Update Follow Up Interview with Dr. Allen Frances
Professor emeritus at Duke University, Dr. Allen Frances, penned an article in Psychology Today entitled Why Social Workers Should Oppose the DSM-5. Dr. Frances was chair of the DSM-IV task force and of the department of Psychiatry at the Duke University School of Medicine. In the article, Dr. Frances acknowledges that Social Workers have not been previously included in the DSM development process despite being the largest providers of mental health services, and he also states that social workers may be the only ones who can prevent the DSM-5 publication in this 11th hour.
The article makes a strong case that the DSM-5 changes may open a gateway for exploitation by drug companies to push unnecessary medications on clients. Dr. Frances in his article quotes several professionals consisting of social workers and doctors. The new DSM 5 publication is schedule to published in the upcoming week, but its publication has suffered several set backs due to continued opposition. The National Institute of Mental Health dealt another blow when it withdrew its support for the new edition.
Here is an excerpt from his article:
Dr. Carney writes:
“Where are the social workers? Where are the NASW and its local and state-wide chapters? Over 12,000 individuals mental health professionals have publicly declared their concern at the planned 2013 publication of the DSM-5. They’ve signed the petition launched six months ago by the Society for Humanistic Psychology requesting that the DSM-5 Task Force delay publication of the new DSM and subject it to an independent scientific review. Fifty-one professional organizations have also endorsed the petition. It is extremely puzzling that the National Association of Social Workers and its local affiliates are not to be found among them.”
“So what’s going on with social workers? It’s almost like asking ‘What’s the matter with Kansas … ?’ It seems like they and their professional organizations are voting against their own self-interest… Ultimately, however, most social workers, like most Kansas voters, are not motivated by self-interest but by core values and beliefs. Their acquiescence to theDSM-5 as currently composed signifies for me an abandonment of core principles—service to others; pursuit of social justice; respect for the worth of the persons being served; the importance of human relationships; and the salience of integrity and competence in social work practice (Code of Ethics @ www.socialworker.org)—and seriously undermines their fundamental mission of helping those who need it.”
“The Open Letter which the Society for Humanistic Psychology states that ‘the proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks … (that) increasing the number of people who qualify for a diagnosis may lead to excessive medicalization’ and the increased prescription of neuroleptic medications, with all their attendant risks.”
“The DSM-5 Task Force will soon announce its last public commentary period—check its website @ www.dsm5.org—after which it will begin to finalize the new edition. Accordingly, if you’re a social worker dismayed with a public mental health system in disarray, alarmed at the distortions resulting from the system’s sole reliance on the biomedical model, determined to re-commit to core social work values and promote change in a system that no longer works, here’s what you need to do:
1. Read the Open Letter and sign the petition …http://www.ipetitions.com/petition/dsm5/
2. E-mail the Board of Directors of NASW and ask them to endorse the petition … President@naswdc.org;
3. Spread the word to your social work brothers and sisters. There’s still time to put a stop to the DSM. Don’t mourn, organize!!”(excerpted from “1984 & DSM5 Revisited: Where Are the Social Workers?” … posted 3/27/12 on www.madinamerica.com) (excerpted from “1984 & DSM5 Revisited: Where Are the Social Workers?” … posted 3/27/12 on www.madinamerica.com)
The petition calls for 50,000 signatures. As of today, only 14, 000 have been collected. Since Social Workers represent 60 percent of those providing mental health services in the US, this publication can’t be stopped without social work support. Last week, I wrote an article asking “Will Clinical Social Workers Embrace the New DSM V“. I got a lot of responses to the question. However, social worker responses reflected a variety of feeling towards the DSM-5 changes, and I would like to share a few.
Interesting (and of course timely) post. Thanks! — Not at all sure that SW must use the DSM-5. Other professions are turning to the ICD, for example. Yes, we need an appropriate manual for diagnosis…esp. for insurance… The DSM-5 isn’t it!! It’s just toooo wrong in too many places. E.g., tell me how we get over the loss of a loved one in 2 weeks. Two weeks? Nonsense! But the DSM-5 (BTW, it is DSM-5, not DSM V) says that if the bereaved doesn’t “get over it” in 2 weeks, he is automatically labeled w/ major depression. — So, I’m not at all happy with this revised manual! ~ Rea G.
I have one question. If clinical social workers DON’T embrace DSM-5, then doesn’t that blur the line between them and those who are not clinically trained? The only certainty is that even DSM-10 will have limitations. My understanding is that client-centered therapists will always be cognizant, and therefore use good judgement on a case-by-case basis. But without a universally accepted standard, the entire field opens itself up to quacks and dubious practices.~ Rodney D.
In answer to your request Rodney (addressing Camille’s point), when DSM-5 comes out this Saturday, DSM-IV-TR will no longer be applicable for diagnostic criteria. Mental health professionals do not have the luxury to pick and choose which manual they prefer. However, as many psychiatrists are pointing out, diagnosis is (and has always been) in the eyes of the evaluating professional and the self reporting of the individual with the concern. Bottom line, we should be up on DSM-5, understand it, apply it appropriately and help our clients to the best of our ability.~Julie R.
