Has the desire not to stigmatize mental health problems resulted in a situation where treatments are inadequate? A few months ago, Professor Nick Craddock, from Cardiff University Medical School in the UK, became one of 36 signatories to an open letter published in the British Journal of Psychiatry. The basic theme - patients are getting a bad deal.
These days, people with mental health problems could end up seeing anyone from a nurse, to a social worker, to a psychologist, but rarely the specialist they need, says Craddock.
"if a [family doctor] suspected a patient had cancer, he wouldn't dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That's what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there's every chance that mental illness or underlying physical illness, will be missed." Craddock stated.
The open letter said that psychiatry is the only medical speciality that distorts its original purpose. Professor Craddock worries that the only member of the mental health team properly able to diagnose and prescribe treatment is the psychiatrist. He is concerned that too many people from various backgrounds are getting involved in the initial assessment process. Craddock gives the example of a patient who is prescribed ‘psychosocial support' rather than medical treatment. What could easily happen is that six months later we see a lack of improvement simply because what the person really needed is the correct medication.
"Psychiatrists may not be the best people to deliver treatments, but they are the best to make assessments," Craddock says.
Another concern expressed is that seemingly obvious psychological symptoms may actually mask a physical cause. In such cases the patient may be put at risk from not receiving treatment that would correct the physical imbalance and, as a consequence, resolve the psychological state. Thyroid conditions or even cancer of the brain are two such examples.
Broader concerns revolve around the whole issue of mental illness and how we respond to it. At the most fundamental level there is concern in the UK that the term "patients" is being overtaken by the term "service user", despite the fact that most people prefer the term patient. "Mental health centers" now provide treatment whereas before it was "clinics". The avoidance of medicalisation is argued to send out the wrong message. People with severe mental health issues need to know that they are ill and that there is treatment. The message, it is argued, is as important for patients to note as it is for the team of caregivers involved in mental health.
Published On: November 14, 2008
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