British Psychological Society is being examined by Charity Commission re complaints over the right for psychologists to prescribe drugs including hormone blockers to transgender patients

[ChristinaXYZ]

From the Telegraph

www.telegraph.co.uk/news/2021/04/25/exclusive-british-psychological-society-faces-charity-commission/

The British Psychological Society (BPS) is being examined by the Charity Commission as it faces complaints including allegations that it is potentially putting patients at risk by arguing for the right for psychologists to prescribe drugs including hormone blockers to transgender patients.

The learned society faces allegations of poor governance, lack of openness and transparency and silencing academic dissent, and The Telegraph understands the president-elect is among those to have complained to the regulator.

There have been at least 10 complaints to the commission, which has confirmed that it is "examining concerns about the governance and management of the BPS as part of an ongoing regulatory compliance case".

It comes amid claims that a recommendation to the NHS that psychologists should be given prescribing rights was a "biased" process "skewed" toward making it easier to prescribe hormone blockers.

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Psychologists do not currently have the power to prescribe drugs, but discussions are ongoing at the NHS on whether to recommend that ministers should be advised to change the rules.

Alongside concerns over the prescribing of hormone blockers, fears have been raised by some BPS members that such a change would lead to an increase in the prescription of drugs such as antidepressants and the over-medication of patients.

Peter Kinderman, a former president of the BPS and professor of clinical psychology at the University of Liverpool, said the society needed to "get its act together" as the advice that it gives on such issues is of "dramatic importance".

Peter Kinderman warned that the society needed to 'get its act together'
Peter Kinderman warned that the society needed to 'get its act together'
It comes as a number of trustees resigned including David Murphy, the vice-president, who publicly cited concerns "about governance oversight, escalating expenditure and lack of openness and transparency".

The BPS said in a statement that the board "has to make difficult decisions" and if a trustee cannot accept the decision then "the correct course of action is to step down".

The society is also embroiled in a police investigation for fraud by abuse of position after a female employee allegedly spent huge sums on a credit card. She has been arrested and bailed by Leicestershire police.

Members, including two former chairs of the society's Division of Clinical Psychology, have set up a campaign group to call for a change in the way it is managed.

One dossier of complaints to the Charity Commission, being considered by a caseworker at the regulator, details seven allegations against the society including routine failure of the complaints process and censorship of academic freedoms and dissent.

The regulator has been told the BPS "flatly ignored" a letter from 100 members expressing concern about the issue of prescribing rights, recommended in a report published by the society in October. The letter, seen by The Telegraph, warned that the professionals had "grave concerns about the proposal to extend prescribing rights to some psychologists, and about the process through which the BPS view is being decided".

Prof Kinderman sat on the panel deciding on the issue and said members had attempted to make their recommendations in favour before the consultation had even concluded.

The professor, who is opposed to extending prescribing rights to psychologists partly because of concerns about society's over-reliance on medication, said the "agenda seemed to be driven by hormone blockers" and the "whole debate was effectively biased and heavily skewed".

"Children are receiving both counselling and, in some cases, medical intervention in order to change gender on the basis of our public, scientific and medical understanding of the nature of gender. What the UK's, and therefore what one of the world's, most reputable scientific bodies says about these issues really matters," he added.

He argued that the society had an impact on way in which psychologists practice and are perceived in the real world, adding: "The negative side of all of this is if the BPS doesn't get its act together then we'll leave this important business to other people who will tell nonsense to the public."

A BPS spokesman said that despite "strong views" among members, the working group on prescribing rights had gone through an "expert and democratic process" and the research and two-year consultation showed that it "could be useful in certain settings".

The spokesman added that the society "does not currently have a fixed position on this issue", which would be decided by Parliament in any event.

The November 2020 prescribing rights report came after a report in July 2019 on gender, sexuality and relationship diversity, with a crossover of some professionals on both panels.

The guidelines were publicly criticised by a group of 23 psychologists who warned the advice that a "'gender-affirmative' stance should be the default position" meant they were required to apply a "pre-determined 'diagnosis' or explanation" without exploring the nature or cause of the distress.

The BPS says the guidelines are aimed at adults only, but concern has been raised that at no point in the document does it state this or define the age range of "young people" that are repeatedly referred to.

