Tell us about a better mental health care system

Edited by Jill Wright, 08 November 2014

The ABC's recent MentalAs coverage of mental health was, as I've mentioned earlier, a positive initiative.

It gave viewers - and listeners - more than a hint of the human dimensions of our mental health care system; it raised funds for research and who knows, might have encouraged people to be more understanding of those who are suffering personal distress and perhaps to seek help for themselves. If MentalAs achieved anything, it certainly spread the understanding that mental health conditions are by no means uncommon and can affect anyone.

And yet it seemed to me that however admirable its intentions, the ABC failed adequately to explore the issues. Instead, it merely sketched out the boundaries of our existing mental health care system, without question or challenge.

I felt there was an implicit acceptance in the ABC's coverage that what was being done was all that could be done. It did not ask whether there might be a better way.

Right now,I think there is something we need far more than research funds, and that is a systematic exploration of what has gone wrong with mental health care and why, and what needs to be done to fix it.

At the end of this month, the National Mental Health Commission is due to provide the government with its review of mental health services and programs. It received 1800 online and paper submissions, and it would have been great if the ABC had given us some insight into the process.

I'd like to think that our policy-makers, the media and our entire mental health community have been listening to and participating in the growing international debate about issues such as the financial and human cost of psychiatry's continued prescribing and promotion of dangerous drugs.

Unfortunately I am not confident that the review will reflect those concerns. Even psychiatrists are dismayed at the refusal of their profession to act on irrefutable evidence that their approach is causing more harm than good, and successive governments - which are wasting untold millions of the taxpayer's money to fund it all - have failed to call them to account.

I am beginning to think that we are not going to get anywhere without a Royal Commission into mental health care.

I'd be the last person to criticise the commitment and humanity of Mark Cross, the psychiatrist in charge of Liverpool Hospital's mental health unit which featured in the ABC's three-episode Changing Minds documentary. He is committed and compassionate, and he seems to engage with patients with good humour and genuine fondness.

But what about all those drugs that we saw being handed out to patients at Liverpool? What about the patients undergoing Electro Convulsive Therapy? Perhaps I missed it, but I can't recall any discussion of long-term effects or the slightest reference to those who warn about the often tragic consequences of both these approaches.

Australia needs to hear from people like senior clinical lecturer in psychiatry at University College of London, Dr Joanna Moncrieff, co-founder of the Critical Psychiatry Network, whose research conclusions call for a fundamental re-orientation of drug-based therapy.

We need to know about American psychiatrist Dr Peter Breggin, who has never prescribed a psychiatric drug in 40 years of practice, and is an expert witness in cases of negligent prescribing.

As Breggin notes, "People are becoming increasingly aware that psychiatric drugs are capable of doing more harm than good, including potentially increasing the risk of violence and suicide. Unfortunately, the medical profession, and especially psychiatry, has been slow to catch on."

Breggin is also passionately opposed to the use of electro-convulsive therapy.

Just last week, an article in Australian Doctor by a Melbourne-based ECT enthusiast - who teaches at three of our universities - advocated the procedure to health professionals as "the most effective known treatment for severe depression".

Despite Breggin’s misgivings, there are cases where ECT has transformed the lives of people suffering acute depression after prolonged, unsuccessful drug treatment, but I’d like to see a little less zeal, more evidence and guidelines restricting its use.

We've seen where this sort of enthusiasm can lead, a few years ago, when Australian children as young as one year were prescribed powerful anti-psychotics that were linked to deaths overseas.

For one thing, as the Australian Doctor article acknowledges, there are many hypotheses as to how ECT works, none of them proven.

There is also the fact that an international literature review concluded that, "Given the strong evidence of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified."

These, surely are topics that the ABC could explore as a follow-up to MentalAs.

It might compare these techniques with those used by psychologists and explore issues such as those being aired in places like the Mad in America blog.

It could examine a number of initiatives around the world that are reforming psychiatric practices.

Sweden, for instance, has introduced a personal ombudsman for psychiatric patients that has achieved encouraging results. The average hospitalisation of clients under this scheme has been reduced from 60 to just four days per year. Some 70 per cent successfully avoid admission to hospital.

In Denmark, the health agency Sundhedsstyrelsen has decided to make it harder for doctors to prescribe anti-depressants to 18-to-24-year-olds following the suicide of 20-year-old Danilo Terrida, 11 days after being prescribed anti-depressants following an eight-minute consultation with a doctor.

A couple of days ago, in a presentation at the 27th European College of Neuropsychopharmacology Congress in the Netherlands, 15 per cent of a survey of 315 medical scientists admitted to recently fabricating or falsifying research data, while more than a quarter admitted to deleting negative data or results that did not confirm their beliefs.

Meanwhile, in Britain, at the University of [the original] Liverpool, Professor of Clinical Psychology Peter Kinderman has recently published a fascinating book called A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing.

The book is an intelligent critique of the lamentable situation that mental health care finds itself in which also offers some common-sense alternatives. The ABC should interview Kinderman, and several other voices around the world who are part of a growing movement to expose the fractures in the mental health care system and set about fixing them.