a copy and began reading.
This is what happened:
The Framework seemed sturdy, 411 pages long, and reputable. It’s on the BPS website, it has their logo (Tagline: Promoting excellence in psychology) as well as the logo for the Division of Clinical Psychologists. It’s clearly stated on the printer’s imprint and copyright page that the publication “has been produced by the British Psychological Society’s Division of Clinical Psychology as a Member Network publication and represents the views and expert contributions of its authors” and it was printed and published by the British Psychological Society.
So far so good.
Next, on page 5, under the heading ‘Document summary‘, I learnt the reason for the existence of the Framework as follows (please bear with me as I give you these somewhat tedious details, their relevance will be more evident later):
In 2013, the Division of Clinical Psychology (DCP) of the British Psychological Society
(BPS) published a Position Statement entitled “Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift.” Recommendation 3 of the position paper is: ‘To support work, in conjunction with service users, on developing a multi-factorial and contextual approach, which incorporates social, psychological and biological factors’ (p.9). This document is the result of a DCP-funded project for work towards fulfilling this aim.
Since I tend to be overly conscientious as well as curious, I decided to read ‘Time for a paradigm shift‘ first so that I could understand the context for the PTMFramework so I downloaded a copy, thankfully only 9 pages long, and began reading (it’s publication format was the same as the Framework’s).
I was more interested when I recognised a few of the author’s names due to their interactions with the Twitter row. Things quickly became more interesting when, on page 2, I read the following paragraph (emphasis mine):
At the same time it should be noted that functional psychiatric diagnoses such as schizophrenia, bipolar disorder, personality disorder, attention deficit hyperactivity disorder, conduct disorders and so on, due to their limited reliability and questionable validity, provide a flawed basis for evidence-based practice, research, intervention guidelines and the various administrative and nonclinical uses of diagnosis.
After this, I carried on reading, paying closer attention to the references and source names, some of whom I also recognised, and by the time I reached the summary (below) on page 5, I’d already concluded that the ‘position statement‘ produced by the Division of Clinical Psychologists was a veiled attempt at undermining psychiatry and diagnoses, i.e. anti-psychiatry. The Twitter row wasn’t the only place I’d seen those names.
The DCP believes there is a clear rationale and need for a paradigm shift in relation to functional psychiatric diagnoses. It argues for an approach that is multi-factorial, contextualises distress and behaviour, and acknowledges the complexity of the interactions involved in all human experience.
The whole Division? I wondered how many psychologists were involved so I did a Google search. I didn’t find numbers for psychologists but I did find an interesting page on the BPS website under “news”. It’s titled “The future of clinical psychology in the Society” which mentions plans for a another UK association for Clinical Psychologists. Intriguingly, there’s strange hints about unity (lack of?) along with a reminder that relationships with external organisations must advance BPS’ objects. The policy is linked to this page. Hmm! Keep all this in mind as you read on.
I returned to reading the Power Threat Meaning Framework. Now, I freely admit that I was slightly distracted by the policy I’d just read and I was aware my bias filters were turned on. I thought I knew what to expect. I was wrong!
I was shocked! And this feeling intensified the more I read. The authors’ tone, conveyed through their choice of words and viewpoint, is arrogant and patronising and their negative and disapproving attitude towards ADHD is stigmatising and discriminatory. Make no mistake the ideology behind the Framework belongs to the anti-psychiatry movement.
I’m not going to analyse the arguments put forward in the Framework other than to say that while some of the ideas are interesting, they aren’t discussed in any depth. The authors’ make some half-hearted attempts at describing different sides of an argument, but these are often spoilt by their habit of using adverbs to manipulate us into choosing their favoured option .
This post is getting too long so I’m only going to add 5 extracts from the Framework so that you have some sort of idea as to what it’s like. I’ve put links to the Framework as well as to the Time for a Paradigm Shift at the very end of this post in the References section. If you’re interested, you can download them and judge them for yourselves.