Peter has summed up the DSM issue in a nutshell for me. I cringe when Social Workers, Psychologists, LPC’s, PsychNP’s, Psychiatrists, and other mental health practitioners refer to DSM “diagnosis:. I do not care how many axsis or qualifiers one puts with diagnosis, when it comes to mental illness we do not need a medical model as yet. We need evidence and outcome based criteria for treatments. I do appreciate psychopharmaceutical interventions, as do I appreciate all other interventions that can work: behavioral, mindful, interpersonal, etc. However, nobody is saying taking away the science. We need the science and the research. We do, however, need to educate the mental health profession about the unreliability and sham the DSM is about. Of course, the way the system is setup, we do need the DSM for insurance and I do embrace it for that.~Sherry L.
The article by Dr. Frances sheds new light on the DSM-5 and what the social worker response should be, but what do think about his article? Do you think psychiatry will begin including social workers in the DSM development process in the future?
It would also be nice to hear the expirence of other SW on the training of the 5. The training I had was 4 hours and really rushed and way to crowded to get questions answered. The training should be 1-2 days and allow for exploration of how these changes will affect clients and practices and some explanation to the changes made in the 5.
I completely agree with the article. This new version will hurt SW’s in the long run and I don’t agree with many of the changes…especially the bereavement issue. Goodness, let’s put everyone on a anti depressant!!! My biggest concern is that the insurance companies are eventually going to require we use the 5 which will definitely become an ethical issue if we don’t clinical agree with these changes and force our hands if we want to maintain our employment/ businesses and eventually be detrimental to the client. The biggest issue I feel will be the over medication and diagnosis of clients!
Excellent Points Rachel!
The NASW, at least as long as I have been in the field, has been a disappointment. They are the largest SW professional association in North America and are given the right to speak on behalf of the profession when it comes to licensing and title protection, yet I find them often silent on important matters such as this.
They have lobbyist, they have been around for decades, and they have substantial revenue(http://www.guidestar.org/FinDocuments/2012/135/643/2012-135643515-09085098-9O.pdf). They should be more than capable of fighting for a seat at the table, but I don’t see them even trying to be heard. They aren’t even bothered with getting a social worker to represent the profession during committee hearings on the Hill (http://swhelper.org/2013/01/25/assessing-the-state-of-americas-mental-health-system/). Why aren’t they doing a better job, or even trying, to organize their members into crating actually change for the profession and for the communities we serve?
Social Work Helper article on Why Social Workers should oppose the DSM V referenced @Jacarneysr @AllenFrancesMD http://t.co/wTQIy6itVZ
I can understand and sympathize with the feeling of being devalued by your peers and those in the field. However, I would like you all to consider that a professional who has worked 30 years in Social Services as social worker feels just as devalued with Clinical Social Workers refer us (my background is in the public sector in CPS) as nonprofessional social workers in public welfare.
As I stated before in a previous comment, LCSW do not want Social Workers who are not licensed competing for jobs, clients, and other benefits because you feel the license elevate your position as a social worker. Folks in psychology feel the same about LCSW as LCSW feel about unlicensed social workers not meeting the LCSW standard. Psychologist and LCSW are equal in the duties performed, but their education and training have higher minimum standards. Only psychiatrist have the ability to prescribe meds.
My impressions from Dr. Frances as he states in his follow-up interview that they made a lot of mistakes. I think that he is doing outreach efforts now and looking forward to finding solutions for the future. For me, the important question is why has the NASW remained silent on this issue and have not engage in conversation with its members on these issues in order to determine whether they would support or deny support of the DSM V. They appear not to have any concerns about the DSM V at all.
Most certainly: Here is the link to the follow-up interview….http://swhelper.org/2013/05/20/interview-with-dr-allen-frances/
I agree that social workers should be critiquing the DSM V and that the NASW needs to demand their rightful place at the table.
That said, here’s what stuck out to me in this recap of the Psychology Today article. Dr. Allen pointed out an abundantly clear systemic issue: social workers were not included in the revision of the DSMs. Yet his conclusion is still: “where are the social workers?” If being a psychiatrist gives him an uncontested invitation to the revision of the DSM, why does he not use his privilege to ensure social workers had a place at the table to begin with? Especially since it is in the best interest of clients and patients.
Can you include a link to the follow-up article please? Thank you!
I would like to weigh in here. As an LCSW-C in private practice for over 30 years, I resent that despite my experience, I am devalued by insurance companies and Medicare in particular (since rates originate with them). I agree that I did not complete a PhD or MD program. I do not provide psychological testing, nor do I prescribe medication. But I provide psychotherapy in the same time frames and with the same standards of care that the other mental health professions do, and yet I am paid 65% of what a physician is paid. I fail to see the justification for this.
