Mental Health Systems Not Fit For Purpose

The promise of evidence based CBT treatments and antidepressants seems not to be realised in practice, an editorial in the current issue of the Canadian Journal of Psychiatry notes:

‘Despite a 3- to 4-fold increase in the use of antidepressant
medications, the prevalence of depression and anxiety dis
orders in Australia, Canada, the United Kingdom, and the United States has remained unchanged over the past .1 20 years In the absence of compelling evidence that the incidence of these disorders is on the rise, a natural conclusion is that depressed or anxious patients who could benefit from treatment are still not identified and treated, or that the duration of illness has remained unchanged in those who are treated. This is a striking and troubling finding, considering the known efficacy of antidepressants and psychotherapies. It emphasizes both a well-delineated treatment gap, whereby many patients with depression or anxiety do not receive treatment, and a quality gap whereby those who are treated either do not need to be treated or do not receive effective 2-7 treatment’. Click link below for full editorial: https://www.dropbox.com/s/kbmly9awq9diflb/Collaborative%20Care%202018%20mediocre%20usual%20care.pdf?dl=0

  1. Jorm AF, Patten SB, Brugha TS, et al. Has increased provision
    of treatment reduced the prevalence of common mental disorders?
    Review of the evidence from four countries. World Psychiatry.
    2017;16(1):90-99.
  2. Jorm AF. The quality gap in mental health treatment in Australia.
    Aust N Z J Psychiatry. 2015;49(10):934-935.
  3. Lin EH, Katon WJ, Simon GE, et al. Low-intensity treatment of depression in primary care: is it problematic? Gen Hosp
    Psychiatry. 2000;22(2):78-83.
  4. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in
    primary care: a meta-analysis. Lancet. 2009;374(9690): 609-619.
  5. Simon GE, VonKorff M, Wagner EH, et al. Patterns of antidepressant
    use in community practice. Gen Hosp Psychiatry. 1993;15(6):399-408.
  6. Kendrick T, King F, Albertella L, et al. GP treatment decisions
    for patients with depression: an observational study. Br J Gen
    Pract J R Coll Gen Pract. 2005;55(513):280-286

But the editorial posits that greater collaboration between services would usher in the promised land. Whilst this might be helpful, a failure to understand what constitutes a faithful translation of the positive results of randomised controlled trials for depression and the anxiety disorders [see Scott (2017) Towards a Mental Health System That Works London: Routledge https://www.amazon.co.uk/Towards-Mental-Health-System-Works/dp/1138932965/ref=sr_1_1?ie=UTF8&qid=1547819366&sr=8-1&keywords=Towards+A+Mental+Health+System] into routine practice will continue to nullify any actions. Unfortunately in the UK, IAPT continues to pursue its own fundamentalist translation of the randomised controlled trials, despite evidence that it doesn’t work, with just a 15% recovery rate [ Scott (2018) see link below:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

Further IAPT has extended its’ empire well beyond the borders of reliable evidence based outcome studies e.g to medically unexplained symptoms. Staff are frightened to speak out publicly. It is difficult to escape charging IAPT with imperialism. Theirs is a dominant narrative in BABCP, British Psychological Society and in journals such as Behaviour Therapy and Research.

Dr Mike Scott

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