Tuesday, December 22, 2020

Oversimplistic psychiatric treatment

Analysis of prescription data in England in 2017/8 found that 16.6% of the population received a prescription for an antidepressant, 3.1% for a benzodiazepine such as diazepam and 2.3% for a z-drug night sedative, such as zopiclone (see Public Health England review). For talking therapies, there were 1.69 million referrals in 2019/20 to Improving Access to Psychological Therapies (IAPT) (see annual report). Psychiatric treatment, both medication and talking therapies, is therefore frequent. 

Consistent with this high level of treatment, around one in six adults surveyed in 2014 met the criteria for a common mental disorder (see Adult Psychiatric Morbidity Survey). IAPT is seen as a treatment for common mental health problems. I have argued (see previous post) that the distinction between common and severe mental health problems in the NHS can become confusing when people are referred on from IAPT to secondary care services. IAPT is essentially a non-medication service. Psychological therapy is also provided in secondary services but very few patients treated in secondary services do not also take medication. People seen in IAPT may well be taking medication, but the expectation usually is that this aspect of their treatment will be managed by the general practitioner (see previous post about role of primary care in mental health treatment).

Concern has been expressed about people becoming over-reliant on medication in psychiatric treatment (eg. see @JDaviesPhD’s tweet). I suppose we shouldn’t be too surprised when medication is sold as an easy answer to mental health problems that people may want to take it. The rhetoric for IAPT has also encouraged seeing psychological therapy as a panacea for mental health problems (eg. see previous post). 

Don’t get me wrong; I’m not being nihilistic about outcome for mental health problems. Plenty of problems can get better spontaneously and over time. But I think services would benefit from becoming more realistic about the nature of mental health problems and what can be done about them. It’s not always as simple as taking a tablet or going for a few sessions of therapy, not that these might not be helpful as long as we realise their limitations. As I said when discussing the response to mental health issues created by the coronavirus pandemic (see previous post), I don’t want to discourage people from coming forward for help if they need it. I just think services need to stop exaggerating the benefits of treatment. Mental health treatment can be helpful, but it may not necessarily have all the answers.

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