Despite the complaints, the spokesman said the guidelines are "not, in our view, at all contentious. They require our members not to discriminate against individuals and to treat them with respect".

The members' campaign group last month called on Ian Karet, the new chairman of the Charity Commission, to formally intervene in the society because "the situation is critical" and they are "desperate to see a restoration of health and reputation for the BPS".

A letter written by Pat Harvey, the former chairman of the Division of Clinical Psychology at the BPS, on behalf of the group warned that there has been "the collapse of legitimate administration, policy and practice at the BPS, a learned and professional Royal Chartered body with important responsibilities to the public and its members".

The BPS spokesman recognised that "debates on professional issues are often vigorous and the past 18 months have been turbulent" as the organisation is going through a process of reorganisation.

But he argued that the complaints had come from a "very small group" of 60,000 members who "are unwilling to accept the outcome of our consultations and policy positions and have continued to be highly vocal in their opposition, as is their right".

The spokesman added: "The BPS is not perfect, and there is always room for improvement in any organisation. It is clear to us that stronger governance processes will be required in the future, and this work is well under way. We have kept the Charity Commission fully informed of developments throughout and continue to engage with them."

In my teens I thought about training as a psychologist, having previously considered medicine and then going into psychiatry. In the end, my life went in a completely different direction, but by coincidence, years later I ended up with working with people from both disciplines (and mental health nursing) in a university. What I gleaned from my psychologist colleagues, which chimed with my teen work experience, was that psychologists didn't have much time for psychiatrists, who in their view relied almost exclusively on prescribing drugs and in earlier times on ECT and other medical methods. They felt these psychiatrists took an entirely biological approach to mental illness. The psychologists wanted the chance to use talking and other therapies with patients. They felt much of what's classified as mental illness has social causes.

To be fair, I met many psychiatrists who would have agreed with a lot of that too. Also, the evidence base for the effectiveness of some of the talking and related therapies isn't necessarily better than for the pharmaceuticals. However, I was astonished when I first learned that the BPS wants prescribing rights for its members. It seems a total turnaround from what I thought clinical psychology was all about.

Here's the letter which includes a link to the affirmative guidance: thepsychologist.bps.org.uk/volume-33/october-2020/freedom-expression-around-diversity-guidelines

Incidentally, I know a couple of psychologists. They're very nice people and committed to their profession but they absolutely should not be able to prescribe because, as a pp has already stated, they have no medical training.

The idea that they should be able to because some of them want to is barking.

Cwenthryth that's the one. It was truly incredible, will go back and read the thread to make myself

You can do a Psychology degree and qualify as a Clinical Psychologist without any hard science qualifications, e.g. Biology A level. The BPS accredits Psychology BSc courses so that anybody who goes on to train as a chartered psychologist will have covered the same basics at undergrad level. That means they do have to do some Neuroscience, I think, but they won't spend years studying aspects of anatomy, physiology, biochemistry, pharmacology in the same way as a doctor.

My impression, which may be wrong, is that a nursing degree would be more likely to cover relevant aspects of biology than a psychology degree.

Nothing to do with the thread, but can I just correct Gaspode - ECT is still used and is 83% effective in treating severe depression. It’s one of the most thoroughly audited treatments in the whole NHS, and more than twice as effective as antidepressants.
I used to anaesthetise the local ECT session, and seeing mute, bedbound, suicidal patients later smiling and chatting while tucking into toast and coffee was amazing.

I sit corrected, @Babdoc! Thanks for that, interesting. I'm obviously still affected by the scorn poured on it by the clinical psychologists I met in 1977. Should have checked.

I have to say, as a layperson, my overall impression after several years working with mental health professionals is that we've barely scratched the surface of how the human brain works.

My impression, which may be wrong, is that a nursing degree would be more likely to cover relevant aspects of biology than a psychology degree.

They already let some nurses prescribe so presumably.

By all means pass off a lot of antidepressant prescribing/dose adjustments to suitably qualified nurses. But not psychologists.

Nurses who prescribe have extra training. The same would have to apply to all other HCPs who want to prescribe.

Can any doctor comment on this? In most other branches of medicine doctors make a diagnosis and decide what drugs (if any) are appropriate, then write a prescription. Patient is issued with drugs to take at home or if an inpatient is given the drugs by the nursing staff.

