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Mental health and market share

31 May 2011

THE RECENT budget changes to the Better Outcomes mental health scheme have been widely celebrated as a victory for mental health in Australia. In reality it has been nothing more than a coup by psychiatrists and pharmaceutical corporations to further their market share, at the expense of ordinary people undergoing distress in their everyday lives who would better benefit from preventative behavioural interventions.

Although there is not yet much detail on the matter, it seems that Medicare funded sessions for psychologists have been reduced from twelve to ten sessions per calendar year and the rebate paid to GPs for their time in making referrals to psychologists has been cut. This will essentially mean that GPs reduce or stop making those referrals and psychiatrists will, by default, extend their market share. This is good news for pharmaceutical corporations since psychiatrists essentially dispense their drugs for them.

These budget changes will take the focus away from early behavioural intervention by psychologists giving people less access to effective treatment at the crucial early stage when problems are relatively easy to solve with the correct interventional strategies. Without assistance, these untreated problems culminate into serious societal problems.

Although psychiatrists often want to claim that mental ‘illness’ is biologically predetermined there is actually very little evidence for this. Human behaviour is generally far too complex to be genetically determined and people almost always present for psychological assistance following serious stressful life events, such as separation, divorce, bullying, job loss, death of a loved one, or career stalling. When we experience serious stressful life events our brains respond by increasing CRF levels to try and make us more focussed on solving the problem. While higher CRF levels do increase vigilance, this can also lead to high levels of anxiety, panic, brain agitation, insomnia, lowered mood, irritability and over-worrying.

These subjective feelings of distress are what you might call early indicators that people are struggling. This is the stage where it is imperative to get some seriously good psychological intervention that is preventative, rather than wait until the problem has become entrenched. This is because subjective feelings of distress can be so overwhelming at these times that people can easily quit work, go on disability, increase alcohol or drugs, become angry, depressed or out of control. People can find themselves admitted into psychiatric units where they will usually be heavily medicated and can then easily lose control over their brain functions and their lives more generally. It is surprisingly easy to become part of the psychiatric revolving-door syndrome even when you have been previously high-functioning.

The reality is that every one of us will experience at least several stressful life events during our lives and when these occur people have to work very hard to stay on track. Our distress is not arising from some ‘abnormal’ gene lurking in our DNA but simply the adversity we all encounter in life and people are variously equipped to deal with these encounters.

Of course, psychiatrists frequently want to argue for genetic causes of this distress as a way of justifying their drug treatments. Yet as a clinical psychologist who has treated thousands of people over the years, I have often seen people made much worse by medications: frequently becoming highly irritable, increasingly agitated and sometimes suicidal. Occasionally people with no previous history of behavioural problems can become homicidal and some will suddenly develop paranoid delusions.

People who have been in-patients in psychiatric units have an increased likelihood of suicide once they are released from these units following drug and psychiatric interventions. With more sedative medications people often become stuporous, blunted and unable to lay down long-term memory rendering them unable to learn effectively or flexibly process new information. I have seen many people take anti-anxiety medications, more or less continuously (until the point of needing a hospital detoxification) because they have failed to remember taking their last tablet perhaps only ten minutes ago.

Similarly, opiate-based analgesics are steadily on the increase as people cope less well with their lives and try to numb their distress. Increasingly, we are putting our children with ADHD onto amphetamines when the long term statistics tell us that ADHD children who are not medicated do no worse (and probably do better) several years down the track. Indeed, many children with ADHD have their ‘symptoms’ reversed when their parents are targeted with behavioural interventions by psychologists. Currently it is estimated we have about 20 per cent of the adult population on psychiatric medications with about sixteen million scripts for antidepressants given per year.

In the past decade there has been an enormous increase in psychiatric medication rates even though we know that drug treatments have very low efficacy rates and many drugs can have serious side effects. In clinical trials, most drugs perform little better than placebo and symptoms return once the medication is stopped.

In comparison to medications, controlled trials in behavioural therapy, delivered by psychologists, is much better than placebo with rates of significant improvement at 85–90 per cent of people treated, and those improvements are sustained over time two to six years later. Behavioural therapy also results in measurable and long-lasting brain changes as the person learns new strategies. Importantly, there are no side-effects apart from enhanced skill acquisition and improved life outcomes.

It seems to me that as a society we need to stop and think very carefully about what we are doing and where we are headed. If we are trying to build a cohesive, robust society that has egalitarianism at its heart, we need to be vigilant about not allowing people to fall by the wayside simply because they are experiencing distress. As a society we ought to help to skill people up, not drug them up, when they falter. At least then people can continue to contribute in a meaningful way towards an improved society for everyone.

Effective behavioural intervention cannot be underestimated. Even though our suicide rates are alarming in Australia, it is important to note that the suicide rate has been steadily declining since shortly after the introduction of the Better Outcomes scheme in 2001. Since around 2002 the suicide rate for males has fallen by 24 per cent and for females by about 13 per cent. While other factors may also have contributed to this decline, there is nonetheless a correlation between early intervention by psychologists and other allied health professionals and significantly better mental health outcomes in Australia nationwide.

Clinical psychologist Sallee McLaren developed Smart Therapy and is author of the self-help book, Don’t Panic: You Can Overcome Anxiety Without Drugs (Scribe 2004).

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