‘We need to step away from artificial targets’ in Pulse @mgtmccartney & @PeterDLROW

We need to step away from artificial targets‘ in Pulse, 7 November 2014

As the lead of a new group tasked with examining the harms of overdiagnosis, Dr Margaret McCartney (@mgtmccartney) tells Pulse reporter Caroline Price why a wider debate is needed about the direction medicine is heading.”


Dr McCartney has wasted no time in using her platform on RCGP council to take these concerns right to the top of the agenda. Since her election to council last year, she has instigated the creation of a new standing group, specifically tasked with addressing these problems and giving GPs more support and professional guidance on how to deal with the conundrum in their daily practice.

The creation of the group, she tells Pulse, has come out of growing concerns from GPs that the Government is shifting the focus away from those patients with the greatest need onto preventative measures for healthy people, for which the benefit-to-risk ratio is far less certain.”


She says: ‘We’re interested in policies that drive over-diagnosis and under-diagnosis – in particular thinking about prescribing practices, guidelines and QOF and what could be done to try and help in those areas.

‘We’re also thinking about practice day-to-day. How to make good evidence-based decisions with patients in the stress of a 10-minute consultation – and quite often two or three problems from patients. So, what kind of information we need easily on hand within five seconds, to help GPs and patients make good decisions.’

But Dr McCartney is also clear these problems are part of a wider debate to be had with patients and in society in general, about the direction of medicine and how best to use limited healthcare resources.

She says: ‘I think it’s patients who deserve to know that the resources are not going in the right direction at the moment and that we should be redirecting it to people who are most likely to benefit.’


Similarly, Dr McCartney argues the controversy over policies to incentivise GPs to screen for and diagnose dementia marks a watershed – a time to ‘let go’ of targets and let GPs’ professionalism take precedence.

She says: ‘There is a revolution needed, we need to step away from targets… that create deprofessionalisation of our work, and let go.’

She adds: ‘Doctors are vocationally trained, reflective people paying attention to the evidence… peer review, being open about diagnosis rates, alert to criticism – that should be what we are basing our practice on. It should not be the creation of artificial targets.’”

[Read complete article]

Comment from Dr Peter J. Gordon (@PeterDLROW), Psychiatrist for Older Adults, NHS Scotland; 25 November 2014

“NHS Scotland had a financially incentivised approach to the “early diagnosis” of dementia. This was HEAT Target 4. The target was reached and the Scottish Government were triumphant about this presenting the achievement to Westminster in 2012 (All Party Parliamentary Group)

NHS Board in Scotland took robust measures to reach the target and thus gain the financial reward. Practice became skewed in many ways to reach the target.

This target was set by the Scottish Government. The most Senior Official for Mental Health in the Government (Mr Geoff Huggins) stated that the Government had been careful “to take out saboteurs” and that any disagreement by doctors or managers would be dealt with “behind the bike shed”.

Wind on nearly 4 years and it is emerging that elderly patients were mis-diagnosed with “early dementia” as a result of this target. In fact they have static age-related memory loss and not dementia.

Scotland stands as evidence emerges of the harmful effects of an incentivised target based on “early diagnosis”. It is no light matter to make a wrong diagnosis. Ask those mis-diagnosed.

I personally campaigned across the United Kingdom for an approach based on a TIMELY approach to diagnosis. This approach was completely rejected by the Scottish Government throughout my “engagement” with them. But CURIOUSLY the Scottish Government are now taking credit for a timely approach to diagnosis. This is quite sickening as Scotland could have offered an important lesson had the Scottish Government been open, honest and shown probity.

I agree with all those who say that chasing a crude uncertain population target, a target that is politically motivated and has been promoted RELENTLESSLY by the Alzheimer’s Society is UNETHICAL.

This approach risks generating a huge amount of fear. It also risks medicalising too much of ageing such that those living with dementia are further disadvantaged as services get ever more stretched.

Above all a TARGET like this, and I realise that NHS England call it an “ambition”, ignores complexity and the parabolic distribution of cognition over our life course. Our elder generation deserve far far better.”


being singled out for “special treatment”

I’ve never liked to be singled out for anything, whether it be praise or admonishment.  Didn’t you do well.  Aren’t you clever.  Go to your room.  You are banned.  That hairstyle suits you.  Where did you get that hat?

For I think that “special treatment” in mental health matters can be another word or words for patronising, patriarchal, bullying, stigmatising and discriminating behaviour from people who have labels after their name.  Rather than labels instead of their name.

For example.  I am a psychiatrist.  I am a social worker.  I am a mental health service user.  I am a schizophrenic.  I am a train driver.  

The other day I was speaking to a class of social work students and said that I call myself a psychiatric survivor.  Some said they found that term offensive, took it personally.  I said that for me it was empowering, it made a statement about my personal experience.  

To go about saying “I am a former mental health service user” or “I used to use mental health services” would definitely, in my opinion, single me out for “special treatment”.  Same goes for being known as a “psychiatric survivor”.

