Mental Health Is an Abominable Mess: Mind and Nature Is a Necessary Unity

By Drury, Nick | New Zealand Journal of Psychology, March 2014 | Go to article overview

Mental Health Is an Abominable Mess: Mind and Nature Is a Necessary Unity


Drury, Nick, New Zealand Journal of Psychology


Abominable Outcomes

A strong argument can be mounted, on the basis of the available evidence, that besides offering an increasing amount of employment, mental health services are not doing a great deal of good. Lambert (2010) claims that 75% of people entering community mental health centres in the USA are either not responding to treatment, or worse, deteriorating whilst in care. The Centre for Social Justice (2012) in Britain, reviewing the effectiveness data generated by the National Health System, found only 15% of people entering Britain's mental health are achieving 'recovery'. In the United States, Hansen and colleagues (who also found a 'recovery' rate of only 14%), along with others, found that about 5-10% of clients in adult services appeared to get worse during treatment (Hansen et al 2002; Lambert & Ogles, 2004; Lilienfeld, 2007). Warren and colleagues (2009, 2010) found a staggering deterioration rate of 24% amongst children in public community mental health settings. There have also been worrying comments in Australia, with claims that despite increases in pharmacological, psychological, and population interventions over the past 16 years there seems to have been no improvement in the adult mental health of the population (Jorm & Reavley, 2012). Reflective of this phenomena, mental health services of King County, Seattle sought and were granted a waiver in 2004 to no longer monitor 'recovery' outcomes (based on GAF scores), after finding for three years in a row that less than 8% of those with a 'serious mental illness' (SMI) ever move out of that category, and of those that did, many regressed back (CCHR Seattle, 2004).

The Hansen study (2002), (65% 'not improved' or 'deteriorated'), often considered the benchmark study of effectiveness in a variety of 'real world' treatment centres, did not include many who dropped out after the initial session; hence Lambert's claim of 75% not responding or deteriorating. Hansen and colleagues cited a number of possible causes for the paucity of results, including limitation of services "..as a result of physician gate-keeping process" (p. 329). Numerous prominent psychiatrists have been more publicly critical in their attribution of ineffectiveness in mental health being due to the dominance of biological psychiatry (Jackson, 2005; Double, 2006; Breggin, 2008; Moncrieff, 2008; Ross, 2008; Healy, 2012) (1). Investigative reporter Robert Whitaker (2010) made a blistering attack on mental health services by documenting a tripling of the number of disabled mentally ill over the past two decades as the sales of various psychotropic medications soared. Also, numerous writers following in the footsteps of Foucault (1980), have argued that there is a 'looping effect', in that as more psychiatric labels enter the public lexicon more people are self-recruited as patients (e.g. Hacking, 2007; Rose, 2007).

Psychotherapy is Efficacious

Despite such poor results in 'real world' clinics, as documented above, psychotherapy has been shown to be highly effective for a variety of mental health problems, including severe mental illness (SMI). Both qualitative and quantitative reviews show that about 75-80% of people benefit from psychotherapy; outcomes that surpass many medical treatments for a variety of non-mental health problems (Wampold, 2001; Lambert & Ogles, 2004; APA, 2012). Meta-analyses of a number of psychotherapies, such as CBT (Wykes et al., 2008; Sarin et al, 2011), and psychosocial treatment with antipsychotic postponement (Bola et al, 2009), have been shown to have a strong evidence base in the treatment of so-called 'schizophrenia' or 'SMI'. Seikkula and colleagues (Aaltonen et al, 2011; Seikkula et al, 2011) have set the benchmark in the treatment of psychosis with a psychosocial intervention. They have shown themselves, at two- and five-year follow-up, to be the most effective mental health service in the world, in terms of having the most clients (approximately 80%) in full-time work or study, medicationfree, and lowest residual psychotic symptoms. …

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