Press Release: Psychological Screening for Aesthetics: Is It The Future?

Recent reports of the possible introduction of mental health screening for new non-surgical aesthetics patients in Australia has caused a similar debate in England and Wales.

Concern has focused on patients who suffer from body dysmorphic disorder, a mental illness characterised by a constant worrying about a perceived or actual defect in one’s physical appearance.

It is estimated that between 0.7% and 2.9% of the population suffers from BDD. The number of sufferers rises amongst non-surgical aesthetics patients, with the percentage rising to approximately 15% to 20%. This is somewhat unsurprising considering that a major attraction of non-surgical treatments is the correction of perceived defects.

There is serious concern that non-surgical aesthetics could accelerate the symptoms of BDD, with the sufferer falling into a vicious cycle of more treatment to negate yet more perceived defects in appearance, encouraging yet more symptoms of BDD which forces the patient into undergoing yet more expensive treatment. Aesthetic treatment will therefore not only be damaging, but also completely inappropriate in the circumstances.

Pre-treatment screening for BDD and other mental illnesses for new clients has been encouraged in recent years, namely by the JCCP since its inception and by more scrupulous practitioners. However, screening is far from mandatory, with the level of screening conducted variable between practices, and no set training is provided to practitioners.

As is often the case with the non-surgical aesthetics sector, the level of care fluctuates between practices.

This is part of a wider issue. As 20/20health’s Introductory Report into England’s unregulated non-surgical aesthetics industry made clear, a regulatory overhaul of the sector is long overdue. A mandatory pre-treatment screening test, properly drafted and administered, will be a vital part of this new framework.

Mandatory pre-treatment screening tests are needed, to the benefit of all sufferers from mental health illnesses, not just sufferers from BDD. It has the potential to stop inappropriate treatment, encouraging mental health sufferers to seek alternative therapy. Furthermore, it has the potential to encourage more trust within the sector.

Properly publicised, patients (both new and current) will be confident that their needs are being met, that they are being neither coerced nor encouraged to undertake a treatment which is unnecessary and potentially damaging. A properly drafted, medically approved screening test, sent to all prospective patients, would demonstrate to the patient that their wellbeing remains the top priority.

Any well-publicised statistics concerning the number of prospective patients denied treatment and encouraged to find alternative therapy would be to the greater benefit of the sector, demonstrating that trust remains at the centre of the patient/practitioner relationship.

Such implementation is needed; current provisions do not go far enough.

As previous reports by 20/20health (please see website) has made clear, there is currently no obligation for non-surgical aesthetics practitioners to be medically qualified. Many practitioners ask new clients to fill in a psychological screening test. However, concerns remain that without suitable medical training, it can be difficult (if not impossible) for practitioners to properly identify “at risk” patients. A regulatory framework is needed to ensure that practitioners receive the correct level of training to identify such patients, to identify when questions are being answered truthfully and know the most appropriate course of action to take.

A problem with BDD sufferers is that they are often embarrassed by their perceived defect, and therefore may not be open about discussing it with their clinician. The signs of BDD and other mental illnesses can be very hard to find and often only the most experienced of medics can recognise it.

Currently, most of the screening tests are only five or six questions in length, followed by a brief consultation, with treatment being administered immediately afterwards. Usually, this is not enough to properly determine the psychological integrity of a new patient.

What must be encouraged (and the more scrupulous practitioners already do this) is that the initial consultation with any new patient must be pre-treatment only, a “fact-finding” consultation followed by a cooling-off period to allow the patient to reach a rational decision and for the practitioner to encourage alternative therapy if required.

Of course, there is always the possibility that unscrupulous practitioners will continue to ignore any new guidelines and will continue to administer treatment accordingly. However, if more and more scrupulous practitioners join up to a properly regulated psychological test, then more patients will be screened.

Furthermore, it would attract its own publicity, making it harder for the unscrupulous to practise, as they would be squeezed out.

There is one additional problem to this issue which has not yet been discussed. The current economic climate and cost of living crisis is putting pressure on everyone, including in non-surgical aesthetics. Such pressures may tempt any practitioner to advise treatment they may not otherwise recommend.

What is needed are for practitioners to be properly medically trained, to adhere (as doctors are) to strict ethical standards in which the needs of the patient take priority over other considerations. The current situation in which non-medics can practise will only help to ensure that BDD and mental illness sufferers will continue to receive inappropriate and potentially harmful treatment.

Psychological screening tests are needed for the reasons outlined in this report. However, a fully implemented regulatory framework, which 20/20health is currently campaigning for, will ensure that is implemented, to the mutual benefit of patients and practitioners.