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Thursday, 11 December 2014

9 BEST TED TALKS TO CHANGE VIEWS ON MENTAL HEALTH

TED TALKS - "ALL KINDS OF MINDS."


All kinds of minds

These powerful stories shatter preconceived notions about mental illness, and pose the provocative question: What can the world learn from different kinds of minds?
HYPERLINK TO 9 TED TALKS : https://www.ted.com/playlists/9/all_kinds_of_minds

Wednesday, 10 December 2014

Huge Rise in Ritalin Use Worldwide is Due to Marketing not Genuine Diagnosis of a Real Condition - Courtesy of the Natural News Website December 2014



By , contributing writer to Natural News
Like many other so-called “behavioral” disorders, attention deficit hyperactivity disorder, or ADHD, is a completely fabricated condition that was invented for the sole purpose of turning normal behavioral variances into “diseases” that require costly drug interventions. This crafty pharmaceutical scam is now spreading around the world, according to a new study, with drug companies effectively lobbying foreign governments to loosen their marketing restrictions on mind-altering drug treatments in order to get more people hooked on legal drugs.

ADHD Diagnoses Spreading From America to Europe, Ritalin Prescriptions Follow

It used to be that ADHD primarily existed only in the U.S., with an overwhelming 90 percent of the world’s Ritalin prescriptions being filled in the States. But this plague of intentionally drugging children with unique personality traits is now spreading to Europe and beyond as American influences progressively topple regulatory restrictions that protect the public from becoming Big Pharma victims, and replace them with policies that treat every child like a defective human in need of mind-altering drugs.
Published in the journal Social Science and Medicine, the study looked at the growth of ADHD diagnoses in places like the U.K., Germany, France, Italy, and Brazil. Together, these countries have captured at least 15 percent of Ritalin prescriptions over the past decade, reducing America’s share to 75 percent. Psychological problems that used to be treated with non-drug interventions like talk therapy are now embracing biological psychiatry – that is, forcibly changing people’s brain chemistries with pharma poisons.
“More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD,” explains a news release summarizing the study’s findings. “Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment.”

Sweeping Diagnosis Questionnaires Label Virtually Everyone as Behaviorally ‘Ill’

But how do you effectively convince otherwise healthy people that they have a behavioral disease in need of drug treatments? One way is to offer online self-assessment questionnaires that are carefully designed to categorize normal behavioral differences as flawed, manipulating individuals to believe that they are sick.
When searching for health information online, web users are increasingly redirected to drug-promoting “resources” that ask generic questions like “Do you fidget a lot?” and “Is it hard for you to concentrate?” Most people would probably agree that they feel this way at least some of the time, and by ignorantly answering “yes” to these and other self-diagnosis questions, they end up being funneled into the system and signed up as new drug customers for completely made-up diseases.
“These checklists turn all kinds of different behaviors into medical problems,” explains Peter Conrad, a professor at Brandeis University and one of the study’s lead authors. “The checklists don’t distinguish what is part of the human condition and what is a disease.”
Many people don’t know that they’re being scammed when they fall into these crafty drug industry traps, and the result is that many of them end up becoming pharma addicts for life. According to the study, less than one percent of children in the U.K., for instance, were behavioral drug addicts in the early 1990s. But today, about five percent of the population is a behavioral drug user.
In Germany, the increase has been even more stark. Between 1998 and 2008, ADHD drug use soared by more than 500 percent, jumping from 10 million daily doses to roughly 53 million daily doses.
“There is no pharmacological magic bullet,” adds Conrad, noting that pharmaceutical drugs are not the answer to behavioral difference. “I think we may look back on this time in 50 years and ask, what did we do to these kids?”
*Image of “girl” via Shutterstock

Thursday, 4 December 2014

THE 3 'C' CHOICES FOR CO-WORKING = THE 'BIO-BIO-BIO MODEL' VERSUS THE 'BIO-PSYCHO-SOCIAL MODEL' - only systemic explanations can explain complex scenarios in which human beings find themselves trapped - particularly children.