“. . .and psychiatric diagnoses are often explicitly used as explanations. But the impression of explanation is false and the reasoning behind it is illogical“. (2018, p.29)
“We underestimate the difficulty of describing patterns in people’s behavioural or bodily problems and often ‘see’ associations which are not there (known as the illusory correlation). This is why medical researchers have developed the kind of rules we discussed earlier to try to ensure that the bodily patterns they describe are ‘real’ and not illusory. The combination of limited public understanding of diagnostic procedures and overconfidence in judgements of patterns, can confer credibility on psychiatric categories which is not justified by the evidence“. 2018, p.30)
“The existence of particular categories can influence how people’s experiences are interpreted and how they express their distress. Aided by the illusory correlation, diagnostic categories can then become self-fulfilling prophecies, conferring further credibility as growing numbers of people seem to match them. And, especially if people do not have access to non-medical, non-blaming explanations, the process can become self-perpetuating as people increasingly request confirmation of self-diagnoses of ‘bipolar disorder’ or ‘ADHD’ and so on.” (2018, p.30)
“All of this is reflected in psychiatric diagnosis’ inevitable dependence on social judgements, as we discussed in Chapter 1, and many critics have traced particular diagnoses back to the social norms they challenge: ‘borderline personality disorder’ for women who are too angry; ‘depression’ for women who are exhausted by domestic demands; ‘anorexia nervosa’ as a reaction to the unrealistic role and appearance standards faced by modern women; alcohol misuse and suicide for men whose socialisation does not permit the expression of despair in other ways; ‘ADHD’ for children who are not suited to educational regimentation, and so on . . .These rule transgressions can involve over-adaption to the ideal image, as well as failing to live up to it; . . . Similarly, it has been suggested that the enormous rise in diagnoses of ‘autism spectrum disorders’ and ‘Asperger’s’ may partly reflect demands made by highly industrialised and service-oriented economies for successful employees to display emotional behaviours such as (faked) sociability, warmth, gratitude, passion and so on – skills which do not come easily to everyone (Roberts, 2015). (NB: Although autism in its most severe forms fits the profile of a neurodevelopmental disorder of some kind, the debates about these diagnoses are particularly complex . . . Given all this, it is hardly surprising that in many parts of the Global South, there may be no equivalent categories to the experiences that DSM and ICD label as ‘depression’, ‘anxiety’, borderline personality disorder, anorexia, and so on. In fact, the distinction between thought and emotion may not even be recognised (Cromby, 2015) and the very notion of an individual who exists in some sense independently from their social network may be alien.” (2018, p. 69-70)
“From a PTM Framework perspective, the trauma-informed model has much to offer. It also has risks and limitations, including: Conceptualising the approach as an alternative explanation for ‘schizophrenia’, ‘bipolar disorder’, ‘ADHD’ and so on, perhaps by reducing adversities to the status of a ‘trigger’ and thus retaining diagnostic categories and thinking . . .” (2018, p.276)
I apologise for the length of the quotes. I’m trying to give you an accurate picture by including some context.
Returning to my story: I revisited the Twitter row, partly because I was angry and looking for a fight and partly because I couldn’t believe that professionals still believed this kind of stuff in 2018.
I’m going to pause now and give myself a pat on the back, as once advised by a psychotherapist.
Despite being angry and upset, I managed to stay calm and polite, except for a couple of little jabs & swipes, as I asked questions and gave feedback to the authors, and yes the medication also helped even when my questions were evaded and ignored. I did, however, get replies from a registered psychologist, supporter of the Framework, who told me, via tweets, that ADHD diagnoses are invalid and damaging. I also saw a tweet from one of the Framework authors in which she stated, “IMO all DX are BS & giving psychoactive meds to kids is immoral. To view ADHD as valid DX seems remarkably lacking in critical thinking.” I’ve kept copies of these tweets.
Eventually, I realised I was wasting my time and energy, the authors didn’t want to hear, even questioned whether I’d read the framework, and then said it was up to me how I used the Framework, I didn’t give the obvious reply! Instead I decided to leave.
I was sorry though to leave behind some of the people I’d met (I’m using the word figuratively) . Not all psychologists support the framework, and the same goes for my fellow service users. In fact the people I met were kind, caring and open-minded, and some even had a wicked sense of humour and mischief. I laughed out loud several times.
I also met service users from the other side of the argument who were kind and helped me to understand and accept their very valid reasons for disliking diagnoses. But my experiences with the professional supporters of the Framework had a completely different nature. I’m not going to give details, it’s not fair. And anyway, we’ve reached the point at which I return to the description I gave earlier of the publication details of the DCP’s position statement and the PTMFramework. My reasons for giving you those dull details at the beginning.
