Many of the words published by Mad in America are critical of organised mental health services, conduct of the pharmaceutical industry, the motives of involved healthcare practitioners, and the hidden agendas of those committed to “research”. I would say Amen to all that, but something has happened recently in the UK that suggests many of these concerns might be better considered signs of a glass half full rather than one half empty.
We have just seen publication of “The Abandoned Illness, A Report by the Schizophrenia Commission”, and it has enjoyed significant national media attention.
The Schizophrenia Commission is an independent body which has been supported by the mental health charity, Rethink. The commission was established in November 2011 in order to review how the outcomes for people with schizophrenia and psychosis could be improved. It has gathered evidence from a wide range of sources which include people who have lived with schizophrenia or psychosis, their family members and carers as well as from health and social care practitioners and researchers, and some 2,500 individuals who responded to an online survey. It was chaired by an eminent member of the UK psychiatry establishment, Professor Sir Robin Murray FRS, and included Dr. Clare Gerada, Chair of the Royal College of General Practitioners, Professor Martin Knapp of the London School of Economics and Professor David Taylor, Professor of Psychopharmacology at King’s College, London, amongst others. Their criticisms of current provision for people with schizophrenia or psychosis are outspoken:
“The inadequate care that many people with psychosis receive adds greatly to their distress and worsens the outcomes for what can already be a devastating illness. Most have a period in a psychiatric hospital unit but too many of these wards have become frightening places where the overwhelmed nurses are unable to provide basic care and support. The pressure on staff for increased “throughput” means that medication is prioritised at the expense of the psychological interventions and social rehabilitation which are also necessary. Furthermore, some wards are so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily; so compulsion rates rise.
The problems are not just in the wards. People with psychosis rarely have the chance to choose their psychiatrist and families are not treated as partners in care but have to battle for basic services. People diagnosed as having schizophrenia have poor access to general practitioners and general hospital care; their physical health suffers and their life is shortened by 15 to 20 years. The fragmentation of services means that people who have a recurrence of their psychosis lose the established relationships with professionals they trust, and instead feel shuttled from one team to another as if on a factory production line.”
The Commission’s “prescription” is equally compelling:
“Good care delivered by kind, compassionate practitioners can make all the difference. Being given hope is central to recovery too – gaining control and being empowered to build self confidence and self esteem. Time and time again we heard of a transformation whereby an apparently downward course was reversed by nurse, doctor, peer or therapist who took the time to listen and understand.”
These are not the views of narrow minded biomedical scientists and practitioners determined to impose a medical approach to mental health difficulties upon policy and practice, as they maintain hegemony at others’ expense. Nevertheless they are the published views of conventionally authoritative opinion leaders. As a result, they will have to be heeded unless darker forces seek to suppress them. Under Robin Murray’s leadership the Commission acknowledges that our researched understanding of schizophrenia and psychosis is still very patchy, and that there is just as much justification for considering them from a psychosocial perspective as there for viewing them bio-medically. This is significant, coming as it does from one who made his own academic reputation in conventional psychiatric research circles and was considered the third most influential psychosis researcher during the decade 1997 – 2007 (Science Watch).
All this is not to say that the world has turned. The report uses the word ”illness” some 140 times … in an 87 page document, and it is clear that the authors still see schizophrenia and psychosis as afflictions to be “treated” by specialists using professional skills. However it is equally clear that the commission recognises that those specialists need not be medical doctors, and that the skills involved are by no means necessarily psycho-pharmaceutical.
“Abandoned Illness” can be found in full at http://www.schizophreniacommission.org.uk/the-report/. Given its origins and authorship, its publication might well suggest to those concerned with change in mental health circles that here in the UK, at least, the glass might be half full rather than half empty. That doesn’t suggest any more wine, but it does suggest a more hopeful prospect and some movement of a door that until recently has seemed firmly shut.