This is my response to the interview in the Guardian with Professor Bhugra, the incoming President of the World Psychiatric Association. If you haven’t read the interview, I strongly recommend it, he makes a lot of very important and relevant points in addition to being honest and humble. It’s here: http://www.theguardian.com/society/2013/nov/27/dinesh-bhugra-psychiatry-mental-illness
I wrote a letter to the Guardian in response but for some reason they declined to publish it, so I rewrote it to Professor Bhugra himself and will be tweeting it to him tonight.
Dear Professor Bhugra,
I read with interest and admiration your passionate and compelling piece on modernising Psychiatry in the Guardian on 27th November and wholeheartedly commend your desire to improve mental health services. My response is only limited in scope so please accept my apologies if you feel I am failing to acknowledge some of the important matters you addressed. Although this is a framed as a response I in no way want to minimise my respect for your honesty and humility.
I was so pleased to hear of your desire for more emphasis on an individual’s functioning rather than symptomatic presentation, which can only lead to an increased focus on the person, not only the problems they have and stress the importance of taking an idiosyncratic approach to supporting people’s well being. It was posited in the article as controversial, I think we and many people who have sought help now and in the past would agree that it is not controversial, it is allowing the person themselves to play a part in defining ‘recovery’. It is an approach I and others have advocated for a long time, sadly it has been lost in another ‘battle of the professions’ type discourse.
My main focus is your plea to adopt a ‘broader focus’ within psychiatry, I would respectfully suggest that this may not require a rethinking of training for psychiatrists as you propose. An emphasis on the societal, developmental and relational context in which an individual exists and presents with difficulties, has long been at the heart of the (on average) 9 year Clinical Psychology training and subsequent practice and this leads to an alternative view of distress that may offer many people in services an more idiosyncratic understanding of their difficulties. The importance of recognising that psychological distress lies on a continuum which is not necessarily commensurate with a symptom focused approach is one which we evidently share, passionately.
Additionally, the need for services to have greater anthropological awareness may be achieved more readily by seeking to adopt an equal partnership approach to having people who have themselves experienced not only mental health difficulties but also experiences of mental health services as an integral part of service design and provision. Recent evidence would suggest that involving ‘service users’ in an integrated manner, rather than ‘add ons’ improves outcomes, (1).
One of the strengths of our NHS is that there is a wealth of highly qualified, experienced professionals who can offer a great deal in supporting people who come to us for assistance. Mental health services incorporate possibly the widest range of practitioners and rightly so but it is important that we acknowledge one another’s existence and value.
The lack of funding from Government is not necessarily a failure of the psychiatric profession to convince successive Governments of its value, more a reflection of the lack of parity between mental health and physical health.
Instead of having psychiatrists retrained in sociological and anthropological awareness might it be prudent to support other, non-medically trained practitioners to bring their thinking, experiences and skills to the fore and allow for greater choices to people who seek support become not only available but standard? This is in no way an inter-profession dispute which the media so often promulgates without any benefit to people who need support, more a call for recognition and utility of what we already have and closer and more equitable working relationships.
Mental health services are today about more than just psychiatry, there are many highly committed professional groups in the NHS both within and outside of the traditional core medical model, of which Clinical Psychology is one and many ‘experts by experience’ who are willing and able to work together with our medical colleagues to make the NHS mental health services a provision we can all be proud of.
Dr Gordon J Milson