The Three ‘C’s - Choices of Co-working for and with Child Clients who have Mental Health Needs.

Inspired by two recent statements by people at the cutting edge of their own professions I decided to try and apply their radical thinking to my main area of professional interest, at the moment, the controversial mass psychotropic drugging of our children in school,who have behavioural difficulties.

Surgeon and writer Dr Atul Gawande  has delivered the inspiring 2014 Reith lecture series on BBC Radio 4 in the last weeks. One phrase that resonated with me was his assertion that we collectively need to move from ‘the age of the molecule’ to ‘the age of the system.’ He went on to state that in his view wonder drugs like penicillin have driven us to search for ‘magic bullet’ cures for almost every human condition . Complex problems need systemic responses he feels not ‘wonder drugs’. I passionately feel that a child’s behaviour and response to the complexities of their environment is such a situation.

My second inspiring quote this week was as follows,“In recent years, psychiatry has embraced what a former president of the American Psychiatric Association has despairingly called a ‘bio/bio/bio’ model.” Professor Allen Frances – Psychiatrist. Huffington Post 2-12-14.

How does this affect the choices that exercise our professional minds when working with children and adolescents who are presenting in a distressed state?

1)   Co-Construction of a Formulation for a Child’s Mental Health Needs.
This is when more than one skilled health care professional contributes to a ‘bio-psycho-social formulation’ of a child’s emotional and health needs. Contributions are equally valued by the team working with the child and a formulation is arrived at which looks at Holistic world that the youmg person inhabits and hopefully helps them and their parents to  better accept the outcome of the professionals’ deliberations.

2)  Collusion with a ‘Medical Model’ or any other Uni-theoretical Formulation of a Child’s Mental Health Needs
This is where there is a ‘pecking order’ of professionals working with a client exists and their contributions are not considered to be of equal value by the team working on the child's problems. Consequently often a ‘bio-bio-bio model’ of formulation, for example, predominates the shared thinking process. Other perspectives are consequently ignored or minimized and the client may not even be made aware of their existence. This type of formulation is often delivered as a scientific ‘faits accomplis.’

3)  Challenge of the ‘Bio-Bio-Bio’ or Other Dominant Formulation of a Child’s Mental Health needs
This is where one on more health care workers decide that they are not professionally comfortable with the predominant process of formulation that they perceive themselves to be professionally  party to accepting. Following consideration of their Ethical Code of Practice e.g. the HCPC Duties of a Registrant, and following a supervisory conversation they decide to contact the perceived ‘lead professional’ to share their concerns and elicit a dialogue with that person, which is in the best interests of the child, with whom they both work. This is the process that I have developed by discussion with colleagues and is called the Practical Professional Protocol, it was published in the BPS DECP Debate (December 2014) to facilitate Safeguarding of Children.It is also available on the American Psychological Association - Division of Humanistic Psychology website : dxsummit.org  - under my name.




Wednesday, 3 December 2014

Professor Allen Frances - Putting The Mind And Soul Back Into Psychiatry from The Huffington Post 2-12-14




Not a "Bio-Bio-Bio Model' of mental Health but a 'Bio-Psycho-Social Model.'
Putting The Mind And Soul Back Into Psychiatry
o   

