[From Times >>>] Madam, – The article by Carl O’Brien, “A cure worse than the illness?” (HEALTHplus, February 22nd) asks urgent questions of psychiatry and I would like to answer them.
There is no evidence that psychiatric drugs are fuelling an epidemic of mental illness. Robert Whitaker, author of Anatomy of an Epidemic, states that there is a question to be asked about the association between increased use of psychiatric drugs and increased disability from mental illness, but clearly states there is no evidence that the use of drugs has caused any increase is mental illness. He quotes from World Health Organisation studies which appeared to show that outcomes from schizophrenia were better in low- and middle-income countries, where just a small percentage of people were on medication. In fact, recent reviews in the psychiatric literature show that claims of better outcomes in poorer countries have been overstated, and the best indicator of good outcome for schizophrenia is ensuring early intervention, which reduces the duration of untreated psychosis.
Similarly, Mr Whitaker quotes work in Western Lapland where there are good outcomes, and there is a low use of medication. The work in Lapland, known as Open Dialogue, uses a partnership approach between patient and family and treating mental health team. The good outcomes are believed to be associated with the fact that problems are identified early, and treatment can be introduced early, before the person develops associated disabilities.
Carl O’Brien is correct in stating that the medical model of care does not work. Today this is well accepted in psychiatry. A combination of biological, psychological and social interventions is needed to enable the person with mental illness reach recovery. The government policy document for mental health A Vision for Change recommends that mental health services be delivered by fully resourced multidisciplinary teams, to include psychology, social work, occupational therapy as well as nursing and medical input. A collaborative, partnership approach, similar to Open Dialogue, is recommended. The College of Psychiatry fully supports the introduction of this approach throughout the country.
Unfortunately the government up to now has not funded the full introduction of A Vision for Change.
There is good evidence to show that many people benefit enormously from taking psychiatric drugs, when they are used as one part of a treatment package. People who have experience of serious mental illnesses do recover and lead fulfilling lives in the community, and for many that recovery is due to medication. People have a better outcome the earlier they are treated. What individuals with mental health problems need are well-resourced services and access to interventions, including medications, which have been well researched and proven to be effective. – Yours, etc,
Dr ANNE JEFFERS, Director, External Affairs Policy, College of Psychiatry of Ireland