Medication, trauma and psychiatry

As the UN Special Rapporteur announced last year:

 “Mental health policies and services are in crisis - not a crisis of chemical imbalances, but of power imbalances. We need bold political commitments, urgent policy responses and immediate remedial action.” 

“We need little short of a revolution in mental health care to end decades of neglect, abuse and violence.”

LINK

However, there is no sign of a revolution around the corner: indeed, with the economic power vested in the pharmaceutical industry and the social power in the medical profession, any UK policy change is likely to be fiercely fought - and very slow.

But there are some signs of an evolution – from the World Health Organisation, from some British professional institutions, the voice of service users, and from a small independent clinic in Oxfordshire – by using the lens of trauma treatment.

WHO

·         Historically, the psychiatric profession has defined disorders by their symptom presentation rather than by cause. This is changing with the 2018 publication of ICD-11: see previous blog ‘Thinking about Diagnosis’.

British professional institutions

·         The British Psychological Association has published a detailed critique of biomedical practice in the ‘Power Threat Meaning Framework’. Its central ideas include trauma-informed thinking, formulation rather than diagnosis, and relational practice.

·         Public Health Wales is running a large public education and information campaign about ‘Adverse Childhood Experiences’ and their consequences for individuals and society.

·         ‘Enabling Environments’ and ‘Psychologically Informed Planned Environments’ are becoming well established in the criminal justice sector, with government support.

·         ‘Psychologically Informed Environments’ are becoming similarly established in the voluntary sector, particularly for homelessness, with support from local commissioners, and lottery funding.

·         Several organisations have come together for a parliamentary launch of a consensus statement about ‘personality disorder’, led by Norman Lamb MP.

·         The Royal College of Psychiatrists is working on a parallel position statement.

Service users and other critics of mainstream services

·         Trauma is often not recorded or registered, and rarely taken seriously.

·         Mainstream psychiatric provision often re-traumatises people.

·         Medication only ever offers temporary and partial relief.

·         The most acceptable services are co-designed with experts by experience.

A small Oxfordshire clinic

·         Khiron House is residential trauma treatment service which takes private and NHS referrals

·         It combines a rigorously designed therapeutic environment with intensive individual and interpersonal neurobiological therapies (based on the work of Daniel Siegel, Pat Ogden and Bessel van der Kolk).

·         No other residential units in the UK offer this level of specific trauma expertise.

·         It prioritises psychosocial treatment over biomedical, and aims to work in collaboration with prescribing doctors.

·         It follows a wholly non-paternalistic model, and expects its residents to be able to take day-to-day responsibility for themselves.

·         Its current working practices are not suitable for CQC registration.

·         A higher dependency unit is being planned, with full nursing cover – for those who experience severe dissociative symptoms which require a higher level of psychosocial containment. This is likely to seek CQC registration.

·         Declaration of interest: I work for them as medical director (ie communication channel to the mainstream system), chair of ethics and governance board, and clinical advisor (specifically on therapeutic environments). It is a very part-time role, and does not involve any contact with the residents or involvement in the specific therapies.