I’d rather be sent out of the room for challenging the system than stay in the room and be subject to patronising, patriarchal, abusive treatment.  That’s for sure.  I’ve never been one to lie down and take it.


‘Going Deeper into “Madness”: ISPS 2015′s International Dialogue’ Ron Unger on madinamerica

rungerGoing Deeper into “Madness”: ISPS 2015′s International Dialogue‘ Ron Unger, Mad in America, 23 November 2014

Recovery from “Schizophrenia” and other “Psychotic Disorders”

“As awareness spreads about there being something wrong with existing approaches to “psychosis” aka “madness.” Interest grows in exploring what to do instead.  One meeting place for exploring this question of “what to do” will be the ISPS conference in NYC in March 2015, which is titled “An International Dialogue on Relationship and Experience in Psychosis.”

“… one great article from the journal Psychosis, which you can access for free is “Spirituality and Hearing Voices:  Considering the Relation.)

ISPS publishes a number of books (listed here – anyone can use the access code “ISPS14” to get a 20% discount when buying ISPS books from Routledge (use that link) before December 31st, 2014.  The most popular book in that series has been “Models of Madness:  Psychological, Social and Biological Approaches to Psychosis” edited by John Read (who has extensively documented the links between childhood adversity and psychosis) and Jacqui Dillon, chair of the UK Hearing Voices Network and an international speaker and trainer.  This book is now in its second edition.

Finally, as a possible substitute or supplement to in-person conferences, ISPS is beginning to hold online meetings, which are expected to occur about monthly.  The first such meeting will be Friday 12/12/14, noon EST, featuring Bertram Karon on the topic of “Who am I to treat this person? What it feels like to treat a ‘seriously mentally ill’ person.”  Those who attend will have opportunities to ask questions and to share their thoughts.

For those of you not already familiar with Bertram Karon, you should know that he has extensive experience providing therapy for people diagnosed with schizophrenia and in researching such therapy, and is co-author of the book “Psychotherapy of schizophrenia: The treatment of choice.”   He was also recently interviewed on Madness Radio.  You can read a bit more about him, and also register for the online meeting, at https://ispswithkaron.eventbrite.com ….”

Read complete blog post


NHS Forth Valley – Hospitality Register 2013/2014

Hole Ousia

As petitioner for the Sunshine Act I undertook Freedom of Information Requests to all 22 NHS Boards in Scotland to establish if Boards had  Registers of Interest for ALL staff. The findings revealed that most Boards did not.

NHS Forth Valley has kept Registers of Interest from 2010 to current date. Following persistent enquiries by myself regarding public transparency these have recently been made available on-line.

This accords with the guidance in HDL 62, issued 2003: “Chief Executives are asked to establish a register of interest for all NHS employees and Primary Care contractors”. For this, and for taking the extra step of ensuring public access to the registers, NHS Forth Valley are to be congratulated.

This blog post encourages you to consider the contents of NHS Forth Valley’s Hospitality Register for 2013 to 2014 as an illustration of the involvement of sponsorship of Continuing Professional Development (“CPD”).

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misogyny and mental health

I do wonder if it’s inevitable in a patriarchal system like psychiatry that we will be faced with misogyny at every level of our engagement in mental health matters?  I’ve found it at the grassroots with paid workers who think they have the right to bully women and mental patients who have been treated like women in psychiatric settings.

I’ve been faced with it recently.  Male workers trying to speak on my behalf and when that doesn’t work then they have a go at bullying me into submission.  Which definitely won’t work, that’s for sure.  There is nothing more irritating to be patronised then picked on by people who are more ignorant than I am.  It means I have to “man up” and get them telt.  

They don’t like to be told and it can lead to an argy bargy with them losing their “cool” and making a fool of themselves in front of others.  Then I just get bored with it.  Move on to other things more interesting. 

scapegoating and solidarity

Yesterday I experienced again what it feels like to be the scapegoat in a situation, the one singled out for “special treatment” because I had a different stance from the “others”.  It didn’t feel pleasant to be ganged up on.  It never does.  However I wasn’t alone.  Friends stood by me.  In solidarity. 

It caused me to think of “mental illness” and my family where all of us through 3 generations have been in and out of the psychiatric system.  All of us subject to “special treatment”.  Forced drugging, detained under law.  Some of us got ECT, others of us didn’t.  Shared pain.  In solidarity.

I think our experience is special and something to be proud of.  A good thing, a bonus.  We have on occasion had to take each other into psychiatric settings and help each other out.  I’ve been more of a rescuer and an advocate for family members.  It’s been a privilege.  A calling.

But I’m not prepared to be scapegoated by “others” for no good reason.  I will resist the “special treatment” because it isn’t special or clever or nice.  I call it bullying and intimidation.  For that’s what it is.  None of us deserves to be singled out in that respect.  I won’t stand for it.  That’s for sure.


