Some fascinating insights into the mental health sector emerged from a survey of participants at The Mental Health Services conference in Perth last week.
The importance of prioritising the needs of youth and children, the unhelpful impact of the dominance of the medical model in mental health, and the potential to expand the role of consumers in service planning and provision – these were some of the issues raised. The results also sound something of a wake-up call for the psychiatry profession.
Professor Gavin Mooney, who conducted the survey, reports:
“The Mental Health Services conference is unusual in that it brings together a wide array of players on the mental health stage – mental health service consumers, carers, health care professionals, administrators, academics, government bureaucrats – the whole spectrum of interests in mental health.
This year the organisers arranged through me to conduct a survey of participants entitled ‘what do you want from the mental health services?’
The survey looked at two things, first the sort of principles or values that participants want to underpin mental health services and second what they see as priorities on a number of levels.
One thing sticks out above all else in the responses. I had assumed that consumers would have very different views from health care professionals and again that academics would see things so differently from carers. Yet the pattern of responses across the groups was quite remarkably similar.
These people – diverse in terms of their roles in mental health services – know what is wrong and what needs to be done and are united in that!
On values and principles they argued for the idea that priorities should reflect the fact that even for people with the same problems, some have greater difficulties in accessing care than others.
The prime goal of the mental health services they see as looking after as well as possible the interests (both health and other) of those with mental illness and their carers and families.
Most interesting perhaps – certainly most radical – is that they want the values of consumers and people with mental illness to drive priorities. Now wouldn’t that be something!
At the same time, of the total of 164 responses not one person wanted the values of politicians or government or administrators to set priorities.
On priorities regarding extending services, there was strong support for more community services, none for general practice and very little for inpatient hospital services.
The top priority on age groups was youth with children second.
The participants were asked what type of staff they would most want if more staff could be attracted into the service. There was a big majority for more consumer advocates and peer workers. Nurses and social workers were second but a long way behind. Psychiatrists came last.
They were also asked about stumbling blocks to reform – both who and what. These open ended questions provided some fascinating but also sad comments.
Regarding who are stumbling blocks, government, the bureaucracy and clinicians came out of this very badly indeed. The participants suggest there is government neglect, no political will for reform, bureaucratic indifference and clinical elitism. Several respondents mentioned the inappropriateness of the medical model and the conservatism of clinicians in the mental health field.
On what is blocking reform the answers are again clear but sad – lack of resources, community attitudes, stigma and again the medical model. Lack of coordination was also highlighted and the issue of power not resting more in the hands of the clients and their carers.
My reading of these results is that there are very real frustrations involved for many of the participants in their dealings with mental health services. There appears from these answers to be a very real need for the service to look at itself in a very critical way and especially for psychiatrists to be looking at what their role is, what it might be and what it should be.
What is most striking is that the participants believe that there is much that needs to be reformed in mental health services, they are remarkably agreed on what that is and they have some pretty good ideas about what needs to change. They know what is wrong and they know what needs to be done to fix it.
That knowledge needs to be heard – but will the current decision makers listen?”
“medical model” means a lot of different things to different people. To some, “medical model” is any mental health service that employs medical practitioners, and presumably we impose the model purely by existing. If Gavin Mooney thinks this is the problem then I beg him to sack the lot of us and let us double our income in private practice. Probably not what he wants.
“Medical model” may also mean the tendency of mental health services to offer medical treatments and not a whole lot else. But this isn’t an issue of what “models” people are using, when a patient walks out of a mental health clinic in Australia, odds on the script they are holding is signed by someone trained in a whole range of “models”, some we are allowed to use and some not, but that’s not our decision.
Ian, what ‘Gavin Mooney thinks is the problem’ is not the issue. I was reporting on this survey from the TheMHS conference. What must be worrying for you and indeed for all of us concerned about mental health issues and mental health services is that regarding the problems reported above – and at least some of them if I might now bring in my own judgement – seem quite serious, there was such unity across the different groups – consumers. carers, academics, health care professionals, etc.
I had hoped in reporting this that some in the mental health service might try to rethink their attitudes and indeed practices rather than saying ‘stuff this lack of appreciation of my skills in the public sector – I am off to earn a fortune in the private sector!’ I still have that hope.
It seems from what the wide range of participants were saying at this conference that there are some perceived problems with the medical model in mental health services.
Quite how precisely they interpreted ‘the medical model’ I do not know but it may be linked to concerns some expressed about ‘clinical elitism’.
But in any case is this concern regarding the medical model (however defined) not an issue that might be worthy of rational debate?
I think it’s worth a debate, certainly, but difficult without some sort of definition of what people mean by the phrase “medical model”. I suspect where things get confused is an misunderstanding of how much professional autonomy clinicians have within services, so that things can change by psychiatrists “rethinking their roles”. Certainly 20 years ago that may have been true but today there are many more external constraints and so you need to look at the whole system, and certainly I’m unsure why one professional group would be picked out for “especial” rethinking.