All medicine should be bio/psycho/social. Illness is never just a biological phenomenon -- more than 80 percent of health outcomes are determined by economic, social, and behavioral factors.
And the psychosocial part is especially important in psychiatry. As Hippocrates pointed out 2,500 years ago, it is more important to know the patient who has the disease than the disease the patient has.
In recent years, psychiatry has embraced what a former president of the American Psychiatric Association has despairingly called a "bio/bio/bio" model. The enormous research budget of the National Institute Of Mental Health has been totally invested in biologically reductionist brain and genomic research.
Pat Bracken is an Irish psychiatrist and philosopher who would like to put the mind and soul back into psychiatry. Pat writes:
"I believe that psychiatry finds itself in a pernicious position. Pharma has used its financial power to mould psychiatry into something that serves corporate needs, not the best interests of patients. And the massive investment in genetic and neuroscience research has yielded practically nothing of clinical value for our patients.
In fact, we have gone backwards. The narrow focus on biological research has led to a profound neglect of the social, cultural and psychological dimensions of mental illness. In the United States, where Pharma has had most influence and the perverse payment system has operated, there is evidence that, to a large extent, psychiatric care has become equated with the provision of a DSM diagnosis and a prescription.
The New York Times carried a story in 2011 in which a psychiatrist spoke of having to train himself not to get too close to his patients and 'not to get too interested in their problems'. His role was simply to check the diagnosis and adjust meds.
The reductionism that now dominates psychiatric theory and practice is ideological in nature: it does not stand up to conceptual challenge and is not supported by the results of empirical investigation. Its dominance is sustained through finance from Pharma allied to a professional quest to be more 'medical' than the rest of medicine.
What we have to grasp is that when we put the word 'mental' in front of the word illness, we are doing something important. We are delineating a territory of human suffering that is primarily about relationships, meanings and values. And, while we cannot experience anything without a functioning nervous system, a knowledge of the brain will not help us a great deal in understanding the nature of this territory.
The brain is a necessary, but not a sufficient cause of human experience. We are embodied beings but we are also encultured. We grow to become human in the midst of language, culture, history and relationships with others. These shape the way we experience ourselves and how we encounter the world around us and cannot be reductively explained in biological terms.
The demand that psychiatry should simply become a 'clinical neuroscience' is nothing more than an assertion of dogma and is not based on a genuinely questioning scientific approach to the sort of problems that face us.
We need to nurture the development of a psychiatry that sees relationships, meanings and values as its primary focus. I have used the word 'hermeneutic' to describe this.
How to get there is the challenge. Evidence-based medicine (EBM), with its focus on controlled studies and meta-analyses, has not proved robust enough in protecting psychiatry, and medicine in general, from corruption. It has been said that EBM itself is 'broken.'
With our colleagues from other medical disciplines we will need to develop a much deeper form of critical appraisal. I believe that any profession that has power in the lives of ordinary people should seek to critically reflect on its own history, assumptions, values and practices in an organized and sustained way. A mature profession should not be afraid of this. We need practitioners who are trained to question and to doubt, to challenge their teachers and to see financial ties to third parties as an aberration.
On a more positive note, our discipline has a rich history of grappling with conceptual issues before the rise of 'neuromania' and the DSM. The work of Karl Jaspers stands out in this area but many of our predecessors struggled to develop a theory and a practice of psychiatry that was not reductionist. The great Swiss psychiatrist, Medard Boss, for example, sought to develop a specifically hermeneutic psychiatry in the post World War II era. We do not have to re-invent the wheel. A growing movement of critical psychiatry is now emerging as a positive force for change within the profession (www.criticalpsychiatry.co.uk).
I believe that we need to develop a practice that is centered on relationships and we need to acknowledge the limitations of a diagnosis-guided practice in our field. This is not anti-medical but simply an acceptance that mental health work demands something different. We need to nurture negotiation skills in our trainees and encourage them to engage with the growing consumer movement in a positive and non-defensive way. We need to accept that psychiatry has done a great deal of harm to many of its patients and professional arrogance should be stigmatized and fought against. We need to nurture doubt, questioning and critical reflection in our academic and clinical practice.
A hermeneutic psychiatry would be one where doctors, patients, carers and other professionals struggle together to determine what research, teaching and service models are appropriate. I also believe that we should struggle to shed the power to order coercive interventions. This is not to say that sometimes people need to be cared for safely and even against their will, but there is no scientific or moral reason why the medical profession should be in charge of this.
I do not claim to have an answer to all the problems of psychiatry but the following moves will be essential if we are to find a cure for our current ills: 1) collaborate with other doctors who are struggling to free medicine of Pharma corruption, 2) find ways of working positively with, and learning from, the growing international consumer movement, 3) balance our involvement with the biological sciences with an equal involvement with the humanities and social sciences, 4) nurture the development of a clinical discourse that is centered on relationships, meanings and values, 5) seek to shed the coercive powers that are now invested in us and promote an open debate about how people can be looked after safely through times of crisis."
Thanks, Pat. We must get back to treating the whole person, not just his brain circuits. The brain is involved in all we do and what we are, but it is also itself influenced by our psychology and social context.
And we must equally counter those who err in recommending an opposite and equally extreme psychosocial reductionism. Mindless psychiatry and brainless psychiatry are equally misguided and harmful.
MORE:


