Mental Health and the Medicalisation of Mental Health

[ThisBigSky]

Just wondering, having been watching and reading some of Derek Summerfield's work over the weekend, has anyone else experienced being on multiple types of mental health medication and, for me at least, reflecting back on it and realising that pharmaceutical medication was never going to be the resolution?

Summerfield touches a lot of exporting of mental health globally, and this may be my issue (I didn't grow up in the UK with the societal norms of the UK) so I am wondering about the experience of others?

Should we (the UK) be offering other first line treatments rather than pharmaceuticals, and if you were, were these successful or did you / do you take medication as well?

If we change our society will the mental health we experience change as well?

We absoloutely should be offering more than just drugs. They have their place but they can just be sticking plaster stuff. In my case they nearly killed me, destroyed my life and I've just been left to rot. I have banged on every single door I've come across. Nothing. It's disgusting how mental health patients are treated. If I'd had cancer I'd have been treated far better.

Depends I think on the impact and causes of the illness. When I was unwell, I could not have participated in any therapy as I was too ill to concentrate or process information.

Medication got me to a place where I could do things that get me/keep me well e.g. sleep, eat, shower, see friends, leave the flat...

exporting of mental health globally

WTAF does this even mean?

It depends on the nature of the mental health issue and the severity. Some can only be treated safely with medications others need a combination of medications and therapies some can manage with therapies alone. As with physical health there is no one cap fits all solution

Use whatever treatment is likely to be most effective- not the same for different people or illnesses

Medicine is increasing becuse its getting better all the time

Both therapies and medication should always be available. I've just gone through six weeks with ds with no medication, despite the fact that he was in a crisis bed in a mental health unit for a week. It's now seven weeks. We have meds but he has not seen a doctor or a psychiatrist in that time.

User - there's a few videos on it, but basically it's about exporting the Western "standards" of mental health globally.

Araiwa- actually, there's very little evidence that antidepressants are more effective than placebos (this is one of Summerfield's statements), yet 1 in 8 are taking them.

Agree that in some cases medication is necessary - thank you for sharing all your thoughts, and experiences. Short term crisis medication got me back on my feet, but the years of antidepressants (various types) did absolutely nothing apart from put me into a crisis (largely because I became convinced I was unfixable). I had close to twenty assessments to talking therapies at this time and was knocked back from every single one (or my referrals were lost post assessment).

Gilead I hope your son feels better soon, I find it scary that he has the medication but hasn't seen a doctor or psychiatrist! Do you? Do you think that seeing someone would be beneficial?

Depends I think on the impact and causes of the illness. When I was unwell, I could not have participated in any therapy as I was too ill to concentrate or process information

This was me, exactly. I did have a LOT of therapy, and it was fantastic, but only after the meds kicked in. They gave me the space in my head to be able to engage with the therapy - I would not have got better without them.

Everybody's experience of mental illness is different - easy access to appropriate therapy and medication (if needed) should be equally available to everyone. Unfortunately it often isn't.

I think there’s definitely something to debate further about our environment and mental health experiences. ‘Cutting’ for instance seems to be a very widespread phenomenon in the first world in a way I just haven’t seen or heard of elsewhere.

‘Society’ not our environment.

Tweet - yes, DP and I were talking about this, actually we have seen cutting elsewhere, but it's been ceremonial and not related to mental health. Another aspect with taking our western approach to mental health elsewhere.

My experience of depression was that I needed the medication first to be able to then participate in talking therapies. Without the medication I wouldn’t be here now.

It depends on the condition and the severity. I've had PTSD and clinical depression, and I wouldn't be here without the meds. They got me through some very bad times to a point where I was ready for therapy.
I have a couple of bipolar friends, one joined a church and they persuaded her to stop taking her meds - she was back in the ward within weeks. It took her months to get back on her feet after that episode. She has kids so it had an effect on them as well.

Its too easy to say people used to manage before drugs but its not true. Mental hospitals used to be the grimmest places you can imagine.

It depends. Not all anti-depressants are no more effective than placebo though there is at least one in the BNF which isn't and it's widely used.

