Showing posts with label medical model of mental illness. Show all posts
Showing posts with label medical model of mental illness. Show all posts

Tuesday, 28 October 2014

Finally receiving treatment - a personal view

I was speaking to someone in Powys recently about their experience of "going outside of the NHS towards private talking therapy... a really positive step". A positive step seemed like a good subject for a blog post, and our guest author agreed. Read on....

As an individual I have been in contact with mainstream services for over nine years, both in Powys and in other areas of the UK. Over these years, a combination of GPs, psychiatrists and occasionally other staff such as Community Psychiatric Nurses and support staff from Community Mental Health Teams have made efforts to try and alleviate the severe difficulties that go along with a diagnosis of schizophrenia.

I have found that during times of crisis access to support has been available, given that it is asked for in the right way. The problem however, for me and many others, has been with the issue of getting back to being able to live and function on a daily basis and to a level where it would be possible to believe that the goal of full and complete recovery is not only a real thing but something worth pursuing.

Although there can never be a guarantee that severe distress, mental ill health or challenges to wellbeing won’t occur either in someone who has previously had first-hand experience of these things, or in someone who hasn’t, the journey I have been on leads me to believe in one or two controversial things.

Firstly, like many others, and as supported by a growing body of evidence, I have a problem with the medical model of mental ‘illness’. The medical model is not a simple view and advanced neuroscience is often used to highlight areas of the human brain which may sometimes work differently in those who are labelled as ‘schizophrenic’ (to use but one example).

That shouldn’t detain us here, for as well as the causes for this diagnosis being perhaps still largely unknown and certainly not agreed upon amongst medics, the issue of how best to treat the condition is a big problem.

In my experience the first and last option for many practicing psychiatrists has been to prescribe powerful anti-psychotic medication, which especially since the second generation of a-typical anti-psychotics have been used, can and do alleviate or suppress ‘symptoms’ (such as psychosis) and with less pronounced side effects than the original first generation medications.


After talking to a pleasant local GP about the possibility of finding other ways to treat my own condition than medication alone, we loosely agreed that some combination of medication and talking therapy would be a sensible plan. However, in Powys the availability of talking therapy through the NHS is highly limited and the waiting list spans several years. One person I met has waited for more than 6 years already.

There are organisations such as Mid Powys Mind in Llandrindod Wells who are able to offer a free counselling service and having tried a couple of months of weekly sessions with a volunteer counsellor I found that the ability to share problems confidentially and in a non-judgemental setting brought much relief. 

More recently though, the view that a deeper and longer level of talking therapy could bring improvements to the way a person feels and functions is something which I managed to pick up from sources such as this blog and which in turn led me to explore the availability of private psychotherapy in our area.

Despite living on benefits, with advice on Employment and Support Allowance (ESA) and Personal Independence Payment (PIP) from the Citizens Advice Bureau it has finally been possible to find just enough capital to arrange for regular sessions with a practicing psychotherapist. Partly this is enabled by my practitioner’s policy of subsidising out of work patients with a slightly lower rate to those who are in work.

When making the long decision to proceed, the view of my psychiatrist was that for certain conditions which they believe to be entirely inherent or set in stone within a person’s biological constitution, there would be a risk associated with stirring up long lost memories or otherwise suppressed thoughts and feelings. I was glad of the discussion we had but, in the nicest possible way, could not disagree more strongly with any view which maintains it is not worth pursuing.

After the first couple of months of psychotherapy the tangible areas that many doctors ask about such as mood, sleep and appetite showed marked improvement and once more it seemed that the future could hold prospect and possibility rather than simply being a drab and bleak inevitability, where, to put it frankly, death would have been a welcome event.

I can’t speak highly enough of the time and space that I am lucky enough to have found within which help is given by another mind to sort through the problems and issues which we otherwise face on our own. This would include issues that an individual is aware of and also issues which it is almost impossible to be aware of by yourself.

As for ‘symptoms’, although my therapist is mindful of these and very respectful of the view of GP and psychiatrist, the outlet for me to unburden and unpack life’s major and minor worries means that as long as any possible reduction in medication is done gradually and carefully there is someone else to help keep a watch should difficulties arise.

There is still lots to do, but finally having some level of regular support has been a great relief not just to me but to remaining friends and family. As for the financing of this I would make the case to individuals, health professionals, charities and funding bodies to give increased engagement with other therapy some serious thought.