Tuesday, 25 November 2014

Professor Peter Kinderman (Liverpool) -Why We Need to Abandon the Disease-Model of Mental Health Care - READ HIS NEW BOOK - "A Prescription for Psychiatry."


Why We Need to Abandon the Disease-Model of Mental Health Care
By Peter Kinderman | November 17, 2014 
The views expressed are those of the author and are not necessarily those of Scientific American.




The original English version of the DSM-5 as well as the French version of the DSM-IV-TR. (Credit: F.RdeC via Wikimedia Commons)
The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one. Our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services.
Clarity without diagnosis
Even mainstream medical authorities have begun to question the creeping medicalization of normal life and criticize the poor reliability, validity, utility and humanity of conventional psychiatric diagnosis. It is important that we are able to define, identify and measure the phenomena we are attempting to study and the problems for which people seek help. But we obfuscate rather than help when we use the language of medical disease to describe the understandable, human and indeed normal response of people to traumatic or distressing circumstances. So there are ethical and humanitarian reasons to be skeptical of traditional psychiatric diagnosis. But there are scientific reasons too. It’s odd but hugely significant that the reliability statistics for the American Psychiatric Association’s influential DSM franchise have been falling steadily over time. It is difficult reliably to distinguish different “disorders”, but also difficult to identify specific biological etiological risk factors. Indeed, Thomas Insel, director of the National Institute of Mental Health, recently suggested that traditional psychiatric diagnoses had outlived their usefulness.
A Prescription for Psychiatry, book cover.
Understanding rather than etiology
It’s all too easy to assume that mental health problems — especially the more severe ones that attract diagnoses like bipolar disorder or schizophrenia — must be mystery biological illnesses, random and essentially unconnected to a person’s life. But when we start asking questions about this traditional disease-model way of thinking, those assumptions start to crumble.
Some neuroscientists have asserted that all emotional distress can ultimately be explained in terms of the functioning of our neural synapses and their neurotransmitter signalers. But this logic applies to all human behavior and every human emotion and it doesn’t differentiate between distress — explained as a product of chemical “imbalances” — and “normal” emotions. Moreover, while it is clear that medication (like many other substances, including drugs and alcohol) has an effect on our neurotransmitters, and therefore on our emotions and behavior, this is a long way from supporting the idea that distressing experiences are caused by imbalances in those neurotransmitters.
Many people continue to assume that serious problems such as hallucinations and delusional beliefs are quintessentially biological in origin, but we now have considerable evidence that traumatic childhood experiences (poverty, abuse, etc.) are associated with later psychotic experiences. There is an almost knee-jerk assumption that suicide, for instance, is a consequence of an underlying illness, explicable only in biological terms. But this contrasts with the observation that the recent economic recession has had a direct impact on suicide rates, a rather dramatic (and sad) example of how social factors impact on our mental health.
Neural activity and chemical processes in the brain lie behind all human experiences, and it’s undoubtedly helpful to understand more about how the human brain works. However, this is very different from assuming that some of those experiences (psychosis, low mood, anxiety, etc) should be classified as illnesses. The human brain is not only a complex biological structure; it is also a fantastically elegant learning engine. We learn as a result of the events that happen to us, and there is increasing evidence that even severe mental health problems are not merely the result simply of faulty genes or brain chemicals. They are also a result of experience — a natural and normal response to the terrible things that can happen to us and that shape our view of the world.
Stigma & empathy
Traditionally, the idea that mental health problems are illnesses like any other and that therefore people should not be blamed or held responsible for their difficulties has been seen as a powerful tool to reduce stigma and discrimination.
Unfortunately, the emphasis on biological explanations for mental health problems may not help matters because it presents problems as a fundamental, heritable and immutable part of the individual. In contrast, a more genuinely empathic approach would be to understand how we all respond emotionally to life’s challenges.
