Psychiatry facing an ‘identity crisis’ on its 200th birthday

Embargoed until Monday, June 30, 2008

Psychiatry is celebrating its 200th birthday this year – but a special article in the July 2008 issue of the British Journal of Psychiatry claims the specialty in Britain is facing ‘an identity crisis’.

 

The authors of the article, which include some of Britain’s most eminent Professors, claim that the quality of patient care is under threat from recent changes in the NHS. In particular, recent welcome improvements in psychosocial care have had the unintended consequence of undermining medical approaches to diagnosis and treatment.

 

The result is a ‘creeping devaluation of medicine’, that is damaging the ability of psychiatrists to deliver excellent psychiatric care.

 

Now, 200 years after the German physician Prof Johann Christian Reil first introduced the term ‘psychiatry’ in 1808, experts are calling for better understanding and recognition of the key role of psychiatry in the management of people with mental illness. Priorities include:

 

  • Maintaining and improving skills, facilities and resources to ensure psychiatric services provide excellence in diagnosis and medical as well as psychological and social care.
  • Recognising the important and close relationship between psychiatric and non-psychiatric illness and ensuring that physical as well as psychological and social factors are fully taken into account in assessment and management.
  • Ensuring that patients referred by their general practitioner receive a thorough, broad-based assessment by a highly trained professional in order that the most appropriate management is implemented at the earliest opportunity.
  • Striving for services and interventions based on robust and unbiased evidence rather than political idealism or a rigid adherence to particular schools of thought.

 

With psychiatry set to assume increasing importance over the coming decades, the article’s authors argue that now is the time for psychiatrists to reconsider the specialty’s core values.

 

Psychiatrists must not simply acquiesce to the short-term practical constraints of the latest NHS initiatives but should be thinking with a longer-term vision of the needs of patients with psychiatric illness. Otherwise, there is a very real risk that as the understanding of psychiatric diseases steadily increases, recent moves away from biomedical approaches to psychiatric illness will further marginalise and stigmatise patients in comparison with those suffering from non-psychiatric illness.
© 2008 Royal College of Psychiatrists