We need to think anew on mental health

MIND MOVES:Progressive thinking needs to be implemented

THE HUMAN sciences have taken us a long way in terms of refining great ideas and great programmes that can really work when they given half a chance. But when it comes to turning good science into improved human services, the best of ideas often fall flat.

Take, for example, one of the classic stories of modern psychiatry concerning a very humane way of treating people with schizophrenia.

In the late 1960s, Dr Loren Mosher, a highly-respected psychiatrist who was head of the Center for Studies of Schizophrenia at the National Institute of Mental Health in the US, decided to try a simple experiment. He opened a number of houses in which people with schizophrenia could be treated by being provided with a comfortable, caring environment.

He was curious to explore how well the experience of a humane and supportive environment would measure up against conventional psychiatric treatments.

The staff were not trained in mental health disciplines, but were selected simply for being caring, empathic people who would treat the patients with kindness. Antipsychotic medications were not a part of the treatment.

This was a complex and carefully controlled study, but skipping to the result: the people who lived in his house, and several others like it in the US, Scandinavia and Switzerland, had outcomes that were every bit as good as the people who were treated with drugs.

You might think his findings would have had some impact on treatment policy at that time. Even if one didn’t accept Dr Mosher’s stance on medication and firmly believed in its positive benefits, surely one couldn’t argue with his finding that the outcome for someone with a diagnosis of schizophrenia was highly dependent on the quality of their immediate environment?

But such was not the outcome of his work. Not only were his research findings resisted, Dr Mosher’s credibility as an innovative psychiatrist was questioned and he was gently pushed out of his job at the NIMH. Funding was progressively cut off for his project until it was no longer possible to sustain any of the houses. Another good idea bit the dust.

The moral of the tale is: just because you have a great idea, even if it comes with hard science to back up its claims, and even if you can show it might save money and when it makes sense to the very people the system is intended to serve, there is no guarantee that it will be adopted by the prevailing mental health system.

We are all wary of change. Everyone who derives some benefit from keeping things just the way they are, will naturally resist change. Not because we are bad people but simply because we have learned to live inside some story we’ve been telling ourselves for years.

We are in a new time where we need a very different conversation around mental health than the one we’ve had up to now. All of us are struggling to understand our personal struggles. Families and carers of people with painful mental health difficulties are asking for more creative interventions that will give those they love a better prognosis than the one they’ve been hearing for years.

Service providers and clinicians are being drawn into conversations with people who speak from personal experience about what recovery involves and requires. Their purpose now is to explore how we can provide services that build on the strengths and the potential of our most vulnerable, and how we can create, with their help, environments that are enabling rather than disabling.

The challenge now is to turn these conversations into new approaches that will improve outcomes for everyone; to risk change and see where that takes us. Not random or impulsive change, but thoughtful change that gives new thinking a real chance. If we do this, we can make this country a place where mental health is finally acknowledged to be critically important and relevant to our survival as a society.

Tony Bates is founder director of Headstrong – The National Centre for Youth Mental Health (headstrong.ie)