Given so many people are suffering from some kind of mental distress at the moment, many of them out of work because of it, it’s heartening to read the report from a group of MPs and peers who want to do something constructive about it. The cross-party ‘Beyond Pills All Party Parliamentary Group’ has published a report criticising the current biomedical approach to mental illness, arguing for a ‘paradigm shift in mental health care towards a more holistic and person-centred approach that addresses the social, economic and psychosocial factors contributing to mental distress’. This is a long way of saying that pills aren’t the solution. They are, in many cases, an important part of treatment, just as painkillers are often important for alleviating the symptoms a musculoskeletal problem, but physiotherapy is essential for a full recovery.
The group goes further than this, arguing that anti-depressant prescriptions are often inappropriate and unnecessary. It says: ‘While rising long-term use is associated with many adverse effects, including withdrawal effects, it is not associated with an improvement in mental health outcomes at the population level, which, according to some measures, have worsened as antidepressant prescribing has risen.’
To a certain extent, government policy has been moving in this direction anyway over the past few years, There is a greater emphasis on social prescribing in general practice, meaning patients are directed to activities that research has found can have a profound impact on mental wellbeing. This is not just something that affects mild anxiety: enlightened acute mental health trusts have occupational health as part of their treatment process. When I visited the Bethlem Royal Hospital as part of the research for my second book, The Natural Health Service, I saw how essential their walled garden was in the treatment of some of their sickest patients.
The problem is not just that clinicians are wedded to a biomedical model, or indeed that they don’t have enough time in their ten minute consultations to work out the complex drivers of someone’s mental illness. It is also that the population more generally thinks that pills are a sign their illness is being taken seriously. We see this not just in mental illness but also in physical conditions, which is why the example of painkillers for musculoskeletal conditions is appropriate: patients are good at remembering to take their pills, but often very poor at doing the physiotherapy and other recovery exercises that will mean they don’t need medication any more. There needs to be a shift in the way the public sees the treatment of mental illness, too, from thinking that a social prescription is a sign that clinicians don’t think it’s that serious, or even that it’s just something a patient should be able to snap out of, to realising how much more complicated our minds and bodies are than mere chemical processes.
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