The burden of mental health is in the community
For several centuries, the mentally
ill were locked away from society and placed in in
asylums for life, for example the Bethlem asylum which first
admitted psychiatric patients in 1357. It has become increasingly
apparent that mental health problems are not unique to a small
proportion of the population, but are pervasive throughout the
population to varying degrees. Mental illness is on a spectrum, and
and the tip of the iceberg is hospitalised patients. It has also
become apparent that much of psychiatry needs to be practised in
the community, where the burden of mental illness is
present. Over the last 50 years, asylums have started to
close down, with resultant emphasis on community services and
de-institutionalisation of inpatients. The adequate planning of
community services has not always followed hot on the heels of the
closure of inpatient services and there have been recent catch-up
initiatives to cope with the burden of community mental
illness, including the recent initiative of Crisis Resolution and
Treatment Teams in the 1990s. For further information on the
history of psychiatry, please click here.
Modern biological treatments
Effective
treatments for mental illness are also relatively recent in
development. The first drug developed with a specific antipsychotic
action, namely chlorpromazine, was synthesised in 1950. Since
then, a number of other safe and effective pharmacalogical and
psychological treatments have been developed, but many advancements
have been very recent in comparison with other branches of
medicine. Modern electroconvulsive therapy (ECT) is practiced in a
very safe manner, unlike that portrayed in films such as 'One flew
over the cuckoo's nest' and 'Changeling'. The public view of safe
biological treatments is still predominantly negative, and
psychiatrists spend considerable time explaining how treatment has
progressed in safety and efficacy.
Psychotherapy within psychiatry
Freud, the father
of psychoanalysis and a neurologist by training, started to publish
his work in 1900 and used scientific rigour in testing
hypotheses. Freudian ideas were used as a springboard
for the development of understanding human subconscious processes
and relationships. In the UK, psychotherapy still plays an
important part in modern psychiatry, and trainee psychiatrists are
expected to become familiar with the major psychological treatment
modalities, taking on cases, and learning to be reflective in
thinking.
For further information on
psychotherapy, please
click here.
The holistic model approach
As an example,
consider a young female with anorexia nervosa who presents as
very underweight. In terms of biological factors, you may need to
monitor her physical state for complications, for example
hypotension, arrhythmias, electrolyte abnormalities, and you
will need to monitor her weight. In terms of
psychological factors, you need to consider the
psychological causes which led to her condition, and you may work
with therapists to offer a suitable psychological treatment,
for example family therapy and cognitive behavioural or
analytic therapy (CBT or CAT). In terms of social factors, you will
need to work out the strength of current social support
system, liaise with colleagues to ensure she is receiving
benefits, and ensure she can manage her day-to-day activities.
Team work
Mulitidisciplinary
teams are the cornerstones to effective functioning on wards and in
community mental health teams (CMHTs). It is essential to be able
to work with a range of professionals both through mental health
services, and also through other organisations, including social
services and non-statutory organisations. Professionals you may
come across in your attachment are: nurses, occupational
therapists, social workers, psychologists and specialist therapists
(for example, family therapists, drama therapists, etc).
Dr Meinou
Simmons
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Page last updated on 16 May 2010 by E
Baker-Glenn