The myth of massive psychiatric need

I want to start this post with a quote:-

There has been a massive growth in mental health services during the past 20 years as psychiatry has extended its boundaries to include an ever-widening array of human problems.

Don’t assume this is a recent quote, although it could be! It was actually written in 1988 in an article entitled ‘More and more is less and less: The myth of massive psychiatric need’.

The article goes on:-

Psychiatric manpower, facilities, and programmes have been vastly increased. However, as more resources are provided, more are perceived to be needed: more and more is less and less.

The article’s warning that the myth of massive psychiatric need was being used to justify additional resources for existing services, rather than solving current problems, has still not been heeded all these years later (see eg. recent post). That’s not to deny requirement for additional investment, but need for services should be prioritised rather than demand.

As supply of services increases, demand also continues to increase. Resources therefore fail to meet that demand. Merely increasing the numbers of professionals doesn’t solve the problem. If treatment is so effective at reducing need, then demand should decrease over time as that need is met, rather than increase. This situation is made even worse by broadening the boundaries of what counts as mental disorder over recent years (see my article referred to in this post).

As the article says, the problem with all this development is that resources are diverted from the most seriously mentally ill. The NHS, including mental health services, has become too fragmented and dysfunctional. We must stop  seeing mental health services as a panacea for society’s difficulties (eg. see previous post). We’re being oversimplistic about what psychiatry can achieve (see eg. another previous post).  Psychiatry, and health services in general, needs to redefine its role.