a coherent system

(A) Common life and lifestyle problems:

Common life problems such as bereavement or divorce can be quite emotionally overwhelming. Additionally, if a person isn’t coping and isn’t supported, these distressing life experiences may sometimes develop into common mental health problems. Both counsellors and life coaches are trained to work with these type of problems. Common lifestyle problems include smoking and obesity, with referral to a health coach.

(B) Common mental health problems including, for example, depression and anxiety:

A huge proportion of GP consultations involve people who don’t have a biophysical health problem and are wanting help with something entirely different – often distress arising from common life problems or common mental health problems. With all of these problems pharmaceutical treatments should be the option of last resort, regardless of patient/client expectations – yet five million people in the UK are currently taking antidepressants. Both counsellors and psychotherapists, for example, are trained to work with common mental health problems.

(C) Severe and complex mental health problems:

These includes those who have psychotic episodes – involving very distinct changes in their perceptions of reality – such as hearing and/or seeing things that are inaudible/invisible to others where this impacts negatively on emotions, thoughts, judgments and their ability to function. A person with this type of mental health problem would normally be referred to a psychiatric service.

(D) Psychosocial disabilities and naturally occurring cognitive variations:

This includes those on the autistic spectrum, those who have difficulties with standard ways of learning, and those diagnosed with ‘Attention Deficit/Hyperactivity Disorder’ (ADHD).

These all represent instances of neuro-diversity, rather than ‘illnesses’ which need to remedied and somehow cured, and thus pharmaceutical treatment is largely inappropriate. Here people need:

• Psychosocial support – and/or specialist-educational support – to help them lead lives that are as independent as possible.
• A society that values neuro-diversity.

(E) Mental and emotional distress that has a proven, main bio-physical cause (as with dementia, for example):

Despite decades of research there is a complete absence of biological markers for, or biogenetic causes of, mental health problems.

This excludes illnesses, such as dementia, which have pronounced mental and emotional effects but stem from a known bio-physical cause.

Adverse life experiences such as prior physical and sexual abuse, racism, bullying and neglect are common on a psychiatric ward, and are understood by a great many patients to have played a significant role in the development of their problems. Moreover, often problems with housing, for instance, are understood by patients to be the trigger for a relapse. Thus many patients resist the attachment of misleading diagnostic labels and see their mental health difficulties as a natural response to adverse experience. Instead of asking people “what’s wrong with you?” – and then giving both “it” and them a label – we need to ask “what has happened to you?” Labelling can also be damaging to the interests of the patient/client in other ways that are difficult to contradict or escape.

Most psychiatric diagnosis is actually based on little scientific evidence – the disorders listed in the highly influential Diagnostic and Statistical Manual of Mental Disorders (DSM) have been arrived at by psychiatrists simply voting on what is, or is not, considered a disorder. It’s also worth noting that, whilst the first edition of the DSM (published in 1952) listed 106 categories of mental illness, the latest version (published in 2013) lists well over 600.

The question we need to ask is “Who does diagnostic labelling benefit – the patient/client or the mental health expert?”

If every GP surgery had in place what might be called a GCP (General Counselling Practitioner), then the burden on GPs would be enormously reduced, leaving them more time to focus on patients who can best benefit from their attention. Each GCP would be an experienced and well-qualified counsellor and health coach, but their main role would be to psychosocially assess each person referred to them, with a view to making an appropriate non-medical prescription – e.g. for counselling, and/or changed housing conditions, and/or health and lifestyle coaching.

Or they may call a help line, or else be found in care homes, or drug and alcohol rehab centres, or homeless shelters, or Salvation Army hostels, or in a variety of drop-in centres. To make matters even worse, some of the people concerned are very ill indeed and deeply traumatised. Welcome to the system’s dark underbelly where much is swept under the carpet or disappears down yawning cracks and where people with mental and emotional health problems are largely given inadequate help by those who, through no fault of their own, are not qualified to do any better. Proper organisation and resourcing of street triage would represent a step forward.