Sunday, January 29, 2012

Could psychiatrists become extinct?

Paul Harrison (who I've mentioned in a previous post), Ed Bullmore (again, who I've mentioned in another previous post) and others have posted an eletter in response to a BJPsych editorial entitled "The future of psychiatry". They argue for what they call a "remedicalised psychiatry". By this they mean that psychiatrists should concentrate on "what doctors do best" and challenge their "involvement in activities or services which are not of this kind". They suggest that without change psychiatrists will be left like "the apothecaries 300 years ago: in decline, mental health care increasingly left to a poorly coordinated coalition of other health professionals".

What these authors are at least partly reacting against are the reforms, such as so-called New Ways of Working, influenced by the previous National Director of Mental Health, Louis Appleby. In a recent interview, Appleby said "I get uneasy if it starts to sound as if doctors have a natural entitlement to a unique place in mental health care".

There were problems with New Ways of Working, such as not paying enough attention to the continuity between the new services created and a lack of proper emphasis on the expertise of mental health staff, not just medical staff. Department of Health policy has now moved on. However, I too, like Appleby, have concerns about Harrison, Bullmore et al's stance.

The danger is that their position could be seen as saying that psychiatrists are not concerned with the personal dimension, which is actually the primary element of mental health practice. It doesn't actually matter that, for example, non-psychiatrists prescribe medication or become approved clinicians under the Mental Health Act, as long as they are properly trained to do so. This is where the debate should focus.

By the way, before completing my university medical degrees, I first practiced medicine as a licentiate in medicine and surgery of the Society of Apothecaries, which could approve medical training in the UK until 2003. I had been sceptical about the value of medical training for mental health practice and gave up my medical training for 8 years before returning to complete it (see eg. a talk I gave some years ago). A patient-centred medical training is indispensible in modern mental health practice. The problem is that medical training is not always as patient-centred as it should be.

Saturday, January 14, 2012

Critical rationality in psychiatry still required

Another book by Arthur Kleinman has made the BMJ medical classics list (see previous post about the other book) - this time The illness narratives - see review.

Kleinman edited a book with Theo Manschreck in 1977 called Renewal in psychiatry in which they defined critical rationality as a:-
commitment to rational evaluation and derivation of knowledge. It encompasses the critical scrutiny of prevalent beliefs and practices; and refers to the use of explicit values and rigorous methods, clear concepts and argument, precision in thinking, and supportive evidence to help us harness the creativity of imagination and intuition in the discovery of new knowledge. It promotes exacting standards for the process of inquiry, regardless of its object; and it is self-critical. It therefore qualifies as an indispensable standard governing clinical discourse, teaching and research. 
Good to see that someone who could be said to have been involved in the origination of critical psychiatry is getting such recognition.