The NHS and the state of psychiatry

Over the last few years there has been a big move in the NHS to provide 'evidence based' practice. This means that there has to have been good quality clinical research to prove the effectiveness of a treatment. For drug treatment this research, carried out of course by drug companies, has been essential to ensure patients' safety. Once the treatment is proved experimentally to be effective and 'safe' for a specific diagnosed complaint, it can be licensed and used.

In psychiatry, it has always been necessary to provide more than just drug treatment, and traditionally mental health workers have known the therapeutic value of activities that change peoples' thoughts and beliefs about themselves and the world around them. It isn't rocket science that someone with confidence, be it through having a good social network or achieving at work, sports, art, music etc, is going to have better mental health as a result. People with depression undertaking therapy to increase their insight, such as counselling, alternative therapies and psychotherapy will also improve their mental health.

The trouble is that there is a requirement in the NHS now for these approaches to have the 'evidence based' stamp of approval. Of course, drug companies will not pay for such research, and funding for any kind of psychological research is pretty sparse. Though psychologists do the bulk through educational funding, the rest of us clinicians are too busy coping with heavy caseloads and large waiting lists. There are also lots of difficulties, apart from time constraints, in doing research in some of these therapies. The 'gold standard' in scientific research is the 'placebo controlled double blind trial', which requires that the patient and clinician doesn't know what treatment they will receive, or whether it be a placebo (just a sugar pill) or not. Of course, it's impossible to do that with most of the non-drug treatments in psychiatry, so even if there are good research findings, they are seen as 'second class' in scientific and medical circles, who advise our government. As a result, there are only a handful of non-drug therapies given the evidence based stamp, the main ones being cognitive behavioural therapy (CBT) and interpersonal therapy (IPT).

In the field of mental health, workers of various disciplines are being encouraged to train to do these therapies, particularly since the government's aim is to reduce antidepressant prescribing and help in other ways, which is a good thing. Some nurses have deskilled and concentrate on only providing evidence based stuff. As a result, all other therapeutic possibilities are dismissed until a 'miracle' happens, and someone in 'research land' comes up with the evidence. What did they do before CBT got the stamp? Didn't people get better? Of course they did, and still do from non-evidence based practice! I am proud to provide this for my patients, though I don't broadcast it too loudly! It's like the emperor's new clothes story. We all put up and shut up. We conform, and go and train do do these therapies, then feel superior to those who provide 'second class' therapeutic interventions to the mass of people that CBT and IPT are not suitable for.

This policy of only providing evidence based practice is stifling original thought at least in mental health in the NHS. We are importing our therapies from the States because that is mainly where the research is being done.

As for alternative therapies, we haven't a hope in getting recognition from the NHS, though privately, it is increasing hugely. Why? Because the NHS is mainly palliating with drugs that have side effects. The doctor's favourite saying is ' there are side effects, but the benefits outweigh the risks'. If someone was willing to provide money and research expertise I'd set about proving my approach's effectiveness. Anyone out there?

To conclude, I'm not anti evidence based practice, but it must be recognised for it's limitations, particularly in the mental health field. I heard an inspiring story the other day from a nurse who got a football team together made up of people with severe mental illness, and how many were able to go and work as a result of increasing their confidence. There's more than one way to skin a cat! I rest my case!

Visit my website for another way! www.stressalternatives.co.uk
Liz Temple

Introducing my ego!

Happy midsummer night!
I have a serious mental health problem! I am deluded that I can help people to make positive changes! I am also egotistical enough to be quite obsessed with trying to figure out how to do this. Instead of taking life easy, I have been afflicted with this illness of feeling responsible (and also that I am always right!). I am not egotistical enough to believe that I have a 'calling' from God or anything, but I can't shake this feeling I need to do the aforementioned. What a waste! I could be partying or watching Big Brother! Actually, I'm not that fond of partying or watching Big Brother. How sick is that?
Visit my website on www.stressalternatives.co.uk
Bye for now
Liz