Nobody is asked whether they are back to their old self with treatments or of the duration of recovery. But these are the metrics that are most important to service users. It appears that evaluations primarily meet the needs of service providers and their academic fellow travellers. The NHS controls Service Providers and it is in their interest to use self-report measures, that give a positive spin to their ministrations. People present at their worst and so there is an inevitable seeming improvement with attention and time on a questionnaire. It is spin not to present apparently positive results in the context of what happens to those not given treatment. The reality is Talking Therapies clients does no better for clients than if they had attended a Citizen’s Advice Bureaux.
In routine practice service users are asked to complete a psychometric test, when their score falls below a cut-off they are discharged. But there is nothing in the process to guarantee:
- the test that was administered is appropriate to their diagnostic status
- the score achieved is a surrogate for loss of diagnostic status as assessed by a blind independent rater using a standardised diagnostic interview
- that there has been an enduring change in the service users functioning that they would recognise
But the same considerations apply to the assessment of the impact of antidepressants. A blog from John Read, Professor of Clinical Psychology at the University of East London shows that the focus has been on the impact of medication over 8-12 weeks and the experience of withdrawal symptoms such as nausea, dizziness as assessed on a scale. Notwithstanding that most patients have been on antidepressants for years and that the withdrawal symptoms are the least of their concerns, ‘I’m still bloody depressed’.
Dr Mike Scott