On another subject, I would like to respond to Dr. Frances’ comment that social workers and their professional organization (NASW) work against our own self-interest. He is right, in my opinion. Since our profession is so multi-faceted it also lacks cohesiveness. NASW is trying to be all things to all people, so to speak. They seem to be just catching on that a large majority of its members are clinicians who provide therapy, not just public welfare. They still seem to emphasize child welfare and other social issues, advocating for the needy and down-trodden instead of their members. An organization with such a large membership should have tremendous power and influence, and yet, it doesn’t seem to be the case when advocating for its members.
Interesting perspective but there are a few concerns. First, you are relying on social constructs and arbitrary requirements to conclude that somehow doctoral level psychologists are better trained than LCSWs because they have a doctorate degree. Or somehow LCSWs receive inferior training. How do you quantify this assumption? It is an incredible leap to make. The reality is that there are competent and incompetent practitioners on both sides, irrespective of a master’s or doctoral degree. I have worked with a doctoral level psychologist who was not interested in doing more than he had to do to earn his pay. He was content with his position and the benefits it afforded him. This is true of some LCSWs, as well.
The doctoral degree provides more prestige in practice and specific training expertise in tests and measure, but it does not automatically render the the practitioner more capable than an LCSW. I will tell you that earning an LCSW is not easy. It requires a great deal of time and effort, knowledge and skills.
Second, title protection is not attacking MSWs and BSWs. I argue that it is protecting all professional social workers and increasing their earning potential. For many years, anyone could refer to oneself as a social worker. When one of these nonprofessional social workers ended up on the evening news for causing harm to a child or family, professional social workers were viewed with the same disdain and considered incompetent. The logical progression in our profession was to protect ourselves through title protection. Consequently, professional social workers have an opportunity to increase earning potential. Fewer people calling themselves social workers means professional social workers will be in greater demand.
I will concede that there is a problem, however. Each state has a different set of standards. Some say anyone with a bachelor’s degree or higher can call oneself a social worker. Others say only an MSW can and a few say only an LCSW. Even with the inconsistency, I believe title protection is vital for our profession’s survival.
Well Lee, my stance on LCSWs being equal with psychologist differs from the majority. I do not think LCSWs should be equal to psychologist without having to go through the same educational requirements and training which requires a doctoral degree. People who want to be psychologist should go through their program instead of using the LCSW with less requirements to bypass meeting their standards. LCSWs are constantly fighting for title protection. LCSW do not want those who do not have an LCSW to use the Social Work Title. These laws also would bar MSW and BSW from using the social work title if not licensed. Isn’t this hypocritical and primarily self-serving to want to be equal to psychologist and at the same time deny other MSW and BSW from using the social work title? I believe in fairness for all social workers and not just the clinical social worker.
The omission of social workers in the article suggests bias and calls the entire DSM-5 controversy into question. The fact is that psychologists have been against social workers providing diagnostics and treatment. In Georgia, for example, psychologists fought to prevent the passage of a bill that would allow social workers to be more equal with psychologists by providing diagnostics and treatment. Thanks to the NASW and its local Georgia chapter, we won–the bill was passed. Social workers in the military are also not given the professional courtesy of providing diagnostics and treatment. Instead, psychologists are preferred. I believe social workers need the DSM to distinguish ourselves from non-clinical, non-professional ostensible social workers. I am interested in seeing what Dr. Frances’ recommendations are.
I interviewed Dr. Frances the author of the Psychology Today post. I think you may be surprised at his recommendations. The follow-up article will be live later today.
Chairman of Duke University Psychiatry Explains Why Social Workers Should Oppose DSM 5 – http://t.co/p8YI7CpDVV #DSM5 #socialwork
If they start to include SW view’s they will have to admit that the medical model is not affective on it’s own and i cant see this happening for a long time to come !!!!
I think that is a reasonable point. I believe a realization set in that it will take a collective effort to prevent the publication of the DSM 5.
Where I appreciate the call for Social Workers to stand up, and the ethical concerns in question, I’m guessing it might have been helpful for Social Workers to also have been referenced in addition to psychologists and psychiatrists in the article link provided.
RT @swhelpercom: Chair of Duke University Psychiatry Explains Why Social Workers Should Oppose DSM 5 http://t.co/vFnKYS8ofM #swscmedia #socialwork #SWunited
Chair of Duke University Psychiatry Explains Why Social Workers Should Oppose DSM 5 http://t.co/vFnKYS8ofM #swscmedia #socialwork #SWunited
Chairman of Duke University Psychiatry Explains Why Social Workers Should Oppose DSM 5 … http://t.co/VBgtoEl1K9
Chairman of Duke University Psychiatry Explains Why Social Workers Should Oppose #DSM 5 – http://t.co/7UOjDIzfHi #socialwork
@swhelpercom Mental Health problems at this point become more normal than their absence. These statistics confuse me!
@swhelpercom With 47% of the westernised population suffering or likely to suffer a MH issue, what happens when its 51%
RT @swhelpercom Chairman of Duke University Psychiatry Explains Why Social … – http://t.co/jOQlo0U2Hs #socialwork http://t.co/eqxKAhNVew
RT @swhelpercom: Chairman of Duke University Psychiatry Explains Why Social … – http://t.co/cXejl68Ajq #SWUnited #socialwork http://t.co/aga8k4HOq7