Psychiatry itself may have ironically at least contributed to the rising demand for services (see eg. previous post). The limitations of treatment do need to be acknowledged by psychiatry as well as by patients. I’m not being nihilistic about the value of treatment, but social interventions, not just from psychiatric services, may well be as effective at least in dealing with people’s psychosocial problems than either medication or psychological therapy. Believing there are simple solutions to mental health difficulties may be counterproductive (see eg. another previous post).
People are also being misled about the nature of mental illness by psychiatry encouraging them to see their problems as caused by the brain (see eg. previous post). Common mental health problems are not generally caused by the brain. Of course they are mediated by the brain but they have psychosocial not physical causes. Neurodiversity is, at least implicitly, being misunderstood as a brain problem (see eg. another previous post). Mental health assessment tends to focus too much on a single-word diagnosis rather than understanding the reasons for people’s difficulties (see eg. yet another previous post).
When I first trained, mental health services concentrated on what was called severe mental illness. More minor, common problems tended to be managed in primary care. Over the years, NHS secondary mental health services have been opened up to all, particularly with the introduction of Improving Access to Psychological Therapies (IAPT) (see eg. previous post). Despite IAPT being particularly aimed at treating common mental health problems and the proportion of people with common mental health problems reporting receipt of treatment steadily increasing, the number of people actually being identified with a common mental disorder in the community has increased (see previous post). The vast increase in treatment may have been expected to reduce prevalence of common mental disorder but in fact it is associated with the reverse trend.
Until the introduction of IAPT, psychological therapy tended not to be readily available in the NHS. Even within IAPT what tends to be on offer is only short-term therapy or guided self-help. I’m not undermining the value of such treatments as long as people recognise their limitations. It’s important they are not left with frustrations that actually increase demand for services.
How much the review set up by the government will address these issues remains to be seen. Non-medical services, often provided within the so-called third sector of voluntary organisations, need to be developed to allow more medical services to concentrate on severe mental illness. Recovery Colleges are an underestimated valuable means of providing support for some people. Neurodiversity should also be provided for within non-medical services. The time-scale for the review is short, so I doubt it will encroach too much on the conceptual issues I have raised, but it could give a steer towards more patient-centred, therapeutic services for the future.
Excellent Duncan. But the situation is like that in the opioid drug business with well-intentioned people (or those who want to appear to be well-intentioned) trying to convince the street dealers not to do it, instead of cutting off the drugs at source?
ReplyDeleteClive