Division of Clinical Psychology Position Statement on Classification

The British Psychological Society, Division of Clinical Psychology, released this position statement yesterday. Some elements of it were discussed on Sunday in the Observer and on other media outlets.

What I intend to do here is briefly comment on each of the major sections of the statement.

Context

Much of the emphasis is on schizophrenia, bipolar disorder, personality disorder, attention deficit hyperactivity disorder, conduct disorders rather than dementia, neuropsychology and learning disability. As the positions statement makes clear there has been considerable disquiet and debate about those diagnostic categories for over a decade. There is also growing disquiet about the ever increasing reach of diagnostic categories into everyday life and the medicalising of more and more aspects of everyday life.

The position statement is careful to note that biological factors are not being ignored, but that the primacy given to them by a disease model needs to be challenged.

The Role of Clinical Psychologists

Obviously the position statement re-affirms the role of clinical psychologists.

The Rationale for a Paradigm Shift

I am normally uneasy with the term paradigm shift being used in the social sciences, however this position statement does the use the term to mean a fundamental shift in world view, which would seem to fit well with the original meaning.

Core Issue 1: Concepts and models

Six conceptual issues are described:

1. Interpretation presented as objective fact
2. Limitations in validity and reliability
3. Restrictions in clinical utility and functions
4. Biological emphasis
5. Decontextualisation
6. Ethnocentric bias

While these are not a surprise to me it is apparent that much of that debate has not penetrated that far outside of the academy.

Core issue 2: Impact on service users

1. Discrimination
2. Stigmatisation and negative impact on identity
3. Marginalising knowledge from lived experience
4. Disempowerment

The hope is that this paradigm shift can address these issues.

There then follow five action points.

Action point 1
To share within the DCP and through pre-qualification training and continuing
professional development, the issues raised by this statement. The aim is to
achieve greater openness and transparency about the uses and limitations of
the current system, and enhance service users’ and carers’ awareness and
understanding of the issues.

Action point 2
To open up dialogue with partner organisations, service users and carers,
voluntary agencies, and other professional bodies in order to find agreed ways
forward. This will necessarily include safeguarding access to health and
social care, benefits, work support, and legal and educational services that are
currently diagnosis-based.

Action point 3
To support work, in conjunction with service users, on developing multifactorial
and contextual approaches which incorporate social, psychological
and biological factors.

 Action point 4
To ensure that a psychosocial perspective and psychological work are
included in the electronic health record.

Action point 5
For the DCP to continue to promote the use of psychological formulation as
one response to the concerns identified in this statement. 

 I feel in addition to these actions there is a need to enter into dialogue with people in general, as well as service users, carers and partner organisations.