The distress continuum was pushed as an idea through the 20th century
and the dual continua model was developed because a person could have a
high level of psychopathological but be doing okay. A newer definition
of mental health was considered in the New Horizons strategy: flourishing.
This could be a third spectrum but there are so many conceptualisations
already. The disorder spectrum becomes confused by personality disorders
since they're not traditional mental illnesses with supposed biological
cause. They're extremes of traits that everyone has. Sadly I think so
are most mental illnesses too. It is suggested that people with
personality disorders also suffer less distress from their illness. The
dual continua model came about in the 20th century and it was only in
the 21st century that psychiatric in the UK gave into pressure to accept
personality disorders like other mental illnesses.
Flourishing is important to me. I think people should have the chance to
achieve their potential and their potential to society be realised to.
But like everything in mental health this can just end up as a coercive
tool. In a person's best interests they may be stopped from taking a
certain direction in life just as they themselves may chose something
they believe to be in their best interests but no one else (or the
person deciding on their best interests) agrees. The quote about Jesus
going back to carpentry had psychiatry been around resonates with why I
question the practical implementation of flourishing rather than the
vision. The vision is great. All government departments working together
to ensure the mentally ill are supported to achieve their rightful place
in society. It's just that psychiatrists have been electrocuting people
to induce seizures (in extreme cases) and this is the practical reality
of all the different conceptualisations.
In this area of enabling the severely mentally ill to retain and regain
their life chances the UK fairs poorly. 5% of people with schizophrenia
are in employment or education whereas other countries in Europe have up
to 25%. Schizophrenia has a well defined psychopathology and that's all
that the NHS seems interested in treating. The revisions to the NICE
schizophrenia guidelines showed they're clearly not interested in the
distress continuum. They recommended against counselling, supportive
psychotherapy and social skills training. These can work to reduce
distress rather than attempt to change the psychopathology of the
supposed illness.
There are few attempts to address the new continuum of flourishing.
There are few successes in correcting the injustice of only 1 in 20
people in the UK with a diagnosis of schizophrenia being in employment
or education. My concern is that within that 5% there are many people
reduced to doing menial jobs because of the stigma. Their value to
society is wasted and the human suffers, but the doctors are satisfied
as long as the disorder is dealt with. It's far cheaper to chemically
restrain people with a diagnosis of schizophrenia for life and leave
them to rot without giving them the support they need to re-establish
their life course. They're left to live out their natural lives with the
burdens of exclusion, poverty and lost life just waiting for death or
taking their own lives.
Finland must have an extraordinary mental health and social care system.
They're system means that people with a diagnosis of schizophrenia live
longer and have better life outcomes. People with a diagnosis of
schizophrenia in the UK have a standardised mortality ratio (or risk) of
about 5. It means they're 5 times more likely to die than the general
population. In Finland the SMR for schizophrenia is about 1. A recent
report published by the Royal College of Psychiatry stated that people
with schizophrenia or bipolar in the UK die on average 20 years earlier
than other people. The figure that used to be bandied about was a 10
year reduced life expectancy.
Thank goodness the motto of the RCPsych is Let wisdom guide otherwise it
wouldn't be funny.
No comments:
Post a Comment