You see, I couldn’t just walk away telling myself that the fuss would die down in a few days and be forgotten. The reality is that the BPS allowed the PTMFramework, despite its evident bias and stigmatising attitude, to be published and available on their website. Registered clinical psychologists promoted it on Twitter, and the BPS and DPC logos are displayed on its front cover. And all this means the PTMFramework carries a backstory of reputability, reliability, and safety. This apparent endorsement by the BPS will encourage the stigmatisation of people with ADHD.
That’s why, here at AADD-UK, we talked and made a plan the first step of which was to send an open letter (below) to the British Psychological Society in which we set out our requests. If these are met we will consider the matter closed as far as we are concerned.
We sent our letter, via Twitter, to BPS on Tuesday, 23rd January but to date we’ve not had a reply.
Never mind, the longer the delay, the longer the length of rope.
We will wait until end of day on Friday, 2 February for a reply.
Tuesday, 23rd January 2018
Open letter to the British Psychological Society
Re: The Power Threat Meaning Framework (PTMFramework) *
We are a service user organisation and via public promotion on Twitter by the authors and their supporters we were alerted to the open availability of the PTMFramework.
We read it and were shocked by the strong, stigmatising suggestion that ADHD is an illusory, unprofessional, unscientific and unethical diagnosis.
We joined the public Twitter debate & gave this feedback to the lead author as well to @BPSOfficial and @UKDCP. We also pointed out that our views were not sought before publication. We asked for your response.
None has been forthcoming regarding our feedback about these two matters although a registered psychologist, supporter of the framework, did send us inappropriate tweets.
As this has taken place on Twitter, we are using the same platform to ask that the current version of the PTMFramework be retracted to allow the removal of all specific references to ADHD as well as all assertions and/or suggestions that ADHD is an invalid diagnosis.
We also respectfully suggest that the Framework be amended to meet academic standards.
Finally, we ask that you issue a public apology acknowledging the distress and stigmatisation that ADHD service users are experiencing due to the open-access publication and ongoing public promotion of the current version. We suggest that you also respond regarding the unprofessional tweets from the registered psychologist.
If these requests are met, we will consider these specific matters closed as far as we are concerned.
Susan Dunn Morua on behalf of AADD-UK
@AADDUK (other contact details supplied upon request)
1.Many psychologists are NOT supportive of this framework. Additionally, there are service users who reject their diagnosis, for valid reasons, and thus support the framework. AADD-UK fully understands, accepts and supports their right to make this choice. Our letter is only addressing the stigmatising attitude displayed towards ADHD people who have benefited from a psychiatric diagnosis
2. The British Psychological Society is a registered charity which according the blurb on their website does the following:
“. . . acts as the representative body for psychology and psychologists in the UK, and is responsible for the promotion of excellence and ethical practice in the science, education, and application of the discipline.”
“As a society we support and enhance the development and application of psychology for the greater public good, setting high standards for research, education, and knowledge, and disseminating our knowledge to increase the wider public awareness of psychology and its importance.”
Awenat, F. & Berger, M., Coles, S., et al. (2013). Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a paradigm shift. DCP Position Statement. Leicester: British Psychological Society
*Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society
Standards of Conduct, Performance and ethics for registered psychologists
[Editor’s note: Please be aware that this is satire so should not be read by anyone without a sense of humour. And probably not doctors of the old-fashioned sort. Despite this being humorous, all the excuses and maltreatment are based on real situations we have been made aware of, mostly on multiple occasions. Now read on…]
We’ve all had them in our surgeries.
“Oo Doctor, I think I may have ADHD. I’ve got all the symptoms” they whine, as if they know anything about themselves, their minds or medicine. You’ve probably rolled your eyes reading this and nodded in recognition and thought “If only there was a way to get rid of these timewasters!” Or Attention-seeking Dithering Hypochondriac Dolts, I call them.
Well, I’m here to tell you that there is a way. In fact several ways. Let’s have a look at some of them.
A) Ignore them. Yes, you read correctly, ignore them. Change the subject, ask a diverting question, bring up a topic spoken of earlier, or bring up another topic you hadn’t yet got to but had down to mention. Or even better, just come up with something new to worry them. You know what these idiots are like. Change the subject or give them something else to think about and you know they’ll forget what they were talking about until long after you’ve ushered them out of the surgery. Small note here – as you shove them out, point out that there are more patients waiting and you have to be fair to them. Remind your ADHDolt that you are very important and your time is precious, but they aren’t and their time isn’t.
