Thursday, April 11, 2024

Rethinking mental health practice

As I said, for example in my 2002 article, there is an overemphasis on psychiatric diagnosis. Nonetheless, the current diagnostic system still needs to be referenced when discussing mental health system reform, if only to avoid confusion. Over the longer term language can change. Certainly it has done so in the past, for example reflected in repeated revision of the DSM manual (see eg. previous post). 

As I have also said, the UK mental health system has become too dysfunctional and fragmented (see eg. previous post and another previous post). The problem is not just insufficient funding. Throwing more money at the problem is not going to solve it and hasn’t worked anyway. For example, waiting lists for assessment for neurodiversity are out of control (see eg. previous post). An excellent report from the N8 Research partnership (2024) on autism in children and young people makes 3 recommendations (see last post). These can be summarised more generally as (1) More integrated working within mental health services and between different services, not just health services. (2) Improve training co-produced with people with lived experience to provide and deliver holistic support which is not overmedicalised and focuses on people’s needs rather than being diagnosis-led. (3) Integrated care including both statutory and non-statutory services at local levels should be overseen by a prioritised governmental approach to addressing the crisis. 

The UK is not in the position to be able to put a large amount of money into health services and public services generally. The next UK government needs to act at pace though. Failure to provide appropriate mental health support results in poor long term outcome and high rates of associated health conditions. A major barrier in our existing systems is the perceived need for a medical diagnosis of mental health problems before people can receive support. Overmedicalisation of mental health problems also means the health system simply cannot meet the demand for all such assessments (see eg. previous post). Giving support on the basis of mental health need is required nonetheless, even if people don’t have a mental health diagnosis. Services need to be developed on the basis of this principle, co-ordinated by NHS England and implemented locally. Such a plan should be prioritised by the next government.

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