Friday, August 10, 2018

Realising the right to mental health

The European Psychiatric Association (EPA) has expressed "great concern and disappointment" in a position paper about what it sees as "the misleading and false portrayal of psychiatry ... as well as the lack of any evidence or statistics supporting this opinion" in a report from the UN Special Rapporteur, Dainius PÅ«ras, who I mentioned in my last post. I actually thought the report was very good (see previous post).

EPA is particularly concerned by what it sees as the ignoring of evidence for the effectiveness of psychotropic medication, which it says "risks harming people" by encouraging avoidance of treatment. It defends the biomedical approach and does not see it as "a source of neglect, abuse and coercion" or as "the key factor explaining the current unsatisfactory status of mental healthcare". Rather, it sees inadequate government funding as the primary obstacle to mental health.

The EPA position paper is helpful in clarifying points of disagreement. I've always emphasised the need to avoid polarisation in the debate about psychiatry. However much I think the biomedical view is wrong, I am aware that it will never go away.

Recognising the bias in the evidence for psychotropic medication is not unscientific. In fact, I've always said psychiatry needs to be more scientific in its interpretation of the evidence (eg. see previous post). It is true that biomedical theories are used to encourage people to take their medication (eg. see previous post) but I've always found that patients are able to understand that a physical basis for mental illness has not been established.

I do see the dominance of the biomedical approach as an obstacle to the realisation of the right to mental health. We need a more balanced perspective. The tendency to reduce people to objects, which the biomedical approach can encourage, hinders understanding of peoples' problems and may prevent helping them deal with their problems. Of course some patients take a biomedical perspective but imposing such a view on people is a misuse of psychiatric power. The EPA should encourage further debate on these issues.

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