A consumer advocate takes issue with a system that waits until people become ill before acting.
Studies have shown that one can present a patient’s notes to a psychiatrist in England, New Zealand, Australia and the US and get a different diagnosis each time. This is especially the case with bipolar, PTSD and Borderline Personality Disorder (a diagnosis which can be conjured by mixing a handful of disparate symptoms from a bucketful on the schizoid spectrum).
There is also no doubt in my mind that there are ‘fad’ diagnoses as pointed out by Martin Whitely (March edition). The ADHD/ADD spectrum springs to mind as does the inability of some GPs to separate sadness and grief, from clinical depression.
It is also my view that the prescription of anti-depressants in the absence of some formal psychiatric assessment and implementation of a mental health plan for individuals is not always helpful. At its simplest a mental health plan can be ‘to function reasonably normally within society’.
Chief Psychiatrist Dr Nathan Gibson noted in the inquest into the deaths of five Fremantle patients, [one being the author’s daughter] that disorders such as BPD can lead to “therapeutic nihilism” from clinicians. I have heard some say of BPD suicides that “it’s not a case of if, but when”.
The issue of having a diagnosis at all is also an interesting one. It is common practice in adolescent mental health to not reveal a diagnosis as it labels the patient. While this may have merit, it does not let the patient or the carer conceptualise the illness and look for treatment options.
The diagnosis from the DSM5 is likely to affect the patient for a long time, maybe for life. It will also influence (even if subliminally) the treatment options explored by clinicians and the amount of hope they hold for a recovery.
There may also be a case for a broader commentary on what language used by society and the professions in mental health. It was noted by a member of the Mental Health Advisory Council that the new Mental Health Act should more accurately be called the Mental Illness Act as it speaks more to the latter and doesn’t really address the former.
While pithy comments and clever semantics are common from professionals, I think it is the starting point for a community discussion as it influences both the stigma of those entering the system but more importantly, how we address the cause of, and pathway from mental ill health. You may note that mental ill health is now the term and not mental illness.
I like the term “social and emotional wellbeing”. Living well requires a suite of habits such as eating well, exercise and avoiding excessive drinking etc., social and interpersonal skills. It is almost impossible to be mentally unwell if you eat well, exercise (both by choice), engage socially and manage the relationships in your life.
So the questions become “is the system letting people get ill and then treating the symptoms?” “Is the diagnosis a recognition of the symptoms and not the illness?”
The message of social and emotional wellbeing is especially important for marginalised groups such as Aboriginal, LGBTI, migrant and refugee communities. Like physical health campaigns, this would not only increase the wellbeing of recipients, but may actually cut costs at the therapeutic end.