With more talk in mind – Dr John Read

This is a great article Id like to share

Sydney Morning Herald, the Age Melbourne

Any review of Victoria’s mental health services must look beyond psychiatry.

John Read

September 15, 2011

Opinion

SERIOUS problems in Victoria’s mental health system have been revealed recently in The Age. The important thing now is to find solutions. In doing so we should remember that although Victoria is in the spotlight, similar ”crises” occur regularly all over the world. Perhaps this is because Victoria is not alone in having a system based on fundamentally flawed principles.

 Mental health services have become increasingly dominated by psychiatry’s ”medical model”, which claims that feeling depressed, anxious or paranoid is primarily caused by genetic predispositions and chemical imbalances.

 This has led to alarming rises in chemical solutions to distress. In New Zealand, one in nine adults (and one in five women) is prescribed antidepressants every year.

 The public, however, in every country studied, including Australia, believes that mental health problems are caused by issues such as stress, poverty and isolation. The public also prefers talking therapies to drugs and electroconvulsive therapy (ECT).

 Research suggests the public is right. For example, the single best predictor of just about every mental health problem is poverty, followed by other social factors such as abuse, neglect and early loss of parents in childhood, and – once in adulthood – loneliness and a range of adverse events including losses and defeats of various kinds.

 Meanwhile, reviews of studies on anti-depressants (which only recently have been able to include those previously kept secret by drug companies) conclude that they are superior to placebos only for those at the extreme end of the ”most severe” group of depressed people. This represents less than 10 per cent of the people who are receiving these drugs.

 A recent Cochrane review (the type most highly regarded in the scientific community) for risperidone, a leading anti-psychotic drug, ”suggests that there is no clear difference between risperidone and [a] placebo”.

 A placebo (from the Latin meaning ”I please”) is not necessarily a bad thing. Indeed the talking therapies are effective partly because, if done well, they too instil hope and expectations of recovery.

 The problem is that psychiatric drugs often have serious adverse effects. Anti-psychotics, for instance, can cause rapid weight gain, loss of sexual function, diabetes, heart disease, neurodegeneration and reduced life span.

 As previously reported, my review of ECT studies (with Professor Richard Bentall of Liverpool University) found that this treatment is ineffective for most recipients and frequently causes permanent memory loss. This in itself can be depressing.

 ECT also has a slight but significant risk of death, most frequently from cardiovascular failure.

 Inpatient units are equally ineffective and can also be damaging. When will we learn that putting large numbers of extremely distressed people in the same building is not a good idea?

 What I conclude from all this is that any review of mental health services in Victoria, or anywhere else for that matter, should probably be led by anyone other than a psychiatrist – and certainly not in Victoria’s case the state’s Chief Psychiatrist, whose job, according to Dr Ruth Vine herself, is “to watch over how the system is functioning”.

It is unfair to expect Dr Vine to take an objective view on the failure of the system for which she is responsible. That lack of objectivity is amply demonstrated by her claims that ECT is “safe and effective” and that the problem is the public’s “negative” views. Perhaps a lawyer from the Mental Health Legal Centre might be a good choice.

 Any review should include mental health service users and their families, and other mental health professionals, including social workers, occupational therapists, psychologists and nurses.

(Psychiatric nurse Philip Lynch reminds us that there are thousands of staff “who quietly continue to do important work every day, often in challenging circumstances”; so why only listen to the doctors?)

 The review should also investigate what percentage of people receive drugs, and what percentage receive safer, more effective alternatives, and how a better balance can be achieved. It must scrutinise the contact and transactions between psychiatrists and drug company reps and consider ways to reduce or eliminate these, and as well find ways to reduce the pressure on psychiatrists by helping them feel OK about sharing decision-making. When things go wrong, as they inevitably will sometimes, everyone should share responsibility, and support one another.

 The review would need to explore the ”recovery model” recently introduced in many other countries, including New Zealand. (No, I am not saying New Zealand is superior to Australia – except, of course, when it comes to rugby.)

 Further, the review would need to learn from the many innovative non-government organisations, such as Voices Vic and Mind, and study ways to prevent mental health problems developing – perhaps by focusing on providing safe and nurturing environments in the first few years of life. Also, simply listen to the public.

 Finally, The Age can assist by reporting the issues without exaggerated headlines such as “1000 DEATHS”.

