Fact or fiction? Post-truth policy writ large

  1. In their recent policy document, The Future of Psychology in Australia, the Australian Psychological Society (APS), cited National Institute for Health and Care Excellence (NICE) and other clinical guidelines as evidence for their recommendations.

The cornerstone of the APS policy document was the recommendation that psychologists without an Area of Practice Endorsement (AOPE) should not be permitted to work with individuals diagnosed with eating disorders, psychotic disorders, conduct disorder, borderline personality disorder, or those with recurrent and persistent depressive disorders. These disorders were termed ‘high intensity’ and their treatment was restricted only to psychologists with ‘advanced competency’ as denoted by AOPE.  A range of other MBS items was also proposed exclusively for psychologists with AOPE.

Despite the sweeping implications of this for the community and the profession, the document failed to provide a shred of evidence to support the premise that AOPE reliably or validly predicts a construct of ‘advanced competency’ to justify the terminology.*

We asked NICE what they thought of the conclusions the APS drew in the name of their guidelines. Unsurprisingly, they did not support the APS’s re-imagining of the material and confirmed this in a recent email to RAPS:

“We have not made any overall recommendation that only clinical psychologists can work with these conditions. Each clinical guideline includes recommendations on assessment and management of the particular condition. These include recommendations relating to psychological interventions.” [personal communication]

At a time when corporate interests are driving public policy, and community mental health is in crisis, the public are at greater risk than ever of their needs being placed last behind a long line of commercial determinants of public mental health policy. What a shame, that when the public need them most, the APS is writing fiction.

The Governnment considers APS to be the voice of Australian Psychology. Is it speaking for you? It’s clearly not speaking for NICE. But does truth drive policy in the current era? It would appear it does not.

* In the post-truth era ‘advanced competency’ exists independently of the presence or absence of a clinician’s advanced applied skill or expertise in a particular psychosocial domain.

Response from NICE:

Dear XX,

Thank you for contacting the National Institute for Health and Care Excellence (NICE). I am sorry for the delay in responding. This is due to a high volume of enquiries.

We have published a range of products on mental health and behavioural conditions and this includes individual clinical guidelines which cover the topics you mention in your email below.

We have not made an overall recommendation that only clinical psychologists can work with the conditions you have listed. Each clinical guideline includes recommendations on assessment and management of the particular condition. These include recommendations relating to psychological interventions.

For further information you may wish to refer to the recommendations in our guidelines that are referenced in the APS White Paper The-Future of Psychology in Australia. I have provided the links below.

Attention deficit hyperactivity disorder: diagnosis and management [NG87]
Depression in adults with a chronic physical health problem: recognition and management [CG91]
Antisocial behaviour and conduct disorders in children and young people: recognition and management[CG158]

When exercising their clinical judgement, healthcare professionals should consider the circumstances and wishes of each individual patient, and make appropriate decisions on a case-by-case basis. It is not mandatory to apply our guideline recommendations, and the guidelines do not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian, as appropriate.

I hope this information is helpful. Please tell us how we did by completing our short survey. It will only take you a couple of minutes.

Kind regards

Heather

Communications Executive (Enquiries)
National Institute for Health and Care Excellence
Level 1A, City Tower | Piccadilly Plaza | Manchester | M1 4BT | United Kingdom
Tel: 44 (0)300 323 0141 Fax: 44 (0)300 323 0149
Web: http://nice.org.uk