Why has the adoption of a non-pharmaceutical approach not happened already?
The standard treatment of psychiatric disorders has developed more from a culture of drug therapy and clinical observation and less from any analysis of underlying neurobiology and is therefore geared to the development of synthetic medicines. And, such drugs are easily available more in keeping with the quick fix culture of today, as opposed to the pursuit of orthomolecular treatments, which can often take many months to achieve the best results. The drug industry is extremely profitable and it has many long established means of inspiring and maintaining ‘brand’ loyalty.
It will be difficult to change established practices, especially where reappraisal of long established theories and assumptions based upon them, is required. But voices both inside and outside the medical community are advocating change and it is hoped an inclusive and considered debate, will lead to non-pharmaceutical approaches being incorporated into the model for the 21st century care.
The scale of mental health disorders should make this a priority area for health treatment and research. The Office for National Statistics Psychiatric Morbidity report says that 1 in 4 British adults experience at least one diagnosable mental health problem in any one year and 1 in 6 experiences this at any given time. MIND breaks this down as out of 1000 people every year in Britain, 102 will be diagnosed as having a mental health problem, 24 of these will be referred to a specialist psychiatric service and 6 of these will become inpatients in a psychiatric hospital.
The 2008 WHO World Mental Health Surveys: ‘Global Perspectives on the Epidemiology of Mental Disorders’, point out that even in countries with the best health care systems only a minority of people with mental disorders are receiving treatment and although more chronic cases eventually obtain treatment, it is often substantially delayed and there is questionable quality of most treatments.
The cost of mental illness in England according to the Centre for Mental Health, taking into account economic and social costs, is estimated at £105.2 billion in 2009/10, an increase by 36% between 2002/03 and 2009/10. They put this into context by pointing out ‘Our 2003 policy paper showed that mental health problems carried a bigger cost to society than crime, and falling crime rates since then imply that the difference is now even bigger’.
The Mental Health Bulletin on NHS adult specialist mental health services 2010 states that over 1.25 million people used NHS specialist mental health services in the year 2009/10 which was the highest number since data collection began in 2003/04 and a 4% increase from 2008/09. The number of people who spent time in a mental hospital rose by 5.1% – the first increase in five years. This rise was due to a 30.1% (estimated at 17.5% allowing for improved recording) in the number of people being compulsorily detained in hospital under the Mental Health Act from 32,649 in 2008/09 to 42,479 in 2009/10.
The 2011 European Neuropsychopharmacology Report, ‘The Size and Burden of Mental Disorders and other Disorders of the Brain in Europe 2010’ stated that, ‘well over one third of the EU population during any given 12 month period suffers from mental disorders alone, most of which are not receiving any treatment’. The report concludes that the true size and burden of disorders of the brain in the EU has been significantly underestimated in the past. ‘Concerted priority action is needed at all levels, including in particular substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the care health challenge of the 21st Century’.
Meanwhile, the Royal College of Psychiatrists point out on their website that for chronic mental health disorders such as bipolar disorder and schizophrenia, they don’t understand what the causes are. The reality is that it has not been possible to identify a specific causal factor and it is recognised that mental disorders come about through a number of causal factors including behavioural and biological changes. Also there is recognition that often mental illnesses are not illnesses as such but the result of the way we live our lives, the nature of society and environment in which we live or were brought up in, and the food we eat or don’t eat.
Given the pervasiveness of mental health problems and their financial and human costs, it seems absurd that limited resources are being provided for mental health research. Treatments need to be brought into the 21st Century and become more advanced than just drug, electroshock, lobotomy and crude interventions. More emphasis needs to be placed on psychosocial methods of treatment, healthy lifestyles and care and support within families and communities.
This has been recognised by psychiatry and the Royal College of Psychiatrists in their June 2011 report ‘Do the Right Thing: How to Judge a Good Ward’ which says that adult inpatient mental healthcare hospital wards should provide patients with access to a range of psychological therapies and follows NICE (National Institute for Health and Clinical Excellence) updated guidelines that recommends the use of psychological interventions, such as cognitive behaviour therapy, family interventions and arts therapies for the treatment of people with schizophrenia. However, it is concerning that the report finds that only 38% of patients have been offered supportive counselling and only 29% of patients receive access to talking therapies, with almost a quarter of patients that request therapy not actually receiving it.
Drugs remain dominant in the treatment of mental illness and this seems to have created its own blinkered approach. Drugs fit the medical paradigm of biological cause and cure, and suit a financially lucrative pharmaceutical industry. However drugs produce problems of withdrawal and with longer term use in chronic mental illness, often produce tardive dyskinesia (movement disorder), tardive dementia (deterioration of mental faculties), tardive akathisia (anxiety and uncontrollable drive to move the body) and brain damage and dysfunction. These effects have become so common, that they have misdiagnosed as symptoms of the illnesses, rather than recognised as consequential effects of long term drug treatment. Studies indicate an integrated treatment approach is best, with use of motivational interviewing, antipsychotic medications used with close monitoring, community based rehabilitation and social skills training; family psychotherapy; cognitive-behavioural therapy to reduce delusions and hallucinations; developing a healthy physical and social lifestyle.
Chy-Sawel recognises the need for an holistic treatment approach to mental illness and regards much of the current heavily drug based treatment approach as inappropriate and believes that other models of treatment need to be researched and, if successful, used to improve mental health problem treatment even if it means re-examining the position of psychiatry and that of the pharmaceutical industry.