Drugs are cheaper in some cases and more readily available and less person intensive than psychological therapies.

It's swings and roundabouts. Before anti-psychotic drugs there was institutionalization and/or psychotherapy.

When the 1st anti-psychotics came out, they did research studies comparing AP drug treatment to those getting psychotherapy 2/3 times a week and the drugs led to far more improvement.

Now psychotherapy is what most people want but can't access.

And a lot of people WANT the drugs. Ask someone to engage in CBT for anxiety or sleep hygiene for insomnia rather than drugs and they often get incredibly annoyed.

And 'exporting mental health treatment globally' isn't quite as straightforward as it seems. If you look at psychosis for instance in countries without easy access to AP drugs most people will recover from a psychotic episode without drugs in 6-12 months. It would be completely unethical to let someone do that in westernised countries because we do have treatments that can help. And not all will recover without drugs.

When Clozapine first became widely used it changed the treatment of schizophrenia completely from a degenerative illness that could only be managed by heavy sedation to the point of Parkinsonian symptoms while still having delusions/hallucinations to in a lot of cases, treating the psychotic symptoms themselves.

It improved the illnesses of chronic patients so much that many patients asked to come off it and became suicidal. Because they were well for the first time in decades and could not tolerate the pain of realising just what they'd lost over the previous many years.

So now we use it earlier (after the failure of other AP drug treatment) to give a group of people a chance of a life when thousands of hours of therapy would make little or no difference.

So it depends on the illness and the background and the individual. But it can't be said that it's the medication or medicalisation of MH that is always the problem.

Dd had to spend nearly two years trying to do therapy while far too ill to engage before doctors would agree to put her on medication

I can see where they were coming from, especially as she was young, but it was scary: I lived in continuous fear of her killing herself, fortunately her attempts did not succeed

A side-effect of this delay is also that her school grades are such that they pretty well preclude her going to university (which thankfully she doesn't want to do anyway)

As I say, I can see where they were coming from, but certainly my experience was not that they were rushing out with pharmaceuticals, far from it

My view is also slightly coloured by having been brought up by a parent suffering from depression and mood swings

Yes, on the face of it she managed- but that was partly because I (from the age of 10 or thereabouts) acted as her personal therapist. That is one hell of a burden to lay on a young child. When people talk about hysterical teenagers I smile wrily: in my teens, I was the one having to manage a hysterical 50yo. It would never have occurred to me to have a foot-stomping tantrum of my own: I had a job to do in keeping the family afloat and I knew it.

My grandfather also managed severe depression- because (as he admitted himself) my grandmother carried him. Well, at least she was an adult. I was not.

Don't get me wrong: she was a great mum and I loved her dearly. Absolutely not abusive in any way. But she was also ill. She refused to see a doctor, partly because she was afraid of talk (small town), partly because she was embarrassed, but partly because she didn't want medication. So she had me instead. It shouldn't have been that way.

I do think that other treatments should be tried before drugs, but maintain drugs have their place.

I had well over 2 years of psychiatric input/hospital as a child before I was put on medication when I got to over 18. When I was put on the right medication (took years to get there) it changed my life in that I was finally able to function like a normal human being...sleep, wake up, go to uni/work etc and stay awake all day, and not be on a mission to self destruct. It also enabled me to stay out of 'services' for a good many years. If I hadn't been put on it, I would be dead, no doubt about it.

Drugs have there place but I do think as a society we are creating issues out of non issues. We aren’t teaching resilience. We are undermining normality.
Teenagers who feel a bit anxious or sad are given drugs and being labelled with mental health issues for life instead of being told it’s normal to feel sad sometimes and anxiety tends to be a symptom of teenage years. We spend all our energies rushing in sorting out every minor squabble or telling off at school instead of trusting our children to deal with it. Some of the ‘I am furious with this teacher’ threads are verging on unbelievable.

I think it's a mixed picture. Sometimes medication is essential and sometimes it isn't. There are definitely people with depression for whom conventional medication does not work - same with psychosis. But I work in mental health research and there is a lot of work going on into the causes of both psychosis and depression. There are strong indications that a small but significant proportion of both illnesses have their roots in the immune system, which will require the development of a completely different generation of medications. There has already been a study showing that in some cases of first episode psychosis there is a definite immunological cause, for which treatment with immunosuppressants works.