Now you may worry that this tactic might be seen as wilful negligence, but remember that these blithering buffoons probably won’t remember and also really lack legal credibility. Who is going to believe a wittering serial user of mental health services compared to an upright member of the medical profession? No one, that’s who.
B) Deny, deny, deny. Okay, so you’ve got an ADHDolt that actually managed to stay on topic for more than two sentences, what do you do? This is actually more than one tactic, it is several but using the same method. Let’s look at the sub topics: Deny there is such a thing as ADHD in adults. You are important, your ADHDolt is not. Whatever they have read or cited (or brought in in those annoying little print-outs they do), just tell them they are wrong, and the information is wrong. Tell of them the courses and exams you passed and the years of experience you’ve had, and that you can assure them there is no such thing. If you have the nerve, just bluntly tell them you read an article about it in a newspaper and it said there’d no such thing. Start with a paper such as The Times, but you’ll find, as your experience and confidence grows that you can work your way down to The Daily Mail and The Mirror and they’ll accept it. Tip: try not to even sound positive that it exists in children, let alone adults.
If you do have to admit something, only acknowledge their problem long enough to get rid of them, not long enough to make them feel supported, and certainly not long enough to start any treatment. You should say something like: “I feel your pain. I understand your problems. I acknowledge the difficulties you have. Now piss off.”
C) Use delaying tactics. Even if they do work out who or where to be referred (which is pretty hard for a regular patient, let alone one of these disorganised bozos) – sometimes they’ve been along to one of these egregious “self-help groups” (which must be veritable buffoon-fests!”) or managed to print something off www.aadduk.org – a web site created and maintained by what one can only imagine is one of the world’s greatest slag heaps of tosspots and ne’er-do-wells – and they’ve actually got hold of the NICE guidelines and the name of somewhere/someone to be referred to (and, if out of area, a copy of the rules pointing out you are duty bound to refer there if there’s nothing suitable locally), delay!
Tell them you’ll think about it, or that you’ll look into it, to get them out of your office. Then do nothing. Most won’t remember. A good trick that has worked for a lot of people is to simply agree with them (yes, agree!). Tell them you’ll refer them. Then do nothing.
Here’s a great example of tactics I have to take my hat off to. A woman was worried about having ADHD and sought an assessment. Her children and husband all had (and still have) varying degrees and combinations of ADHD and Autism Spectrum Disorder. She was referred to the local service but didn’t hear anything for a while. Three times she followed it up and each time was told she’d hear something within two weeks. Needless to say, each deadline sailed by without her hearing a dickybird. She went to one of these loathsome busybodies that try and help and advocate for such people. The busybody complained and the practitioner was able to come back with not only a bunch of the usual excuses (someone’s on holiday etc etc) but also an absolute blinder. People being assessed for ADHD should chase up their own cases because… wait for it… it empowers them! Genius! Make it difficult for them, ignore them, sideline them and it is good for them! It’s part of the treatment! The sods should be grateful. Punch them in the face and then tell them they should thank you. Masterful use of delaying tactics there, followed up with an assertion so utterly outrageous it is almost impossible to counter. Full marks to whoever thought that one up.
Another brilliant delaying tactic is to find some other problem they’ve got and use that to avoid treating the ADHD. People who have had lifelong ADHD almost always have had anxiety and depression because of it. Just say that you have to treat the depression and anxiety first. Of course, if they go on bogging up their lives because of the ADHD they’ll go on feeling depressed and anxious, so you never have to treat the ADHD!
Quite a few have co-morbid Autism Spectrum Disorder. Get them on that. If any have mood swings or anger management problems, and they show them on front of you (or even a member of staff), you can bung them out on the spot for being abusive, and anyway you can put down “difficult patient” in their file’s private bit.You may even be able to get them banned from almost all the primary medical services in the whole area.
Or put them down as having a personality disorder (there are several, take you pick). A lot of areas don’t treat personality disorders so that finishes that, but even if your area does have such a service, and you actually think the patient does have a personality disorder, just treat them for that alone. Don’t make the mistake of admitting that it is possible to have ADHD and something else at the same time.
