1 week ago
21
Mental health services are overwhelmed by rising demand, evidently due to deteriorating social and economic conditions. There is little that clinicians can do about the political context, yet some of the personal injustices that patients have experienced do have a direct impact on their condition.
I have been an NHS psychiatrist for 50 years and have witnessed the increasing dominance of disease classification among my colleagues. Once we know what the patient has “got”, the less interest there is in how they reached this point. As things stand, even with far greater numbers of specialists, our model of care would not be fit for purpose. (Does the UK have a mental health overdiagnosis problem?, 5 April). We have a problem with overdependence on diagnosis.
The case of schizophrenia – the archetype of 20th-century psychiatry – is instructive. One of our foremost clinical scientists, Prof Sir Robin Murray, said: “In the last two decades, it has become obvious that child abuse, urbanisation, migration, and adverse life events contribute to the etiology of schizophrenia and other psychoses”, adding that “my preconceptions had made me blind to the influence of the social environment”. This courageous confession exposes the tip of an iceberg of indifference to the developmental origins of mental disorder, which has impoverished the curiosity and imagination of the besieged workforce that so many are waiting to meet.
Dr Sebastian Kraemer
Tavistock and Portman NHS trust
It was a privilege to work with the late Prof David Goldberg on his project about common mental illnesses for the WHO. In general, across places and languages, the same common conditions came up (an exception was depression, where the diagnostic questions used then were offensive, in Chinese). The prevalence of problematic anxiety, depression and alcohol use varied a lot, even in one country. Residents in “depressed” (disadvantaged) communities were more often depressed and anxious, and likely to drink until they were “disabled”. Questioning clients at a job centre not only found many had mental disorders but had struggled since their teens.
How much the UK spends on benefits is a matter of policy. But it is clear that the government is failing to ask why rates of common mental disorder have increased so “steeply”. Keir Starmer is overseeing conditions that are making more and more people ill. The young are most vulnerable. The postwar Attlee government had little money, but it shared a vision of reconstruction. When do we all start, Sir Keir?
Woody Caan
Former editor, Journal of Public Mental Health
Your article on mental health and disability benefits is apposite but asks the wrong questions. Wes Streeting asserts that society cannot afford a disability benefit bill of £48bn per annum, so the correct questions revolve around what support is required to achieve full employment, including those in prison and those with interacting physical and mental health problems. To not work is bad for one’s health.
The medical sociologists quoted in your article are closer to the solution than health professionals, who seem unable to determine what a mental disorder is, let alone agree overdiagnosis v underdiagnosis. The answer lies in whole-scale exercise, be it walking, yoga, or passive exercise in the gym. Social prescribing benefits all mental and physical conditions, including depression. If you can exercise, you can work.
The correct questions revolve around: how can workplaces predicated on global capitalism be induced to profitably employ and support a much wider range of employees, including people with mental illness? Employment practices in Denmark, the “well man” of Europe, suggest that this is possible through political change.
Jeremy Seymour
Retired psychiatrist, Sheffield