But things are changing. Over the past 20 years or so, we’ve seen a very positive and welcome growth of the user and survivor movements, where people who have experienced psychiatric care actively campaign for reform, and signs of more responsible media coverage. We are just starting to see the beginnings of transparency and democracy in mental health care. This has led to calls for radical alternatives to traditional models of care, but I would argue that we do not need to develop new alternatives.We already have robust and effective alternatives. We just need to use them.
Therapy
Clinicians have raised concerns about the relative benefits of psychiatric medication and there is increasing evidence for the effectiveness of psychological therapies such as cognitive behavioral therapy. Indeed, even for people with very serious mental health problems, such as those leading to a diagnosis of schizophrenia, and even for those choosing not to take medication, such therapies have great promise.
We need to place people and human psychology central in our thinking. Psychological science offers robust scientific models of mental health and well-being, which integrate biological findings with the substantial evidence of the social determinants of health and well-being, mediated by psychological processes.
We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future and the world. Biological factors, social factors and circumstantial factors — our human experience — affect the key psychological processes that help us build up our sense of who we are and the way the world works.
A new approach
In my new book A Prescription for Psychiatry I offer a manifesto for mental health and well-being. I argue that services should be based on the premise that the origins of distress are largely social. The guiding idea underpinning mental health services needs to change; from an assumption that our role is to treat disease to an appreciation that our role is to help and support people who are distressed as a result of their life circumstances.
This also means we should replace traditional diagnoses with straightforward descriptions of problems. We must stop regarding people’s very real emotional distress as merely the symptom of diagnosable “illnesses”. A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and for the design and planning of services. This does not mean rejecting rigor or the scientific method — quite the opposite. While psychiatric diagnoses lack reliability, validity and utility, there is no barrier to the operational definition of specific psychological phenomena, and it is equally possible to develop coherent treatment plans from such a basis.
All this means that we should turn from the diagnosis of illness and the pursuit of etiology and instead identify and understand the causal mechanisms of operationally defined psychological phenomena. Our health services should sharply reduce our reliance on medication to address emotional distress. We should not look to medication to “cure” or even “manage” non-existent underlying “illnesses”.
We must offer services that help people to help themselves and each other rather than disempowering them — services that facilitate “personal agency” in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions. Where individual therapy is needed, effective, formulation-based (and therefore individually tailored) psychological therapies should be available to all. When people are in acute crisis, residential care may be needed, but this should not be seen as a medical issue. Since a disease model is inappropriate, it is also inappropriate to care for people in hospital wards. A different model of care is needed.
Adopting this approach would result in a fundamental shift from a medical to a psychosocial focus. It would mean a move from hospital to residential social care and a substantial reduction in the prescription of medication. And because experiences of neglect, rejection and abuse are hugely important in the genesis of many problems, we need to redouble our efforts to address the underlying issues of abuse, discrimination and social inequity.
This is an unequivocal call for a revolution in the way we conceptualize mental health and in how we provide services for people in distress, but I believe it’s a revolution that’s already underway.
About the Author: Peter Kinderman is professor of Clinical Psychology at the University of Liverpool, and is a Chartered Clinical Psychologist. He is Head of the Institute of Psychology, Health and Society at the University of Liverpool. His research interests are in psychological processes underpinning well-being and mental health, and in particular psychotic phenomena such as delusions and hallucinations. In 2000, he received the British Psychological Society's Division of Clinical Psychology 'May Davidson Award', an annual award for outstanding contributions to the field of clinical psychology, in the first ten years after qualifying. He was twice elected Chair of the British Psychological Society Division of Clinical Psychology; from 2004 to 2005, and again from 2010-2011. In that role, he worked with the UK Department of Health, the BBC, the Health Professions Council, the European Union Fundamental Rights Agency and the UK Office for National Statistics, amongst others. He has recently launched a free, online, open-access course exploring our understanding of mental health and well-being. Follow on Twitter @peterkinderman.