If you didn’t want to see people with mobility problems, you could agree to only see them in an office that is up three flights of stairs with no lift. Do the psychological equivalent to the ADHDolts. They just don’t have the gumption or organisation to stick at anything so just keep giving them hoops to jump through.
D) Divert. If denying or delaying doesn’t work, divert. Send them to the wrong type of therapy – in particular to a therapist that knows little of ADHD. This is widely practiced. One good example we know of was someone who had an assessment saying “Emma doesn’t have ADHD because she can concentrate sometimes.” [Editor’s note: if you don’t know why this is nonsense, then you really don’t understand ADHD. Name changed, BTW.]
Only a psychiatrist can diagnose ADHD so make sure to send patients to anything but a psychiatrist. Then, even if the person does realise the patient has ADHD, there is nothing they can do about it. That works so often, and even now never fails to make me laugh!
E) Discontinue. But, just suppose they’ve previously been treated by one of the increasing number of modern goody-goody doctors (who are letting the side down quite frankly). Suppose they actually are getting some treatment (thankfully probably only medication on a long-term basis) all is not lost. Get them off it!
There are all sorts of excuses, sorry, I mean reasons. Age is a good one. Almost every complaint treated is treated for the whole of the patient’s life, but sometimes they’ll believe the age thing with ADHD.
Keep doing blood tests. Liver ones are good, but do as many as you can. You might not take someone off statins at the first sign of liver problems, but do so with ADHD meds.
If any one of the possible side effects even if unlikely occur (and there’s a huge list on the leaflet with the medication – as with any medicine the leaflet has to list even the really unlikely and unproven ones), take them off. Now arguably you are supposed to refer them to an expert, but hey, just stop the prescription and let the ADHDolt argue. To see a specialist they have to go through you!
Depression and anxiety are great excuses. In one list of possible but unlikely side effects is “Behaving With Excessive Cheerfulness And Activity”! A happy productive member of society? We can’t have that. Get them off the stuff at once!
Oh, and any possible addiction or substance abuse even if you only have circumstantial evidence is a great excuse to get them off the meds. Now a lot of these whiners say they sometimes have trouble remembering to take their medication, which on the face of it looks rather the opposite of addiction. Have you ever heard an alky exclaim, “Damn, I forgot to drink vodka today!”? But remember, what you feel about the matter is a much better guide than what the patient reports.
F) And finally, if all else fails, remember to stigmatise them. The poor little darlings, because of their ‘life difficulties’ become sensitive to rejection. (Let’s be honest, if they didn’t keep claiming they had anything wrong with them, they wouldn’t keep getting rejected!) Be patronising. Ask them if they get a buzz off the meds. Tell them they are lucky to be seen at all, let alone diagnosed. Tell them how controversial the whole topic is, how expensive the drugs are, that they aren’t trying hard enough (especially on timekeeping – even if your surgery habitually runs late). After all, shame has been shown to work so well with topics such as addiction and obesity, and, let’s be honest, and the GUM clinics are a disgrace the way they go around treating people for diseases in a non-judgemental way. Let’s hope it doesn’t spread to the rest of the medical field or well end up letting these ADHDolts off the hook for their moral failings!
Goodbye and Don’t Forget To Grind The Bastards Down!
[Editor’s note: We would be delighted to hear your personal experience of trying to get assessed or treated for ADHD in the UK – we may be able to do a follow-up article. Please contact the (real) author: firstname.lastname@example.org
If you have or might have ADHD or otherwise been affected by this article please come to an ADHD support group or join our forum, and if you are having trouble getting treatment Here’s the relevant page on NICE, and here’s a summary of your rights and here are some more – try printing them out and taking them with you (sorry, currently in England, other regions to follow), and of course, please tell your story be it gruesome or funny – they’re often both – to Aethelred The Unready who is currently saddling his horse to sally forth against the ranking hordes of Schweinekopfs.]
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It was originally published here.
The following has been taken from the introduction to an Expert Policy Paper that explores the reasons why transitioning from child to adult mental healthcare is problematic and challenging. We’ve put a link to the full paper at the end of the following introduction:
Transition to adult services is often a difficult time for young people living with a mental
health condition. The journey through adolescence into adulthood is a time of significant
physical, psychological and social change not only for the adolescent, but also their
families. Overall rates of mental health problems can also increase during adolescence and issues become more complex, and in some cases serious disorders such as psychosis
may emerge. During this period, adolescents may also have a greater tendency for risky
behaviour, become lost in the system between child and adult mental health services and are also at greater risk of disengagement from services.