If other HCPs are going to be allowed to write prescriptions, are they also going to be expected to diagnose, or would they just be signing off a prescription for a drug already approved by a medically qualified doctor?

I'm sure I've read in the past that some GPs are uncomfortable with being asked to prescribe puberty blockers and cross-hormones as they don't have enough endocrinology training to feel confident they know what they're doing. It seems extraordinary to me that if GPs, who are fully qualified doctors, feel this way, that other HCPs, with no medical training, would happily sign off a prescription.

I am a psychologist and I don't want to prescribe. I don't know any colleagues who do either. We are not trained for it and we don't want to be. We do have an understanding of biochemistry of the brain and so on, but not the same as a medical training. The BPS has gone right off the rails recently.

For nurses to be able to prescribe they have to undertake further training and assessment and must be at least 3 years since they qualified as a nurse and have extensive experience in the field. They already are used to giving medication and looking at contraindications. They are used to taking a medical history and obs etc. There's no way they can be compared to Psychologists. I have one cousin who is a Clinical Psyc and one who is an emergency medicine Doctor. The Clinical Psyc is great at her job but she herself acknowledges that she couldn't and shouldn't prescribe medications. She doesn't have access to medical records for a start!

Here is a Mental Health nurse explaining why and how she became a Nurse Prescriber www.nurses.co.uk/nursing/blog/why-i-became-an-independent-nurse-prescriber/

I have a friend who is a psychiatric registrar. She complains that psychologists do all the interesting talking therapies so by the time the more complex patients reach her all that is left is prescribing.

This request to prescribe seems to show a fundamental lack of understanding, purposefully ignorance or dismissal, of physiology. I suppose this reflects the attitude towards sex versus gender.

There are a few misconceptions here so will just clarify a few. Clinical psychologists do have indemnity insurance, whether privately or through NHS employment. Other healthcare professionals (ie nurses) can undertake additional training to prescribe medications without formal medical training so theoretically it wouldn't be unique to this profession. I'm a clinical psychologist working in Neuropsychology so have an understanding of neuroanatomy and the biology associated with this. All clinical psychologists in the UK are trained to doctorate level (although as others have pointed out, not a medical doctorate) and in my experience most an A level in another science or a relevant masters degree prior to getting a place on the doctorate course.

Having said all of that- I think @MajesticWhine hits the nail on the head. I don't want prescribing rights and from discussions we've had at work nor do any of my colleagues working within Neuropsychology or mental health that I know. To me personally although I have seen medication appear to be helpful for some people in managing their levels of distress I view mental health difficulties as being rooted in more than purely someone's biology, so I don't view medication as a long term solution. I also don't particularly like that the medical model of mental health difficulties locates the problem within the person, whereas I like to think more systemically about what shapes us and our experiences. (Dr Lucy Johnstone's approach that instead of asking "what's wrong with you?" we should be asking "what happened to you?" sums it up nicely). For me the use of psychiatric medication in general, especially without exploring any additional influences such as lived experience, trauma, someone's values etc doesn't fit with how I view the bedrock of our profession and therefore I would never want to be in a position where I was expected to prescribe as part of my role, nor would I do so. The BPS are not representative of all psychologists, and especially not on this topic.

You can do a Psychology degree and qualify as a Clinical Psychologist without any hard science qualifications, e.g. Biology A level.

Bloody hell, is this true?

Haven't read the full thread so sorry if it's been covered- but what does the BMA think of this suggestion that psychologists should be able to prescribe? I can't imagine they'd be supportive.

And as others have said if GPs are saying they don't want to prescribe blockers on the basis that they are not expert enough in endocrinology, allowing psychologists to do so is clearly insane.

I'm a clinical psychologist working in Neuropsychology so have an understanding of neuroanatomy and the biology associated with this.

This is totally indequate for prescribing. Drugs rarely affect just a single system. How much did time did you spend studying bone growth? The heart? Reproductive system? The incredibly complex endocrine system? To suggest an A level in biology is in anyway sufficient shows a complete lack of understanding. As does your dismissal of biological bases for apparently mental health difficulties. No wonder my friend whose son has Lymes took 10 years to get a diagnosis, or another who had PANDAS took six months to get antibiotics (and she was lucky - the antibiotics weren't prescribed for PANDAS).

