黑料正能量 Note: A very provocative must read. 黑料正能量 is looking to explore this issue with an upcoming webinar or virtual conference workshop. In the meantime, feel free to send me your thoughts and I鈥檒l try to bundle them for further discussion here.
W.H.O. and U.N. Join Calls to Transcend the Medical Model
On June 10 The W.H.O. Called For A Fundamental Change In Mental Health Services
By John Read Psychology Today June 22, 2021
The thousands around the world who critique an overly biological approach to understanding and helping one another when we are very distressed are often dismissed as “radical” or “extremists” or “ideologues.” Critics of the dominant , promoted by biological psychiatry and the drug companies, are often labeled and denigrated as “anti-psychiatry”, while we view ourselves as anti bad science and anti ineffective, unsafe treatments.
Yet even some prominent psychiatrists have spoken up against the corrupting role of drug companies and the simplistic model they have promoted in order to sell their products. In 2005, Dr. Steven Sharfstein, then President of the American Association, :
鈥淚f we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model.鈥
In the same year, his British counterpart, Professor Mike Shooter, President of the Royal College of Psychiatrists, in no uncertain terms:
鈥淚 cannot be the only person to be sickened by the sight of parties of psychiatrists standing at the airport desk with so many gifts with them that they might as well have the name of the drug company tattooed across their foreheads.鈥
More recently the message has been taken up by no less an organisation than the United Nations, in the person of its “Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health” (2014-2000), Dainius P奴ras. In 2019, Dr. P奴ras, a Lithuanian psychiatrist, :
鈥淐urrent mental health policies have been affected to a large extent by the asymmetry of power and biases because of the dominance of the biomedical model and biomedical interventions. This model has led not only to the overuse of coercion in case of psychosocial, intellectual and cognitive disabilities, but also to the medicalization of normal reactions to life鈥檚 many pressures, including moderate forms of , sadness, shyness, truancy and antisocial behaviour.
“鈥his message may further the excessive use of diagnostic categories and expand the medical model to diagnose pathologies and provide individual treatment modalities that lead to excessive medicalization. The message diverts policies and practices from embracing two powerful modern approaches: a public health approach and a human rights based approach … Overmedicalization is especially harmful to children, and global trends to medicalize complex psychosocial and public health issues in should be addressed with a stronger political will.鈥
On June 10th, the World Health Organization joined in, with a 300-page document entitled 鈥淧romoting Person-Centred and Rights-Based Approaches.鈥 The document emerged from a UN group headed by Dr. Michelle Funk, a psychologist who is Director of the Policy, Law, and Human Rights unit at the WHO Department of Mental Health and . It argues:
“The predominant focus of care in many contexts continues to be on diagnosis, and symptom reduction. Critical social determinants that impact on people鈥檚 mental health such as violence, , poverty, exclusion, isolation, job insecurity or unemployment, lack of access to housing, social safety nets, and health services, are often overlooked or excluded from mental health concepts and practice. This leads to an over-diagnosis of human distress and over-reliance on psychotropic drugs to the detriment of psychosocial interventions.
“A fundamental shift within the mental health field is required, in order to end this current situation. This means rethinking policies, laws, systems, services and practices across the different sectors which negatively affect people with mental health conditions and psychosocial disabilities, ensuring that human rights underpin all actions in the field of mental health. In the mental health service context specifically, this means a move towards more balanced, person-centered, holistic, and recovery-oriented practices that consider people in the context of their whole lives, respecting their will and preferences in treatment, implementing alternatives to coercion, and promoting people鈥檚 right to participation and community inclusion.”
Here is a of the launch of the Guidance. The document offers 22 exciting international examples of the way forward, including , , in New Zealand, and .
Esteemed journalist and campaigner Robert Whitaker has :
“The WHO report makes for a landmark event. A global rethinking of mental health is clearly underway, and the model programs highlighted in this WHO publication, most of which are of fairly recent origin, tell of real-world initiatives that are springing up everywhere.”
Previously isolated pockets of activists 鈥 patients, family members, mental health staff and researchers 鈥 are increasingly joining together in global organisations, such as the and the , to name just two.
It will be harder for die-hard defenders of the medical model to dismiss such organisations, or the UN and the WHO, as extremist, anti-psychiatry radicals. The time for a fundamental in mental health may, finally, be drawing near.