The views expressed are those of the author and are not necessarily those of Scientific American.
By Peter Kinderman | November 17, 2014 |   30
The views expressed are those of the author and are not necessarily those of Scientific American.



The original English version of the DSM-5 as well as the French version of the DSM-IV-TR. (Credit: F.RdeC via Wikimedia Commons)
The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one. Our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services.
Clarity without diagnosis
Even mainstream medical authorities have begun to question the creeping medicalization of normal life and criticize the poor reliability, validity, utility and humanity of conventional psychiatric diagnosis. It is important that we are able to define, identify and measure the phenomena we are attempting to study and the problems for which people seek help. But we obfuscate rather than help when we use the language of medical disease to describe the understandable, human and indeed normal response of people to traumatic or distressing circumstances. So there are ethical and humanitarian reasons to be skeptical of traditional psychiatric diagnosis. But there are scientific reasons too. It’s odd but hugely significant that the reliability statistics for the American Psychiatric Association’s influential DSM franchise have been falling steadily over time. It is difficult reliably to distinguish different “disorders”, but also difficult to identify specific biological etiological risk factors. Indeed, Thomas Insel, director of the National Institute of Mental Health, recently suggested that traditional psychiatric diagnoses had outlived their usefulness.
A Prescription for Psychiatry, book cover.
Understanding rather than etiology
It’s all too easy to assume that mental health problems — especially the more severe ones that attract diagnoses like bipolar disorder or schizophrenia — must be mystery biological illnesses, random and essentially unconnected to a person’s life. But when we start asking questions about this traditional disease-model way of thinking, those assumptions start to crumble.
Some neuroscientists have asserted that all emotional distress can ultimately be explained in terms of the functioning of our neural synapses and their neurotransmitter signalers. But this logic applies to all human behavior and every human emotion and it doesn’t differentiate between distress — explained as a product of chemical “imbalances” — and “normal” emotions. Moreover, while it is clear that medication (like many other substances, including drugs and alcohol) has an effect on our neurotransmitters, and therefore on our emotions and behavior, this is a long way from supporting the idea that distressing experiences are caused by imbalances in those neurotransmitters.
Many people continue to assume that serious problems such as hallucinations and delusional beliefs are quintessentially biological in origin, but we now have considerable evidence that traumatic childhood experiences (poverty, abuse, etc.) are associated with later psychotic experiences. There is an almost knee-jerk assumption that suicide, for instance, is a consequence of an underlying illness, explicable only in biological terms. But this contrasts with the observation that the recent economic recession has had a direct impact on suicide rates, a rather dramatic (and sad) example of how social factors impact on our mental health.
Neural activity and chemical processes in the brain lie behind all human experiences, and it’s undoubtedly helpful to understand more about how the human brain works. However, this is very different from assuming that some of those experiences (psychosis, low mood, anxiety, etc) should be classified as illnesses. The human brain is not only a complex biological structure; it is also a fantastically elegant learning engine. We learn as a result of the events that happen to us, and there is increasing evidence that even severe mental health problems are not merely the result simply of faulty genes or brain chemicals. They are also a result of experience — a natural and normal response to the terrible things that can happen to us and that shape our view of the world.
Stigma & empathy
Traditionally, the idea that mental health problems are illnesses like any other and that therefore people should not be blamed or held responsible for their difficulties has been seen as a powerful tool to reduce stigma and discrimination.
Unfortunately, the emphasis on biological explanations for mental health problems may not help matters because it presents problems as a fundamental, heritable and immutable part of the individual. In contrast, a more genuinely empathic approach would be to understand how we all respond emotionally to life’s challenges.
But things are changing. Over the past 20 years or so, we’ve seen a very positive and welcome growth of the user and survivor movements, where people who have experienced psychiatric care actively campaign for reform, and signs of more responsible media coverage. We are just starting to see the beginnings of transparency and democracy in mental health care. This has led to calls for radical alternatives to traditional models of care, but I would argue that we do not need to develop new alternatives.We already have robust and effective alternatives. We just need to use them.
Therapy
