Necessity, nice idea or nuisance? An exploration of clinical psychologists’ beliefs about, and uses of, diagnostically driven NICE guidelines

Section A is a scoping review, exploring UK clinical psychologists’ beliefs about psychiatric diagnosis. Reviewed beliefs are considered in relation to associated leadership documents. Most literature critiqued the practice of diagnosis. However, some clinical psychologists considered diagnosis a helpful practice. This perspective was unrepresented in recent leadership publications. For many, the debate was not binary; empirical literature suggested clinical psychologists had concerns with diagnosis but considered complete withdrawal from diagnostic practices unfeasible. The review suggests that more empirical literature is needed to understand clinical psychologists’ beliefs and practices regarding diagnostic practices in routine NHS work.

Section B presents the findings of a mixed-methodological investigation of clinical psychologists’ (n = 55) beliefs about, and uses of diagnostically driven NICE guidelines. An integrated thematic map was produced, entitled: Threat, useful guide and vital manual: the shades of grey within and between clinical psychologists’ beliefs about, and uses of, NICE guidelines. Participants were concerned about the medical-model basis of NICE guidelines and their implementation as ‘rules’, and managed these concerns in various ways. Some worried the guidelines threatened clinical psychologists’ skills and jobs. A minority fully endorsed NICE guidelines. The need for clinical psychologists to feel safe to use their skills transparently is highlighted.