This Expert Policy Paper was developed on the basis of an Expert Working Meeting on
Mental Health and Transition, held in Brussels on 11 July 2017. The meeting brought
together expert clinicians (psychiatrists and neurologists), patient representatives, academics and mental health advocacy groups to explore the reasons why transition of care is currently suboptimal, discuss and agree on the principles for good transition and develop practical recommendations for improving transition to adult mental healthcare services. The group included expert stakeholders from the field of transition of care, mental health in general and attention-deficit hyperactivity disorder (ADHD).
The Expert Working Group highlighted that the problems associated with transition from child to adult services are not disease-specific; they apply to all mental health disorders, for example, epilepsy, autism and social phobia. However, to identify practical policy solutions, the Expert Working Meeting focused on ADHD as a case study in the analysis of the problems, barriers to change and potential solutions associated with transition of care.
ADHD is a diverse condition characterised by symptoms of inattention, hyperactivity
and impulsivity that can have a significant impact on patients’ lives. ADHD is relatively
common and often persists into adulthood. Despite this, access to adult ADHD services
and support is generally poor, resulting in frequent gaps in care.2,11 For these reasons,
ADHD provides an example in which to frame transition to adult services across the
mental health sector.
If you would like to read the full Policy Paper, please click on Bridging the Gap
Researchers for the study of Comorbid Conditions in ADHD (CoCA) at King’s College London are looking for adolescents and young adults aged between 14 to 30 years, who have a current diagnosis of ADHD and are on stable treatment for ADHD (i.e. medical or non-medical, or no active treatment at all), to take part in a new research study investigating the use of exercise and bright light therapy to improve low mood, weight problems and general health. Participation involves one of the following 10-week interventions as well as five visits to their research centre in south London for a number of physical and mental health assessments.
(1) Exercise programme – to evaluate the effects of exercise
(2) Bright light therapy – to evaluate the effects of bright light
(3) Treatment as usual – to provide a control group with no additional interventions.
1. Diagnosis of ADHD
2. Stable treatment as usual
3.Age 14-30 years old
4. No diagnosis of autism spectrum disorder, bipolar disorder, or any other severe psychiatric disorder requiring inpatient treatment
5. No severe medical or neurological condition not allowing bright light therapy or physical exercise
6. No history of epilepsy
They will help make the travel arrangements as convenient as possible and will reimburse all of your travel expenses. They will also provide a reimbursement of £200 for your time and effort, which will be paid in instalments for each of the five appointments attended.
This particular project is one part of a large international & collaborative ADHD research project (launched in April 2016) called “Comorbid Conditions of Attention deficit/hyperactivity disorder (CoCA)”. The aim of CoCA is to understand how and why ADHD often occurs alongside other physical and mental health problems, including anxiety, depression, substance use disorders and obesity. King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN) is one of 17 institutions across nine countries to receive funding for this project.
Through CoCA, the researchers hope to raise awareness of ADHD, reduce the stigma associated with ADHD, and empower prevention and therapy approaches as well as providing new tools to prevent ADHD from escalating into additional disorders.
How to get involved:
For further information as well as contact details please click on the following links:
Here at AADD-UK we avidly followed the news about mental health issues during Mental Health Awareness Week. We admired the bravery of those telling their own stories, we retweeted some general mental health links instead of those that only dealt directly with ADHD, all the while preparing for our 10th Year Anniversary by revamping our website. Then suddenly we realised we’d forgotten the elephant in our own parlour! So we decided to write, just before the week ended, our own position for Mental Health Awareness Week.. Here it is:
First, we thanked the Mental Health Foundation for hosting the week, and thanked them for commissioning the survey and consequent report “Surviving or Thriving? The state of the UK’s mental health.” The authors of the report wrote that despite “many areas of advances in human health we are not seeing these reflected in mental health. If anything, the signs are that we are slipping back.” They backed this up by shockingly disclosing that only 13% of those surveyed in England, Scotland and Wales had “high positive mental health” and that nearly “two-thirds of people say that they have experienced a mental health problem” and others were clearly “just about surviving.”