@Tibtom Please kindly refer me to anywhere in my post where I've said that I think I'm qualified to prescribe medication... I'm not and I don't! I was merely responding to comments about not needing any scientific knowledge to work as a clinical psychologist. Our training covers biological theories of mental health difficulties.

I also don't dismiss a biological component of mental health difficulties. I love how on Mumsnet people can take one sentence and make a whole myriad of dichotomous assumptions about someone's knowledge or thoughts. I'm sorry that your friend had a negative experience though.

Your post was very clear @mummabubs

The weird thing about all this is that there are basically no Clinical Psychologists who want to prescribe. I've never met one IRL and I don't think I've really come across one on Twitter either!

There was a big fuss because the member consultation on asking for prescribing rights seems to have largely ignored the actual opinions of members, who overwhelmingly do not want to prescribe and do not feel that other psychologists should be prescribing either (for all the reasons described in previous posts).

The open conversations about prescribing largely focused on psychologists doing the same kind of extra training that nurses do, so that they could prescribe in a limited number of scenarios. The argument that I saw was for eg prescribing methadone in drug recovery clinics, which are quite often psychology-led.

It was therefore a big surprise to see that one of the places where the BPS was suggesting psychologists could prescribe was puberty blockers in gender clinics. As if this is just a technicality, rather than one of the most complex and sensitive areas of mental health care. It was completely bizarre and came across like some sort of backdoor bait and switch. Very unsettling.

Thank you @Clymene 😊

@Tibtom

There is no way powerful drugs which have affects on bodywide systems should ever be prescribed by someone without medical training. Even if they knew what contraindications there were, what tests may need to be carried out first and were able to request these tests, they wouldn't be able to interpret the results.

Would be interesting to see the increase in their indemity insurance premiums! (Do psychologist even need this?)

Yes we need the insurance. I believe a clinical psychologist with additional training could be authorised to prescribe medication. I think this should be allowed in a hospital setting where the clinical psychologist works with people who need medication for psychosis and severe depression and other medicated illnesses. I don't think those of us in the private sector should be allowed to prescribe.

However, I think the society has been overtaken by the trans lobby.

I do not think that a clinical psychologist working in a hospital being allowed to prescribe medication should be conflated with the prescribing of hormone blockers to teenagers.

I don't believe a psychiatrist can prescribe hormone treatment - is that not the job of an endocrinologist?

Clinical psychologists have 10 years of training and often have a PhD in an area like Neuroscience.

BTW - I don't think anyone should be allowed to prescribe hormone blockers to anyone.

And I don't think psychiatrists, GPs or psychologists or any other person outside of endocrinology should be allowed to prescribe hormone treatment (except for HRT and the pill - for GPs).

There was a thread on here last year when some members wrote an open letter to the society about the trans issue.

@IloveJKRowling

You can do a Psychology degree and qualify as a Clinical Psychologist without any hard science qualifications, e.g. Biology A level.

Bloody hell, is this true?

Yes. I just checked a few places at random.

Northumbria University - BPS accredited degree. No subject specific requirements at all. London Met - ditto. Bath - wants a combo of A level or equivalent subjects showing numeracy and essay-writing ability. No specific subjects required.

King's College London - At least one of Biology, Chemistry, Mathematics, Physics or Psychology. Preferred subjects: Biology and Mathematics

Of course, that's not to say that those with science and maths A levels won't have a big advantage in (a) getting on to the most competitive courses, (b) coming out with a First or a very high 2.1, (c) getting Assistant Psychology jobs on the strength of that, (d) getting a place on a good Master's course and/or going on to do a Ph.D. and (e) finally getting a place on a Clinical Psychology doctorate programme (like winning the Lottery - few places, huge number of applicants).

Anyway, I'm relieved to hear the membership doesn't what their leaders are trying to get for them.

mummabubs: I also don't dismiss a biological component of mental health difficulties.

But you did say you don't view medication as a long term solution. What do you mean by that exactly?

Something like psychosis could be basically a biological illness that needs long term treatment with medications.

Or ADHD is another example that isn't going to be cured by any type of psychological therapies. (Although you can teach coping strategies.)

I'm sure you must have thought about these examples and have an answer.