 Dr John Read is a professor of clinical psychology at Auckland University. He advises that no one should reduce or come off medication on the basis of information in this article but should, if they have concerns, consult the prescribing doctor.

 http://www.smh.com.au/opinion/society-and-culture/with-more-talk-in-mind-20110914-1k9m2.html

 

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6 thoughts on “With more talk in mind – Dr John Read

  1. the following comment is part of a response to this article that i wrote a couple of months back…

    I’ve been mulling over John Read’s article, posted in advance of our clinical lectures, which was published in The Sydney Morning Herald this month.
    I agree, in the main, and admire any effort to effect a conversation about mental health services and the safety and efficacy of treatments. That said, any such conversation needs show careful application of information, and awareness of its inferential potency when in possession of a sometimes infinitely credulous public.
    This article seems a somewhat hyperbolic account of conventional psychiatric treatments, and one that, I fear, may spook people from approaching the related services for intervention.
    I ought disclaim here, that I am somebody who has been, and is presently, treated within the psychiatric services of the public health system. I have resisted, but now subscribe to, treatment that has involved inpatient care, medications, supported living, and psychosocial rehabilitation. Disclaimer offered, I envisage that most reading the article lug some back-story, prenotion or mind-baggage into play.
    My worry is that a ‘straw-man’ of psychiatry is presented here. Psychiatry is more and more approaching treatment using an interdisciplinary treatment model, rather than a one that’s solely medical. Genetic precursors, life events, chemical happenings, environmental stresses and such are treated as enmeshed. A medical model and a ‘recovery’ model need not be mutually exclusive.
    Read’s suggestion that ‘inpatient units are equally ineffective and can also be damaging’ seems a simplistic take on things. When one is at risk of harming others or oneself, such places can provide a respite of sorts. Sure, it’s not optimal. Sometimes it’s pretty darned horrific. And they sure need work. But it beats the option of romping the streets, lying in filth and terror within one’s own home or relying on self-incapacitation by way of drugs and booze … those situations can be at least, if not much more, unsafe.
    Also, the information extracted from the Cochrane report with regards to risperidone demands a little more context. The particular study rendered some pretty murky conclusions (nothing hardboiled) but did state:
    ‘Risperidone appears to have a marginal benefit in terms of clinical improvement compared with placebo in the first few weeks of treatment ‘
    and …
    ‘This review supports the notion that risperidone is more effective than placebo for people with schizophrenia in terms of marginal improvements in symptoms, and in terms of adhering to the medication for longer’.
    So the Sydney Herald article’s statement that ‘a recent Cochrane review (the type most highly regarded in the scientific community) for risperidone, a leading anti-psychotic drug, ”suggests that there is no clear difference between risperidone and [a] placebo”’ seems to be hauled in at at the expense of its context.
    Where Read suggests ‘the review should also investigate what percentage of people receive drugs, and what percentage receive safer, more effective alternatives’, I think again, facts are being compromised, perhaps merely for the sake of brevity.
    I am assuming that these ‘safer, more effective alternatives’ are psychological, psychosocial or psychotherapeutic in kind (I may be wrong, here).
    There is nothing, offered here at least, to substantiate the claim that these alternatives are indeed ‘safer’ or ‘more effective’. Maybe when individuals are wellish, maybe as an adjunct to medication, maybe as a standalone treatment for those individuals who can get through sans medication… I don’t know.
    I would be interested in any thoughts. And I thank John Read’s article for making me think.

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  2. I feel that this article inadvertently touches upon the “real” issue regarding “mental illness,” that actually, everyone is different. My own experience (and research) totally mirrors everything that John Read refers to, and the fact that liz has found otherwise bears this out, in my opinion.
    Inpatient “treatment” and medication was completely ineffective, and in fact, harmful in my case, and Risperidone did indeed cause these side-effects, while not relieving any of my “symptoms.”
    There are alternatives to Inpatient “care” including respite and home-based treatment, and I also found that self-education, adopting holistic principles, a healthy lifestyle and environment, as well as dealing with unresolved issues which triggered periods of unwellness, did away with the need for medication entirely.
    This is not for everyone, which brings me back to my main point; the western “medical model” categorises us according to a label, which denies the experience of the individual and their own resilience, resourcefulness and unique insight into what is happening for them.
    Psychiatry also claims that the “only” successful long-term strategy is medication, whereas more and more people are proving that is NOT the case, and to discount the link to trauma and abuse simply ignores the facts.
    If we were to discard the labels and get back to treating people as individuals experiencing a reaction to distress, teach them coping strategies and acknowledge that OVERALL Wellness is the key to Recovery, I am sure that our mental health services would produce infinitely better results.

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    • Hi Shane,
      Thanks for taking the time to share your comments. Interestingly I have just been reading about the Open Dialogue in Finland, and its success with people labelled with Schizophrenia or Psychosis. Their treatments are based on using as little medication as possible.
      The Hearing Voices Network is formed for people like you, who can talk from their own experiences, and say what works for them and what deosnt. So often our voices are muffled due to fear of enforced treatment due to noncompliance. I will post the link to article on Open dialogue and the youtube video on this blog.