Have you had experience of talking therapies in Powys recently, whether provided by the NHS, by the voluntary sector or privately? Or are you still on the NHS waiting list? Let us know about your experiences in the comments' section below.

Friday, 7 February 2014

Unconventional Wisdom: Shaping Services Together Conference, Powys, September 2013 - Adding To The Debate?

2013 Conference Theme: Shaping Mental Health Services Participation


In September 2013, Powys Association of Voluntary Organisations  (PAVO) were involved in running a conference in Powys, one of three events across Wales (you can access all three conference reports here).  The event was funded by Public Health Wales and supported by Welsh Government.  The theme was mental health participation.

PAVO lead on the Powys Stronger in Partnership Participation Network and we are a member of Mental Health Action Wales.  You can find out more about the activities we are involved in and the difference we think we are making here.

You can read a full report (12 pages) from the 2013 Shaping Services Together Conference, Powys, on our website here.  In this blog though I wanted to explain a bit about the ideas underpinning the conference planning in 2013.  I also want to tell you about another free conference that you are invited to on Friday 7th March 2014.
 

Learning From Previous Conferences ...

We first ran an event of this kind (i.e. national participation) in 2012, you can watch a video from this event here and read the conference report here.   Eleanor Longden spoke at this event and her talk continued the debate in Powys that challenges the conventional wisdom underpinning our mental health system.  A wisdom that is founded on the idea of "mental illness". You can read more about this debate in my previous blogs here and you can watch Eleanor talk on ted.com in this link.  

Eleanor Longden is joining us again on 7th March 2014, you can find out more about this here.
 
Thanks to people's willingness to get involved in the 2012 conference and to the feedback we received we were able to learn a lot from this event. 

We used this learning to help us to underpin the  2013 conference planning on two questions:
 
“Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?”  
 
"If so, how can mental health participation influence such a fundamental change to our mainstream mental health services?"
 
As well as asking us to provide more opportunities to explore the de-medicalisation of distress, you also told us that future conferences should include:

"...time for exceptional and inspirational speakers that bring to the debate their own experience of mental distress"
 
... no pressure then! 
 

So A Big Thank You To Jacqui Dillon...

 
Given this we were absolutely delighted when Jacqui Dillon agreed to come to Powys and talk at this conference.  We think that she fitted the bill and luckily you don't have to take my word for it,  you can watch her full talk here.

“Jacqui Dillon is one of the most inspirational speakers I have ever met, thank you for enabling me to be part of today"

Jacqui Dillon is a writer, campaigner, international speaker and trainer.  She is the National Chair in England of the international Hearing Voices Network.  Her talk was entitled "The Personal is Political" and you can download the slides here

She began by sharing something of her own story, her experiences and her survival strategies.  Survival strategies such as self-harm, hearing voices, eating "disorder", creativity and resourcefulness.  Survival strategies that are often judged by mainstream wisdom as "symptoms" of "mental illness" rather than a natural and normal response to difficult life experiences.

She then shared her own experience of mental health services which she summarised against 6 themes:
  • Pathologised:  "You are ill. Everything that you say and do will be seen as a consequence of your illness."
  • Denial:  ‘It never happened’ or ‘It did happen but you will never recover’.
  • Medication:  ‘You are resistant and the fact that you don’t want to take medication is evidence that you are ill’ .
  • Dependency & Compliance: ‘You must accept the psychiatric diagnosis and medication and we will give you benefits and a bus pass’. 
  • Disempowered: ‘You will never recover. You will always have this illness. You won’t be able to work’.
  • Passive:  ‘You do not know what is best for you. We know what is best for you’. her own experience of mental distress

Then she talked about finding a new paradigm, which she broke down into 4 main areas:
  • Trauma & Recovery
  • Understanding Dissociation
  • Attachment Theory
  • The Personal Is Political 
She shared some of the latest research findings around childhood adversity & psychosis, for example:
  • People abused as children are 9.3 times more likely to develop "psychosis"; for those suffering the severest kinds of abuse, the risk rises to 48 times (Janssen et al., 2004).
  • People who have endured three kinds of abuse (e.g., sexual, physical, bullying) are at 18-fold higher risk of psychosis, whereas those experiencing five types are 193 more likely to become psychotic (Shevlin et al., 2007).
  • People with "psychosis" are three times more likely to have experienced childhood sexual abuse (CSA) than those with other diagnoses, and 15 times more likely to have been abused than non-patients (Bebbington et al., 2004).
She ended her talk by suggesting some answers to the question:  "What is to be done?".  Her ideas can be read in detail on the slides from her talk available here.