Capacity and Consent – Scottish Parliament has to act – Scottish Government has to serve and be accountable

[An Email response I wrote this morning to a mental health human rights campaigner who had sent his paper on Capacity and Consent which was “relevant to the two petitions” that he “submitted to the Public Petitions Committee”.  I was copied in to his Email along with a number of fellow campaigners, journalists, law experts, MSPs and others.]

“Dear …… thanks for your Email.

I agree with you that “a conference that incorporated campaigners, mental health professionals, human rights experts and legal experts” makes perfect sense and would enable frank and honest discussions, all voices to be heard, more level playing fields and meaningful involvement.  

I was excluded from the Scottish Patient Safety Programme for Mental Health (SPSP-MH) events from its inception until the present day.  Why?  Healthcare Improvement Scotland (HIS) chair Denise Coia gave no full explanation and neither did Ruth Glassborow who used to work with Scottish Government and now works with HIS.  The only reason given was that if I attended then “others” wouldn’t attend.  No good reason whatsoever.  And then I received an Email from Dr Coia, apparently mistakenly sent to me, which talked about me.  I also questioned the allocation of places for the IIMHL in Manchester, but as usual got no response.

I believe that I was excluded from patient safety events because of the dehumanising treatment perpetrated on my son in Stratheden Hospital in February 2012.  At the time this happened I was a member of the Scottish Crisis and Acute Care Network Steering Group, whose co-leader was Dr David Hall, also lead on the SPSP-MH,  The crisis steering group therefore was a party to all that happened with my son in the seclusion room of the Stratheden IPCU.  There could have been no dubiety because I wrote blog posts about it at time, in detail.

I complained again about being excluded, this time in June from celebrations at Edinburgh Castle where fellow psychiatric survivors and mental health service users were invited to an event with Alex Neil, MSP and CabSec for Health (I saw photos on Facebook), and I wasn’t.  I wrote an Email about it on the morning of 24 June 2014, to Alex Neil, Michael Matheson, Nicola Sturgeon and Alex Salmond, then forwarded it to Geoff Huggins and his colleagues on the SG mental health division.  And then at 5pm 24 June I received a bullying and undermining Email from Mr Huggins which slandered my intentions and character.

On 25 June I had been booked to present a paper at the Liverpool INTAR conference, on the Mental Health Act Safeguards, and had to give apologies due to being upset at Mr Huggins Email which hurt me because of its unfair allegations about my character.  Then on the 27 June my son had to call out the paramedics on my behalf due to blood pressure issues.

On 29 September 2014 I received a letter from SPSO telling me that my complaint against NHS Fife, in respect of “unreasonable treatment” of my son in the Stratheden IPCU seclusion room, was upheld.  He had been locked in for hours on end with no toilet, drinking water, light switch outside, broken hand untreated.  He had also been transferred in his underpants and bare feet, I was a witness, by porters, without any covering, between acute and locked wards, in a minibus.  I saw his shame from outside in the car park where I had been left to stand for hours.

I agree that there does seem to be a “cover up” and a silencing of critical voices in Scotland’s mental health world.  No dissenters allowed.  Furthermore there is a maligning of reputations when we will not be silenced or “shut up and go to bed”, as I was told by a VOX (national mental health service user organisation) Board member.  The chair of the VOX Board is employed by NHS, works with HIS.  A conflict of interest.  They are more of a focus group of government (FoG) rather than a member led group, to the detriment of “meaningful involvement”.

Even the other week at a Mental Welfare Commission consultation in Edinburgh I had two VOX Board members bending my ear about their Board Chair and her links with HIS and Scottish Government.  As if I could do something about it.  No I can’t.  I have tried and the game’s a bogey.  If the world is watching Scotland in terms of mental health matters or the work of Healthcare Improvement Scotland then what they are hearing from HIS on social networking is nothing like the reality.  That’s for sure.  

“If ye want to ken us then come and bide wi’ us.”  The reality of being a mental (psychiatric) patient in Scotland is one of Russian Roulette and a postcode lottery.  Nothing is guaranteed.  Patients aren’t safe.  Mental Health Act safeguards don’t work, in my experience of both NHS Fife and NHS Tayside, Stratheden Hospital in 2012, Carseview Centre in 2013.  I knew my rights and we knew the MH Act but that made no difference because the Act was not implemented properly or monitored effectively.

Mental Health Tribunals are weighted in favour of the “professionals”, the patients are often drugged up before attending.  Advance Statements are altered by psychiatrists to fit their regime.  Named Persons if they also happen to be mothers and carers are not respected.  Independent Advocacy isn’t independent and isn’t available when you really need it, the workers are paid a pittance compared to other “professionals”.  In my experience Mental Health Officers behaved unprofessionally and the Mental Welfare Commission were wise after the event and had no power to influence health boards to improve buildings that they had declared “unfit for purpose”.

I hope that you will be heard, that justice will be done, that Scottish Parliament will act and that Scottish Government civil servants will be accountable.

Yours sincerely,

Chrys Muirhead (Mrs)”