03.12.14
De-medicalisation of psychiatry and its consequences
Source: Philip Barber, FRCP, consultant respiratory physician
There is one critical aspect of mental healthcare which will not be addressed by 'changing attitudes'. It is the virtual disappearance of medical psychiatry as a diagnostic and therapeutic discipline available to patients and referring clinicians.
Not only is this a serious problem in workforce terms, but also a major issue in respect of team-working in mental health, with no clear medical leadership informing on diagnosis and management. Instead, patients are seen (often with some resistance) by overworked 'teams' with no medical qualifications, who often simply pass the buck back to the GP who requested specialist help in the first place, and with no scheduled consultation with a qualified psychiatrist.
The occasional catastrophic events which make the headlines represent the extreme tip of a massive iceberg of deprivation and morbidity, and specialist help with diagnosis and treatment is almost impossible to come by, sometimes even for the most seriously disturbed patients. It is not at all clear, for example, how a patient presenting with psychiatric manifestations of a neurological or other physical illness would ever be diagnosed under the existing arrangements, particularly if the clinical issues were complex or obscure, as they often can be.
No progress has been made, either, with the stated and courageous aim of recent legislation to equalise access to mental and physical health care. Nick Clegg certainly has a job on his hands, but to address it he needs to be aware of where the deficiencies lie, and the comprehensive de-medicalisation of psychiatry as a clinical discipline is undoubtedly one of them.
Re: Clegg to chair Mental Health Taskforce