People seeking cosmetic injections such as botox or filler treatments should undergo compulsory mental health screening in order to stop vulnerable patients worsening pre-existing psychological conditions and increasing their risk of self harm, experts say.
Calls for clinicians to be trained to conduct psychological assessments come amid demands for greater regulation of the cosmetic injectables industry after Guardian Australia reported serious side-effects following an a common procedure to dissolve facial filler.
Dr Toni Pikoos, a clinical psychologist who specialises in body image and related disorders, said injectables were often ignored when regulators considered the psychological risks of cosmetic treatments but their relatively low cost “can make them an even more dangerous space than surgery”.
“They’re seen as being these quick and easy low-risk treatments… [but] the research tells us that body dysmorphic disorder (BDD) and other mental health issues are much higher prevalence in people seeking non-surgical cosmetic procedures,” Pikoos said.
BDD is a mental illness characterised by constant worrying about a perceived or slight defect in one’s looks. While only up to 3% of the general population are thought to experience BDD, that number jumps to 15-20% of people seeking cosmetic treatments including fillers and anti-wrinkle injections, Pikoos said.
According to Pikoos, when people with BDD seek out treatments most often they do not experience any psychological benefit and, in many cases, it makes them feel worse.
“It makes them more and more fixated on their appearance; it creates more distress,” she said.
There is no required psychological training for many of the people allowed under current regulations to administer injectables, including nurse practitioners, nor is there any mandate to screen patients before they are treated, unlike cosmetic surgery.
Surgeons, who have basic psychological training as part of their medical degrees, are required to discuss and assess the reasons a patient gives for wanting cosmetic surgery and should refer them to a psychologist if they have concerns. There is also a cooling off period of a number of days between the patient giving informed consent and the surgical procedure.
Last year a UK parliamentary inquiry recommended the government develop mandatory psychological pre-screening tests to cover a range of conditions before any non-surgical cosmetic treatment.
Dr Gemma Sharp, a body image research lead at Monash University and clinical psychologist, said mental health screening would improve satisfaction levels and improve patient outcomes.
“[Psychologists] are able to predict who will likely most benefit and be satisfied from it and who might be trying to treat an underlying mental health condition through injectables, which we know won’t work,” she said.
She said the issue was particularly bad for people with BDD who could feel worse after treatments, harm themselves or take legal action against the practitioner who treated them.
Sharp explained that when people were disappointed with the outcome, which a psychologist or someone with training could have predicted, the patient may end up coming back again and again for further treatments “in the hope that it will fix their psychological concerns”.
“I get referrals because I’m known in this space, but I know that I’m seeing the tip of the iceberg here,” Sharp said.
“Any cosmetic procedure [should be] in the hands of health professionals who are trained, and also I believe that there should be a mental health professional, like a psychologist attached to every practice.”
Injectable treatments were excluded from the scathing recently released independent review into cosmetic surgery in Australia, commissioned by the Australian Health Practitioner Regulation Agency (Ahpra) late last year. Pikoos said this was a “missed opportunity” and was concerned people would see that as a stamp of approval from the regulator on a highly unregulated industry.
“Mental health screening needs to be mandatory for all procedures. I’ve seen lots of clients who have had really bad experiences with anti-wrinkle injections and fillers, who were really vulnerable at the time that they went to go to go to a clinic. They’re so vulnerable to just getting anything that’s recommended to them,” Pikoos said.
A spokesperson for Ahpra and the National Boards said it was up to practitioners to consider the appropriateness of any treatment they are recommending to a patient.
“Psychological screening requirements may be considered as we review, consult on and update the guidelines,” the spokesperson said.
Cosmetic injections require a valid prescription from an authorised prescriber such as a doctor, dentist or nurse practitioner.