The authors further reported that those of us living with either low household incomes or unemployment have worse mental health than those employed at higher incomes. 3 in 4 people at the lowest income level, 85% of unemployed people, 7 in every 10 women, 7 in every 10 young adults (aged 18-34), and 7 in 10 people living alone experienced poor mental health. Additionally, the authors quoted the “Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014” (published last year) which revealed that every week 1 in 6 adults experienced a “common mental health problem, such as anxiety or depression. 1 in 5 adults reported that they had considered taking their own life at some point.”
I sat in silence and reflected upon those numbers and felt an overwhelming sadness. So much unnoticed desperation and despair! Swiftly followed by anger; “Who can I blame?” “Where shall I point my finger?” You see, all this correlated almost exactly with our own experiences in the ADHD world.
It’s been almost 10 years since we set up AADD-UK with hope and optimism. During that 10 years, the National Institute for Health and Clinical Excellence (NICE) published ADHD Guidelines in which adults were included for the first time. Of course there was some initial resistance but over the years more and more professionals became interested, more and more moved into the field, more and more research confirmed ADHD as valid (even the usual tabloid suspects now, tentatively, report positive ADHD stories) and there are more ADHD services in the UK than the 3 that existed 10 years ago.
But all is not well! As awareness of ADHD grows, funding for ADHD services dwindles. Some GP’s, due to funding shortages, are reluctant to refer us to services. In truth, not all of the ADHD services have enough funding to meet the NICE Guidelines. It’s even been suggested, in one known circumstance, that the Guidelines be disregarded. A couple of services have surreptitiously tried to close. Some have decided not to publicise their contact details for fear they’ll get more referrals than allowed for by their funding. Of course, this means that waiting lists are getting longer and longer; even up to 2 years long! It’s true that gate keepers and sign posters cheerily point us to psychological therapies suggesting we use them while waiting. But guess what? Yep that’s right! We’re shuffled onto the end of another waiting list where some of us must try not to listen to whispers about the low quality of the offerings. So, there we are, stuck waiting, struggling to cope with abysmally low self-esteem, hurting, lonely, barely surviving. What does this matter when it’s said that ADHD makes us resilient, that we’re used to hard knocks, that we’re survivors? It matters because we understand too well that surviving is not thriving and that knowledge is painful!
And what about those of us who’ve been diagnosed and are taking medication? We’re all thriving right? Well not exactly. Medication is indeed all that some of us need. We can now concentrate as well as focus better. That helps us to, at last, move on and up. It helps us to feel relief as well as feel the joy of achievement. Some of us can even choose between seeing a consultant privately for follow-ups or waiting months to see the same consultant on the NHS. There’s a group of us too who, after a competent diagnosis of ADHD, don’t need any further help, not even medication. It’s enough that somebody listened, took us seriously, evaluated patterns underlying our difficulties, and found a way to help us understand. That’s all we needed to find our own way, to thrive and flourish.
Some of us, though, have been so pressured and battered by an uncomprehending and stigmatising life that the clarity that comes with medication also carries the aching revelation that our graceful childhood spirits have turned into cut-down and subjugated ghosts. Taking the right medication is not all we need. Before we can move from surviving to thriving we need help, we need to rediscover our true spirits, our real potential. Yet we’re stuck in the low income, or underemployed, or unemployed bracket. So we ask the NHS for help, get sign posted to psychological therapies, by the same cheery folk our clan members encountered, and off we shuffle to join the end of a waiting list. There we are waiting, masks firmly in place (we don’t want pity), acting as if we don’t care but feeling worn-out, inside crying, mourning for our lost and trusting childhood. We’re surviving and that’s all!
Still, at least the mere fact that we’re waiting allows us a bit more hope than those of us who’ve not been noticed. Some of us in this group are being shuffled from one wrong diagnosis to another wrong diagnosis, from one wrong medicine to another wrong medicine. Never having our true reality heard or acknowledged. Some of us become disheartened, lose faith and sink into helplessness. And then what about those of us who learn to believe from early on that we are seemingly born to live life as a failure, never understanding why that appears to be our fate? All of us too are barely surviving!
It’s such a waste because every single one of us with ADHD has the potential to flourish. We would love to use our strengths and abilities to help others, to be a benefit. We don’t need much. Just the right attention and the right support at the right time. Actually you know what? That’s not hard to provide!