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  3. I totally agree hearingvoicesnetworkanz, initially I didn’t even disclose that I heard voices for fear of this very reaction from clinicians-actually my diagnosis is Bipolar, and it shocks me how many people still get diagnosed with Schizophrenia based ONLY on this presentation.
    Recently I printed off some of your EXCELLENT material for fellow staff that were struggling to support a resident in our local service who is terribly distressed by his voices, despite ever-increasing medication and 13 years of “treatment.”
    These staff were blown away by this information and the suggestions listed for coping with these experiences.
    For me, there was definitely a spiritual component to what I experienced, but pursuing this when not securely “grounded” and otherwise Well was fraught with peril, so it came down largely to a healthy lifestyle and environment and an arsenal of coping strategies.
    Thank you for the opportunity to comment.

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  4. Thanks Shane. I agree. Sometimes the experiences, whilst of a spiritual nature, are so huge, or so overwhelming that we are not able to digest or even understand the meaning that is contained within them. It can take some time just to settle down, feel safe, and with support and encouragement then take time to look at them in more detail to gain an understanding of what it is that they represent to us.

    In an email I sent out the other day, I likened hearing voices ( and seeing visions) like riding on a tiger through the jungle.
    Sometimes it can terrify you whilst other times it can provide you with an amazing experience on many different levels of being. First however we need to learn how to ride the tiger without him devouring us!
    Once we have learned to “tame” the tiger, we can then gain a greater understanding of our journey, and have more say in where we are going.

    Yesterday I was contemplating the Open Dialogue video. The nurse said something along the lines of
    Schiziphrenia, is not a disease, it is like something that happens when a person has had an experience / or feels an emotion that they cannot express in words.

    This I felt was profound. As our voices and visions are often highly symbolic in nature, bypassing the language we have been taught in schools. So we are left not able to understand the message our spirit may be expressing. Often by drawing, or even just describing what we saw or what the voices said, and in the context, we can see the meaning better. It is like the great artists. They had a huge emotional or spiritual concept, that could not be described in normal language, and so they paint the images. Every item, every colour, every stroke imbuing meaning into the painting.

    Our voices can be like that. To some it may seem to make no sense, but when put in the right context they often convey so much more than we can describe.

    Thinking about this, I then realised with sadness, that the current view that is often espoused or dictated in hospital environments – is that if you still hear voices you are sick. If people talk to staff about their voices, ( trying to express their experience) they are sometimes moved to a higher security ward, or given higher doses of medication. This leads to most after some time, learning not to talk about their voices, and to lie to staff saying they do not hear them.
    This presents the following scenarios
    1) If Schizophrenia as suggested by the finnish Nurse, is an experience people are unable to express, then the solution they have found is talking openly about them, and finding ways to express and learn what its meaning is. Then systems where people are “punished” for talking about their voices, in fact makes the situation worse, as not only can they not sufficiently express the experience that caused the voices, now they cannot express it AT ALL.
    2) Hospitals believe their medications are working, because people lie about its effectiveness in order to be released from there. And now instead of telling someone about their voices when they become distressed, may wait until they are at crisis point to seek help.

    I am not saying this happens everywhere, I can see from my work in the Hearing Voices Network, that change is taking place. There is more awareness on both sides on what is actually happening. Many hospitals in NZ, are starting their own hearing voices groups. Encouraging better understanding and co- management of conditions with those that hear voices. I see there is a real turning point taking place in mental health. More responsibility being returned to those in care. Acknowledgement that their experiences do have meaning. That working together creates more empowerment, than having one without the experience telling the other what is wrong and what they have to do.
    Even in the past 6 years, of the HVN is New Zealand we have seen these changes taking place. Slowly. slowly.But surely we will get there.
    Thank you for taking the time to post a comment Shane. I am glad that you have found our information provided helpful. It is always nice to have positive feedback.

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    • I totally agree-I have also experienced amazing visions, and often described this as “having the tiger by the tail.” Having engaged with this phenomena I couldn’t let go in case it swallowed me up, and it then becomes kind of like not being able to look away from the sun.
      Initially terrifying and demonic in nature, I gradually began to feel these experiences were a test of character or resolve, whereby your deepest, darkest fears have to be confronted and overcome, your faith is stretched to the limit, and you have to decide what really matters to you.
      I have always said that to survive such torments is a TRIUMPH, not a weakness, and if one is open to communicate with the living or dead from a distance, this can be of practical value once you learn which of those is helpful, or not.
      I believe I have had these sensitivities since I was a young child, and they only became a problem when things were at “crisis point” in my life generally. Learning the tools to deal with the distress this caused, and unearth the hidden meanings as well as underlying issues they represented was a time of personal growth and self-discovery I wouldn’t give up for the world.
      As I am still a voice-hearer (and so still “sick”) I have to smile when I inform people that I work full-time, have a wonderful relationship and social life, and am fully capable of anything anyone else is, that many are shocked that this is possible.
      I guess like most mental health issues, there is still so much ignorance and misinformation about, probably because many of us are too scared to discuss these experiences openly. Excellent sites such as this can help to educate and inform regarding this subject though-keep up the good work.

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