Tuesday, August 18, 2020

Developing a non-medical mental health service

I've said before (eg. see previous post) that I'm keen to see how non-medical mental health services could be developed within the NHS. Doing so would make explicit that treatment on offer in such a service does not include medication (despite there now being a limited amount of non-medical prescribing by healthcare professionals other than doctors and dentists). Psychological therapy of course is non-medical in this sense, and non-medical treatment is in fact much wider, including all psychosocial interventions.

Improving Access to Psychological Therapies (IAPT) was originally designed as a non-medical service. In the NHS plan, IAPT has now become the service for common mental health problems, for example being renamed within NHS Trusts as Wellbeing Services. Severe mental illness is managed within the traditional community mental health team (CMHT). Unfortunately, this means that some people who are explicitly seeking a non-medical service are told they are "too complex" for IAPT and become quite confused when they are referred on to the CMHT.

I've mentioned before (see eg. previous post) that some clinical psychologists, such as Peter Kinderman, want mental health services to become non-medical. There's even support from within psychiatry for such a position (see eg. another previous post). Although the motivation for such a change may largely be coming from a 'drop the disorder' argument, in the sense that it's thought to be wrong to regard mental health problems as 'illnesses', it is possible that a non-medical mental health service could actually encompass a range of different views about the nature of mental illness/ health problems. Its fundamental feature would rather be about managing mental health problems without medication. Such a service would provide real options for patients, alongside more medically based services to deal with medication and psychosomatic issues.

There are plans to increase the number of people working in the psychological professions in NHS commissioned health care (see vision). Increasing the number of clinical psychologists makes sense, considering the difficulties in recruitment to other mental health professions at present. Clinical psychology has no difficulty with recruitment, and in fact could be made even more attractive, by its training being geared towards creating the new leaders in a non-medical mental health service. 

I'm not undermining the importance of medication in treatment or the role of the doctor in mental health work, having been a doctor myself in my working life. I just think that a division between medical and non-medical mental health services may well make more sense than the current division between services for common versus severe mental health problems. 

1 comment:

James Poulter said...

As someone with a diagnosis of bipolar, with lived experience of severe psychosis, I think we need a massive investment in research better understanding psychosis, talking in depth to many people who have experienced psychosis, and drawing together the common threads. The small fragments I have learned from reading in-depth accounts of other's psychosis has helped me so much. Having the will power to resist psychosis when it strikes is extremely hard and requires so much ground work when well. Medication of course dampens these symptoms but does not get to the cause. Thank you for your blog and important work in this area.