The elderly mother of your best friend, who is developing dementia. The young girl in your daughter's class, who has stopped eating. Your distant cousin, who had a car crash and has not been able to move on. Your neighbour, who has terminal cancer. Your old friend from school, who now has an abusive partner. The soldier you see marching in the street, who has just returned traumatised from a tour of duty. Your colleague at work, who has depression but is too ashamed to disclose it. The person sitting with you in the GP waiting room, who has stopped working because of anxiety. Your son's mate in the football team, who has dropped out of school because he is hearing voices. The stranger sitting across from you in the pub, who almost died of a heroin overdose, perhaps it was accidental or perhaps it was a suicide attempt. All of them have been helped by a psychiatrist, or by a mental health professional working in psychiatric services.
This week London is hosting the International Congress of the Royal College of Psychiatrists, the association responsible for training, certification and activities of my medical specialty, and I want to dedicate this blog entry to our success stories: to the psychological and pharmacological interventions that are changing lives, and to the cultural and social initiatives that are changing public perceptions. An advertisement for what we do, as psychiatrists? Perhaps - but criticisms are coming from left and right: depending on who is criticising us, we are accused of being either too biological or not biological enough, either too social or not social enough. So, a little bit of PR, based on facts reviewed by experts, can only be a good thing.
The College has recently published the booklet The Science of Psychiatry: Making an Impact reporting 29 'impact statements' produced by psychiatrists, usually working closely with psychologists and social scientists, and submitted to the Government as evidence of health, scientific, societal and economic impact. The menu could not be more enticing.
Did you know that psychiatry research has promoted an important debate on the potential harm of recreational drugs and on how to best address this? We now know that individuals who start smoking cannabis early in their life, and smoke the particularly strong 'skunk' variety, are at increased risk of developing schizophrenia, a severe mental illness characterized by hearing voices (hallucinations) and developing false, often bizarre, beliefs (delusions). This is because some ingredients of cannabis induce these symptoms, and reducing cannabis abuse would prevent 1,200 new cases of schizophrenia every year in the UK alone. In contrast, other components of cannabis have beneficial effects on mood and pain. Treatment for heroin addicts is similarly contentious. Researchers have proposed supervised treatment for heroin addicts, but some of these treatment options have ethical implications, such as allowing addicts to take heroin while a doctor or a nurse is watching. Yet these approaches reduce crime and save lives. We do not provide all the answers, but we do provide the evidence for the debate.
Did you know that the UK is at world forefront in the development and provision of 'talking therapies'? In 2008 the UK government launched the Improving Access to Psychological Therapies (IAPT) programme to ensure faster access to psychological therapies, now treating almost 500,000 individuals every year across the UK. But not just any psychological therapies, only those that are 'evidence-based', that is, those that have been demonstrated to be beneficial using the most stringent studies. And guess who has conducted those studies? Yes, psychiatrists and psychologists, working together; entire books have been written on what kind of 'talking therapy' works for whom, and specific approaches for specific disorders have been developed, mostly based on the so-called cognitive-behavioural therapy (CBT) model. For example, 80% of people with panic disorder (sudden, our-of-the-blue anxiety attacks) and social anxiety (intense fear over routine social interactions) now reach recovery; people with schizophrenia (and their families) are helped finding better ways of coping with their hallucinations and delusions; and people with anorexia are helped focussing on their cognitive and emotional characteristics rather than on the preoccupations with food and eating. Some of our work is preventative: for example, military troops returning from active duty receive a post-deployment mental health resilience programme that decreases risk-taking behaviour and alcohol misuse. And some of our work is about showing what does not work: researchers have demonstrated that, contrary to expectations, talking about a trauma right after it has occurred does not help.
And did you know that psychiatrists inform policies that affects society? For example, by setting up a register of all suicides occurring in the UK (the largest database of its kind in the world), researchers have generated a number of recommendations, including the creation of 24-hour crisis teams and of multidisciplinary reviews following a patient suicide, now credited with saving 200-300 patient deaths per year. Also in the context of suicide, other research studies led to legislation for reducing the maximum pack size of over-the-counter sales of paracetamol from 100 tablets to 32, with a limit of one pack per sale; and this has led to hundreds fewer deliberate and accidental deaths. Public attitudes towards mental health have also improved thanks to efforts from psychiatrists through the Time for Change anti-stigma campaign; for example, in the last five years, fewer people with mental health problems have experienced discrimination in their social life or in securing a job.
Not all we do, as psychiatrists, is perfect. But, for once, this is an occasion to talk about the good stuff. Read the rest of the booklet. Read more about psychiatry. Take an e-learning course on psychiatry. If you are a medical student, consider a career in psychiatry. You may have never met one of us, but you will definitely know someone who has been helped by one of us.Suggest a correction