Now I’m angry again so I’m jumping right off the fence and pointing my finger squarely at you, the Government. I’m pointing at you, Theresa May, as well as at you, Jeremy Hunt. If you get back in charge, for goodness sake stop with your wasteful changing, privatising and building inequality into the health service. Instead, if you really care about helping people to thrive, helping the country to prosper (you do, don’t you?), stand back and for once look at the big picture.
The prevalence rate for children with ADHD is between 5 to 7%, of whom approximately 65% will continue to experience symptoms in adulthood. In other words, roughly 3% to 4% of all adults have ADHD. To make it clearer, about 1 in 25 adults have ADHD. That’s a lot of us! That’s a lot of us costing you a lot of money!
Leaving us unrecognised, undiagnosed, untreated or treated ineffectively, or pushing us onto waiting lists is costing you, the Government, a lot of money in lost tax revenue, inappropriate treatments, repeat visits to A&E, clearing up after our accidents, looking after our brothers and sisters in prisons, and so on and so on (you want evidence, ask and we’ll give it freely). It’s cheaper, far cheaper, to increase NHS mental health funding so that all of us can receive proper help! We want to use our strengths, abilities and skills. We can use them to thrive and flourish!
And here’s a final note, the need for mental health awareness and funding did not disappear with the end of Mental Health Awareness Week. The two thirds of people living in England, Scotland and Wales who’ve experienced mental health problems, including all of us with ADHD, are still here on Monday morning. Funding and treatment for everybody experiencing mental ill health is still needed and is still vital. With that, and with preventative care, all of us will thrive and flourish and so too will the country.
I’ve had my say for now! It’s time for you, the Government (whichever of you ends up in charge) to listen and act!
Background and context
This survey came as a result of the researcher’s collaboration with AADD-UK and his regular attendance to 4 support groups which generated questions in relation to the development of adult ADHD support groups; how many groups are there in the UK, what is their membership and what do they do? The numbers of groups making contact with AADD-UK and its website has been growing in the last five years; they are very diverse in their organization, in what they provide and so are the local contexts in which they evolve. But they all have in common that they provide a much needed space for information, help and support for individuals who are or have yet to be diagnosed with ADHD as well as for their relatives and partners.
The aim of this survey was to provide an updated picture of the state of adult ADHD support groups in the UK; we hope this would in turn help individuals, families and professionals in accessing updated information on the AADD-UK website for better local signposting.
SUMMARY OF FINDINGS
1. Significant increase in numbers of support groups, starting from 2009, peaking in 2011 and an increase of membership.
It is worth noting a rapid increase in numbers of groups since 2009, but it is unclear if this trend will continue. Some groups have also folded in the last 2 years, mainly for reason of lack of funding and so the present economical context may make it difficult for some groups to develop or sustain their activities. An increase in membership has also been observed in the three groups the researcher has had contact with since 2009; the average attendance then was of 11 members per meeting, it is now in 2013 an average of 19 members per meeting with a gender mix of 52% male, 48% female.
2. 9 groups out of 23 , just under 40% , receive funding
There are more groups receiving funding than ever before, and the more recent groups seem very good at that. More data is required to understand how funding is accessed, if groups are set up as charities, social enterprise and how sustainable the funding is.
3. Three quarters of the groups are run by adults who describe themselves as having ADHD.
Despite the difficulties that ADHD can produce the large majority of groups are run by facilitators that identify themselves as having ADHD, and some do this in partnership with people who do not have ADHD. Out of the 14 new groups that have formed since 2009, 13 of them have been formed by adults identifying themselves as having ADHD. More research would help in understanding what their experiences bring in the running of a support group.
4. Wide range of activities, including 6 groups providing structured courses.
The groups are adapting to the local context and the needs of their members with ADHD and provide more and more services that are not provided anywhere else. But the main activity the groups have in common is the support and help they give to each other through the sharing of their experience of living with ADHD.
We believe these findings show a vibrant and growing community of support groups for adult with ADHD that are resourceful and determined to provide a safe place to share experience and information.. This survey highlights some of the common points between groups but the diversity between groups is also worth noting, each group is unique in its history and style and respond to particular local circumstances. The full survey is available in our library here.
Claude Jousselin and the AADD-UK team.