I highly recommend watching her talk (just over an hour).  So far over 1,000 people have viewed it and the feedback, not only from the conference but also from people who have watched her talk on youtube, has been incredibly positive.

 Further Information and Videos From Shaping Services Together 2013



Jo Mussen, Vice Chair of Powys Teaching Health Board and their Lead for Mental Health, Chaired the morning, as part of her conference introductions which included a thought provoking reading from the Robert Whitaker book,  Anatomy of an Epidemic.  The extract was entitled “A Modern Plague” and it can be read here

Sian Richards, Welsh Government Strategy Lead, National Mental Health Partnership Board, alongside other partnership members, and David Crepaz-Keay, Head of Empowerment and Social Inclusion, Mental Health Foundation, talked next presenting us with a presentation entitled “Together for Mental Health” that provided the latest information about: 

  • The National Mental Health Partnership Board

  •  Developing a National Forum for strategic participation in national and local mental health partnership boards 
You can listen to this in full (36 minutes) here.
 
Powys Youth Forum and Clwyd Theatr Cymru developed, planned, led and ran a participatory workshop on the theme: “Wisdom Across All Ages”.  This helped us to begin to explore participation for people of all ages.
 
You can find out more about the conference and read a full conference report (12 pages) here.

Unconventional Wisdom:  The Debate Continues 7th March 2014



Free Conference:  Wales Early Intervention Service Conference:  Finding Meaning in "Psychosis"?
Friday 7th March 2014.  The Pavilion, Llandrindod Wells Powys.  9.30 am for refreshments.  Finish 4.30 pm.   
 
Another chance to join us and find out more about the debate that challenges the conventional wisdom and to explore the question:  “Should mental health services be underpinned by the question what happened to you rather than the question what is wrong with you?”. 
 
Speakers Are:
 
Euan Hails - Clinical Lead Psychosis Services, Hywel Dda Health Board.  Bio to follow.  But to find out more about his work click here.
 
Eleanor Longden - an award-winning postgraduate researcher with a specialist interest in psychosis, trauma, and dissociation. She is a three times TED speaker, a trustee of Intervoice: The International Network for Training, Education, and Research into Hearing Voices and Soteria Network UK, and has lectured and published internationally on promoting creative, person-centred approaches to understanding and recovering from psychosis.  More here.
 
Dr Lucy Johnstone - consultant clinical psychologist and the author of 'Users and abusers of psychiatry' (2nd edition Routledge 2000) and co-editor of 'Formulation in psychology and psychotherapy: making sense of people's problems' (2nd edition Routledge 2013) along with a number of other publications taking a critical perspective on mental health theory and practice.   More here
 
Dr Sami Timimi - Consultant Child and Adolescent Psychiatrist and Director of Medical Education in the National Health Service in Lincolnshire and a Visiting Professor of Child and Adolescent Psychiatry at the University of Lincoln, UK. He writes from a critical psychiatry perspective on topics relating to mental health and has published over a hundred articles and tens of chapters on many subjects including childhood, psychotherapy, behavioural disorders and cross-cultural psychiatry.  More here.
 
This conference is an opportunity to explore:
  • how we understand and make sense of these “psychotic” experiences
  • best practice in early intervention responses that help people and those close to them cope with these experiences, learn from them and thrive
  • the interactions, treatments and ideas that make a positive difference to people’s lives and how we make sure that these are offered with openness and transparency
  • interventions and treatments that early intervention services could deliver and how they might continue to develop
Interested in joining us?  To find out more about this conference and to get more detail about how to book, click here or contact the team on pamhinfo@pavo.org.uk, telephone 01686 628 300.
 




Sunday, 8 September 2013

Unconventional Wisdom: Organic Reasons for Psychosis – Do we need to make sure that we don’t miss the question “is there anything physically/organically wrong with you”?

The Madness Of King George
I am on a bit of a mission at the moment trying to encourage people across Powys to explore whether the important question we need to be asking is:  

“Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?”