In Mental Health, and generally at TheMHS Conference, when delegates talk about the “medical model” they are using the contrasting definition as opposed to the Social Model of Disability.
I am surprised that someone who, apparently, works within the system, seems not to understand the, apparently, widespread antagonism to something called “the medical model”. I agreed immediately with the comment about “the inappropriateness of the medical model”. But on reflection, I cannot define exactly what it means. (It’s the “vibe”, man!).
I can think of many different themes that could be included. Let’s take three: (1) The attitiude that Psychiatry is somehow based in science, when there is no experimentally verifiable theory of the mind and no laboratory test to support almost any psychiatric diagnosis. (2) The DSM IV. (see http://www.harpers.org/archive/1997/02/0008270) (3) The pathologisation of ordinary behaviour.
I am neither a patient nor a clinician and I have no medical training. I am a friend and supporter of someone with undoubted problems, who has been chewed up and spat out by a dysfunctional system. I don’t feel qualified to put together a proper critique, especially within the small space provided here. But plenty of others have done it for me, if one knows where to look and who to listen to.
I welcome and agree with almost all of the conclusions presented in this article.
In terms of Australia’s Mental Health Consumer Movement (excuse the terminology, it was their decision) many leading advocates have co-opted their terminology verbatim from the international Disability Rights Movement. The World Health Organisation (WHO) has ruminated for some time on various classifications of disability, in which they also discuss mental illness. A quick google search has uncovered a link to their recent attempt to pinpoint a wholistic definition, including reference to the “medical model”:
The inclusive model that is shown as a diagram on page 9 is referenced continually in journal articles, and at major conferences worldwide, as an efficient understanding of the “medical model” and how it may fit within a full “biopsychosocial” view of disability.
we have similar problems in New Zealand. Unfortunately there hasn’t been a similar survey over here. For too long the politicians and administrators have set the values for care with scant input from consumers. Congratulations for brining these matters into the public arena for debate.
The question of the interpretation of ‘the medical model’ in this survey does raise some interesting issues. The survey was such that the comments about this model came in answers to open ended questions and there was not scope for respondents to define what they meant. I have however gone back to the questionnaires and it seems that what respondents are getting at is the way in which some psychiatrists see themselves as being at the centre of the care model or even dominating that which while it might be appropriate in say surgery they consider to be less appropriate in mental health. Respondents seem to be arguing that more of a team approach is needed including in that team not just other staff members but the person who is mentally ill and their carers and family.
This would seem to tie in with the fact that in terms of which types of staff the respondents wanted more of – if more money were available – they opted for consumer advocates and peer workers.
Concerns expressed about clinical elitism and conservative medical attitudes may also be relevant to how the respondents were seeing the ‘medical model’.
The two key things from the survey however seem to be that conducting such surveys is useful and the views of TheMHS conference participants are valued!
For me when I talk about the medical model its about coesive treatment and forced treatment and over use of drugs to treat all conditions that are presented to the medical team Ossie Rights
Gavin, thanks for that clarification. The College’s position (not my own) is psychiatrists should be leaders in certain clinical decisions by virtue of their extended training (about 13 years, next runners up in the training game are psychologists at 6)
I agree with Gavin Mooney.
At the TheMHS conference at one talk the speaker said “A study by American Psychiatrists showed…etc.” and then the speaker said “Who cares”. There was a murmur of agreement from the people in the room!
That’s exactly how many consumers feel. They are sick and tired of being treated as a statistics by health professionals who don’t regard people as human beings but who see people as some kind of tick to put into a survey, an experiment in medication!
Quibbllng about what the exact meaning of “medical model” means is another example of not wanting to listen to consumers. Psychiatrists and psychologist obviously do not have all the answers to life’s problems or they would be redundant.
Nor is Psychiatry an exact science.
So I plead with health professionals to come out of their ivory towers and see the person behind the statistics.
And what happens to all those reports while grossly underpaid real people (in the NGOs) who provide 85% of mental health services at the coal face try to cope?
This is not a stab at caring psychiatrists and psychologists but it is a stab at clinicians who are only that – clinicians, not caring human beings – and arrogant with it. All the reports, reviews and surveys in the world do nothing unless the outcomes are to genuinely help people with a mental illness.
In the meantime, stop the rot, services are being cut in Western Australia. Ken Steele, a consumer advocate who was given an award by the WA Health Department last year, has resigned from his role on a steering committe connected to the new Mental Health Plan for WA and says he is being gagged from speaking out (according to his letter last week in “The West Australian”).
Go to the Mental Health Consultation on 29th September 2009 and make your voice heard about mental health in Western Australia.