Clinicians have raised concerns about the relative benefits of psychiatric medication and there is increasing evidence for the effectiveness of psychological therapies such as cognitive behavioral therapy. Indeed, even for people with very serious mental health problems, such as those leading to a diagnosis of schizophrenia, and even for those choosing not to take medication, such therapies have great promise.
We need to place people and human psychology central in our thinking. Psychological science offers robust scientific models of mental health and well-being, which integrate biological findings with the substantial evidence of the social determinants of health and well-being, mediated by psychological processes.
We must move away from the disease model, which assumes that emotional distress is merely symptomatic of biological illness, and instead embrace a model of mental health and well-being that recognizes our essential and shared humanity. Our mental health is largely dependent on our understanding of the world and our thoughts about ourselves, other people, the future and the world. Biological factors, social factors and circumstantial factors — our human experience — affect the key psychological processes that help us build up our sense of who we are and the way the world works.
A new approach
In my new book A Prescription for Psychiatry I offer a manifesto for mental health and well-being. I argue that services should be based on the premise that the origins of distress are largely social. The guiding idea underpinning mental health services needs to change; from an assumption that our role is to treat disease to an appreciation that our role is to help and support people who are distressed as a result of their life circumstances.
This also means we should replace traditional diagnoses with straightforward descriptions of problems. We must stop regarding people’s very real emotional distress as merely the symptom of diagnosable “illnesses”. A simple list of people’s problems (properly defined) would have greater scientific validity and would be more than sufficient as a basis for individual care planning and for the design and planning of services. This does not mean rejecting rigor or the scientific method — quite the opposite. While psychiatric diagnoses lack reliability, validity and utility, there is no barrier to the operational definition of specific psychological phenomena, and it is equally possible to develop coherent treatment plans from such a basis.
All this means that we should turn from the diagnosis of illness and the pursuit of etiology and instead identify and understand the causal mechanisms of operationally defined psychological phenomena. Our health services should sharply reduce our reliance on medication to address emotional distress. We should not look to medication to “cure” or even “manage” non-existent underlying “illnesses”.
We must offer services that help people to help themselves and each other rather than disempowering them — services that facilitate “personal agency” in psychological jargon. That means involving a wide range of community workers and psychologists in multidisciplinary teams, and promoting psychosocial rather than medical solutions. Where individual therapy is needed, effective, formulation-based (and therefore individually tailored) psychological therapies should be available to all. When people are in acute crisis, residential care may be needed, but this should not be seen as a medical issue. Since a disease model is inappropriate, it is also inappropriate to care for people in hospital wards. A different model of care is needed.
Adopting this approach would result in a fundamental shift from a medical to a psychosocial focus. It would mean a move from hospital to residential social care and a substantial reduction in the prescription of medication. And because experiences of neglect, rejection and abuse are hugely important in the genesis of many problems, we need to redouble our efforts to address the underlying issues of abuse, discrimination and social inequity.
This is an unequivocal call for a revolution in the way we conceptualize mental health and in how we provide services for people in distress, but I believe it’s a revolution that’s already underway.
About the Author: Peter Kinderman is professor of Clinical Psychology at the University of Liverpool, and is a Chartered Clinical Psychologist. He is Head of the Institute of Psychology, Health and Society at the University of Liverpool. His research interests are in psychological processes underpinning well-being and mental health, and in particular psychotic phenomena such as delusions and hallucinations. In 2000, he received the British Psychological Society's Division of Clinical Psychology 'May Davidson Award', an annual award for outstanding contributions to the field of clinical psychology, in the first ten years after qualifying. He was twice elected Chair of the British Psychological Society Division of Clinical Psychology; from 2004 to 2005, and again from 2010-2011. In that role, he worked with the UK Department of Health, the BBC, the Health Professions Council, the European Union Fundamental Rights Agency and the UK Office for National Statistics, amongst others. He has recently launched a free, online, open-access course exploring our understanding of mental health and well-being. Follow on Twitter @peterkinderman.