In May 2012, Eleanor Longden spoke at an event we ran and raised this question. In a conference here in 2013 Jacqui Dillon helped us further this debate and you can here her speak here.  In April 2014 we ran a conference called Finding Meaning in "Psychosis" when again we were able to consider this question with the help of Lucy Johnstone, Sami Timimi and Eleanor Londgen

We are by no means the only ones debating this.  In fact, it seems that this question is resonating with may others and fuelling a debate across the world around the validity of mental illness diagnosis.  You can access some of this debate on twitter, my account is @powysmh.  

Whilst I for one am very interested in the impact that asking this question may have, I also wish to raise the need for caution.

In our drive to ensure that people are asked "what has happened to you" within health services, do we need to make sure that we don't miss the question “is there anything physically/organically wrong with you”? 

Psychotic symptoms (e.g. hallucinations, delusions, disturbed and confused thoughts), for instance, can be caused by illnesses, diseases and physical health conditions.  On the NHS Choices website there is a page that lists the medical conditions that have been known to trigger psychotic episodes.  These include Malaria, Syphilis, Azheimer's disease, Hypoglycaemia, Lupus, brain tumour and Lyme disease. But, this does not seem to be a complete list. I have also come across other organic causes that were not listed there.  B12 Deficiency, Porphyria, Wilson’s Disease, cerebrovascular disease can be found elsewhere on their site citing psychosis as one of the symptoms of these conditions . 

These organic/physical causes produce symptoms of psychosis for a number of reasons, for example abnormal enzyme production, brain damage, tumours, chemical element poisoning, abnormal hormone action, abnormal blood supply to the brain and vitamin deficiencies.  There are physical investigations and tests that can be done to determine whether someone is suffering from these conditions.
 

When someone first seeks help, or finds “help” thrust upon them, for psychotic symptoms, what investigations will occur to determine whether there is a organic/physical/biological cause?  
Diagnosed with syphillis
For adults, the Map Of Medicine Pathway based on National Institute for Health and Care Excellence (NICE) medical guidelines states that if someone presents to them with suspected schizophrenia, then doctors need to determine whether or not there are any physical/organic explanations for their symptoms.  

Worryingly, I think, the recently published (Jan 13) NICE guidelines for psychosis and schizophrenia in children and young people, does not seem to indicate that psychotic symptoms can have organic causes.  I could not find anything in the guidance, the supporting care pathway or the information for the public that indicated that psychotic symptoms could have organic causes.  I have to admit that I might be missing something, the guidance is very long, so I will be contacting NICE to ask.


Can psychotic symptoms be misdiagnosed as "mental illness" when they are actually caused by organic/physical conditions? 

Unfortunately it seems the answer to this is yes.  It is not difficult to find examples of misdiagnosis, where psychotic symptoms that have an organic/physical/medical explanation have led to people being given a mental illness diagnosis.  There has also been scientific work  that highlights where organic disease has been incorrectly diagnosed as mental illness (e.g. schizophrenia).     

How often can psychotic symptoms be attributed to organic/physical/medical explanation? 

I am not sure that we really have the information that would enable us to get to a definitive answer, I have found figures that range widely, from 5% through to 30%.   

So over to you. Can you help me answer these questions?  Are they questions worth asking?  Tell me what you think ...
 

  • Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?
  • In our drive to ensure that people are asked "what has happened to you" within health services, do we need to make sure that we don't miss the question “is there anything physically/organically wrong with you”?
  • When someone first seeks help, or finds “help” thrust upon them, for psychotic symptoms, what investigations will occur to determine whether there is a organic/physical/biological cause?
  • Can psychotic symptoms be misdiagnosed as "mental illness" when they are actually caused by organic/physical conditions?
  • How often can psychotic symptoms be attributed to organic/physical/medical explanations?

Wednesday, 10 October 2012

First, do no harm: Confronting the myths of psychiatric drugs


New paper by Phil Barker, University of Dundee, and Poppy Buchanan-Barker, Clan Unity International.  Nursing Ethics 2012.


Abstract
The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are
manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with
psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any
specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with
‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drugfocused research, much of this funded by the pharmaceutical industry. The pervasive myth of psychiatric
drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues
for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care.

For full paper click here