While human psychology is (I believe) universal, societies differ widely. This has two important implications. It’s a major explanation for the diversity of human experience (it explains why people can be so different when we all have very similar brains). And it also means that we can learn from each other in a leap-frogging of innovation.
Toppmøte is Norwegian for ‘summit,’ and Toppmøte2015 is the second of two very successful seminars bringing together professionals, academics, and policymakers with citizens, voters and users of services – under the aegis of the Norwegian ‘Nasjonalt senter for erfaringskompetanse innen psykisk helse’ or “National Centre for Knowledge through Experience in Mental Health.” That’s a rather wonderful organisation, funded by the Norwegian government, which ensures that the experience of people who have used mental health services is reflected in the commissioning, design, management and evaluation of those services.
Toppmøte2015 gave us the opportunity to share our views on the future of mental health services. The summit had a focus on basic values and rights – as the organisers suggested; “”a dialogue on how the future of health care should look like … the opportunity to focus on knowledge base, rights, dignity, responsibility, separation of powers and freedom of choice, the very basis of thinking in services.” For me, personally, I found myself sharing a vision (my version of which can be found here on Mad in America, and other blogs and books), with the other participants, and indeed even the Prime Minister of Norway!
The event reflected the best of Nordic social attitudes (I’m an unabashed fan) and advanced, civilised, thinking about mental health care. There is a debate in Norway – a debate that has been echoed in other countries – about the setting of targets and expectations in mental health care, and about clinical guidelines. These debates are reasonably well understood. Many people wait for unacceptable lengths of time before receiving services at all, and often find that they have to battle to get access to therapies that are demonstrably effective. So it makes perfect sense for policy-makers and politicians to set demanding targets and to work with bodies such as the UK’s National Institute of Clinical Excellence to commission interventions for which there is a good evidence base. Of course, tensions emerge as to whether these expectations and guidelines are overly flexible (allowing services to avoid their duties) or vague on the one hand, or excessively rigid – for example by following a dogmatically diagnostic approach, limiting the provision of services to such an extent that any intervention becomes ineffective, restricting the scope of interventions to exclude the most promising new approaches or – very popular with politicians – applying cost-saving rather than gold-standard algorithms.
These tensions exist in Norway as much as in any other country. But what we saw at Toppmøte2015 was widespread agreement between professionals of all kinds – psychiatrists, general practitioners (primary care physicians or family doctors in other terms), psychologists, nurses, social workers – the users of services and civic groups representing the public in presenting a vision for the future.
As Dagfinn Bjoergen said, this was not a meeting to condemn the use of medication: “We’re not out to take medicine away from people, but to offer alternatives.” Rather it was a meeting – a ‘top summit’ – to plan the future of mental health care in Norway.
I have great optimism that this will succeed. The flow of comments certainly chimed with our shared, emerging, vision of scientifically robust but essentially humane mental health care. This, of course, fits well with the Scandinavian social model – we heard, for instance, of a mental health care scheme based on psychosocial principles and engaging with people sentenced by the criminal courts. This approach is perhaps easier to imagine in Oslo than San Antonio, Texas or in the planning meetings of Donald Trump’s presidential campaign.
But perhaps the most concrete reason for optimism was the support of the Prime Minister of Norway, Erna Solberg, introducing the summit. I’m not naive. I am aware that politicians use words like weapons, and I’ve learned to trust only some politicians. But there can be no doubt that leadership – leaders who publicly support humane, socially responsible, well-funded, services, services designed by, led by and governed by service users and the public – is both vital and welcome.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Being interested in Britain’s system of mental health provision, I took a look at some of the links.
In this – http://www.bbc.com/news/health-29228148 – it says, “An estimated three quarters of people with a mental illness receive no treatment”.
To the article’s credit, it spoke about the value of psychological therapies for “mental illness” and “symptoms”. It could indeed make a big difference if more psychotherapy were provided quickly to distressed people.
On the other hand, this article could imply that “three quarters of people without mental illness” are not receiving medications. Since the net effect of medication use is usually negative, 75% of people not getting treated could be seen as an encouraging statistic, with less damage being done in the long term.
Then I looked at the NICE Guidelines. Unfortunately, some of the ones about mental illness stink. Here are some highlights from:
“Schizophrenia” – https://www.nice.org.uk/guidance/QS80/chapter/introduction
“In both hospital and community settings, antipsychotic drugs are the primary treatment for psychosis and schizophrenia. There is well‑established evidence for their efficacy in both treating acute psychotic episodes and preventing relapse over time in conjunction with psychological interventions.”
Therefore, the primary guidelines given by the British government about treatment of psychosis are bald lies to the public…. There is not well established evidence for any of the assertions above about neuroleptics…. nor should “symptom control” or even “relapse prevention” be the primary focus of any serious long-term effort to help a psychotic person.
So I am not sure why Kinderman suggests that NICE is commissioning interventions for which there is a “good evidence base.” Rather, it sounds like NICE has been infected by the drug companies and psychiatrists.
To be fair, I did look at some of the other NICE guidelines, and some of the information about conditions like personality disorders and depression is less distorted and more supportive in its representations. But, the tinge of the disease model and distortions about efficacy of medications is still bleeding all over England’s national guidelines.
Hopefully Britain can learn from what sounds like a more humane, open, realistic attitude prevailing in Norway.
Wow! The Prime Minister introduced the summit. I hope the President here in the USA will one day affirmatively support a summit, program, law, etc. that helps to build a pro-choice psychiatric system.