You can't say the abscence of cutting in some other countries/cultures means that we're taking a western approach to MH elsewhere.

It simply means that MH illnesses manifest differently in other countries/cultures. And of course they will.

Somali/Somaliland for example have no perception of a spectrum of mental illnesses like we do in the west. They have in rough terms 'mad' and 'fine'.

They don't even have the language that we do to describe anxiety or depression or OCD. Nor ADHD or Autism but what we do see in Somali communities in the west is that all those disorders ARE present, just not recognised or described in the way that we do. And they are present in their countries of origin - just not seen as such.

Summerfield has done some good research but a lot of people look at anti-psychiatry and think you can throw the baby out with the bathwater. And it's not as simple as that.

We should be offering advice on nutrition because the gut biome is linked to loads of health problems including brain related problems. It’s the latest area of research.

I’d always try changing what I eat before trying medication.

Noimbrian There is some interesting new research that shows that schizophrenia may actually have a physical cause.

ThisBigSky
Yes I find it scary that he hasn't seen a doctor and is on medication. Fortunately I have worked in the field and managed to have informed discussions with those who have seen him about which drugs were and weren't appropriate. Not the point, however. He needs therapy as well as drugs, he needs ongoing support. He is in receipt of medication, everything else is coming from me. What concerns me is what happens to those who do not have someone to advocate for them. Where is their voice?

Crumbs1 Sun 12-Nov-17 18:02:48

"Teenagers who feel a bit anxious or sad are given drugs and being labelled with mental health issues for life instead of being told it’s normal to feel sad sometimes and anxiety tends to be a symptom of teenage years."

Do you have actual experience that this is happening? Because my experience, with my own and other teenagers, is that it is a very long wait even to get seen and that they will try almost anything else before they prescribe drugs. My dd had been school refusing for over two years, cut herself, attempted suicide - and they still didn't want to prescribe the drugs. My own feeling is that this "we throw drugs at teenagers at the drop of a hat" is a media-fuelled belief that probably has more to do with the US than the UK.

But if you have a different experience, it could also be that it's a postcode lottery.

Pointy - I was involved in recruiting people for that study.

Fascinating and significant but still quite a small number of people. For the rest, we have what we have available and although I know some people have a non-biological cause which would require more intense psychological intervention or psychotherapy, we don't have the therapists needed to provide it nor the money to pay for it.

An IAPT course just won't cut it for a lot of people so there's a huge gap between people who IAPT can't help but those people will never meet the threshold for secondary MH services and NHS complex psychological interventions. It's an often unrecognised scandal of MH treatment in the UK.

Private psychotherapy is often amazing but not cheap and requires dedication from the service user.

So if IAPT won't help much and you don't meet criteria for NHS therapy and you can't afford private, drugs are all that are available.

Shit and I don't like it but it is what it is.

Gilead - yes I know. It'll be years before that trickles down to the frontline where the UK has lost almost 100,00 acute MH beds (or more) since the 1980s and we regularly have NO beds available at all. None. Not even private ones the NHS pays over the odds for.

And we're closing more every year and a lot of the beds we do have are in PFI buildings crippling the NHS with costs. So if you're 'lucky' enough to be admitted to a unit under section (my large city hasn't admitted an informal patient for years I don't think) they plan to discharge you within 2 weeks and that plan has to be made within 24 hrs of you being admitted.

If you go on leave within that 2 weeks, your bed will likely be used when you're away and you'll be put on more leave till you can be discharged. If you have literally nowhere to go, there'll be talk of discharging you to a Premier Inn with the Crisis team popping in.

Till this frankly dangerous situation is sorted out, biological causes of SMI don't mean much at all. We have drugs to dampen things enough to discharge people.

As for the people that will never be ill enough to be hospital, like I said - drugs and/ or IAPT.

It's more than shit. It's a disgusting way to treat people. Lots of us out there in a living hell with no hope. And yet it's imperative to keep us alive. You wouldn't keep an animal like this.