Monday, September 22, 2014

Responsible clinicians under the Mental Health Act

As I said in my previous post, I have been reading Peter Kinderman's new book, A prescription for psychiatry. He suggests that, "In time, I believe it should be routine for the 'responsible clinician' [under the Mental Health Act] to be a psychologist or social worker". He makes an interesting reference to discussions on New Ways of Working in which he was involved on behalf of the British Psychological Society. He objected to a phrase, which did not appear in the final report, about the "clinical primacy of the consultant [psychiatrist] in dealing with treatment resistant, acute, severe or dangerous clinical situations". Peter does not agree with the concept of 'clinical primacy'. However, if it does have any meaning, it may arise because generally consultant psychiatrists, not psychologists or social workers, undertake the responsible clinician role.

I've commented before on this issue (see previous post) in relation to an eletter by Sam Thomson and Peter in response to what Peter calls in his book the 'Bracken Manifesto'. Clinical psychologists have been split about whether they should take on the role of responsible clinician. Peter quotes from David Smail, who unfortunately recently died (see tweet), who thought that it was good that "the only power we have [as clinical psychologists] is power of persuasion". Peter thinks what's more important is the "markedly different framework of knowledge and skills" of clinical psychologists, rather than their "historical absence of formal power" under the Mental Health Act.

I would have liked to have seen more discussion of this issue in Peter's book. Would Peter go as far as suggesting that recommendations for detention under the Mental Health Act should not be restricted to doctors? I think the logic of his position suggests he would.


Anonymous said...

A quick response to this blog post which just arrived by Email. It was the mention of "I believe it should be routine for the 'responsible clinician' [under the Mental Health Act] to be a psychologist or social worker".

In particular the thought of a social worker being in such a "responsible" position. Very scary. I haven't found social workers, on the whole, to be professional in mental health settings and have had to raise a number of complaints about them. One is ongoing.

In Scotland we have Mental Health Officers under the Act, meant to be specially trained social workers who act as a go between, the patient and the psychiatric system. I have found that MHOs are neither one thing nor the other, can hinder the process by dint of their dubiety of role.

As for clinical psychologists being in that position I am not convinced of that either. Animal Farm comes to mind. Therapists and CPs should be more like advocates, standing alongside the patients/people. Bringing balance by helping the patient take control of their own life. They are not, and should not be, pretenders to the throne.

If clinical psychologists want to influence psychiatrists then let it be in their therapeutic practice so that psychiatrists become more skilled therapists rather than clinical psychologists becoming more clinical.

I speak from the perspective of a person who has tapered psychiatric drugs, on 3 separate occasions over 25 years, and made a full recovery after each. I did this under my own steam with no help from clinical psychology. More recently my son and I were supported by his psychiatrist in Fife to taper his antipsychotic, with my peer support, he is now drug free although with a mental disorder diagnosis.

I am critical of psychiatry but this does not translate into critical of psychiatrists as a whole. Rather I'm critical of the system which isn't working well enough, for all sorts of reasons that don't lie solely at the door of psychiatrists. And I'd rather have a psychiatrist than a clinical psychologist or social worker as the most "responsible" person despite their faults.

(I've written this quickly so hope it makes sense)

Cem Atbasoglu said...

The responsible clinician is a problematic idea, to begin with. If that is formally stipulated in your country, that's bad news. Psychiatry worldwide entertains the brain disease illusion. Many psychiatrists are either trained unaware of the possibility of general medical conditions causing behavioral symptoms, with a wishful belief in the magic of pharmacotherapy, or forced later by the system to a clinical reasoning based on reification. Clinical psychologists are ...well psychologists, not clinicians.

Scary indeed.

Anonymous said...

Giving more varieties of quacks the power to force their way into peoples lives against their will, is something that will happen, because we live in a therapeutic technocracy not a democracy. The people targeted for this unwanted "help", by definition, will not get a say in the matter. The hubris of forcing quackery on distressed people against their will, will continue to dominate the scene. The people labeled "ill" have never had a say. This is a debate that will occur amongst the elites, the elites that prove they don't give a shit what the mundanes think, simply by virtue of the elites using force and coercion to have their way with the mundanes.