#biomedical model

The WHO Calls for Radical Change in Global Mental Health

On June 10, the World Health Organization released a 300-page document titled “Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches.” The document and its authors call for wholesale change and a revolution in mental health:

Although some countries have taken critical steps towards closing psychiatric and social care institutions, simply moving mental health services out of these settings has not automatically led to dramatic improvements in care. The predominant focus of care in many contexts continues to be on diagnosis, medication and symptom reduction.

Critical social determinants that impact on people’s mental health such as violence, discrimination, poverty, exclusion, isolation, job insecurity or unemployment, lack of access to housing, social safety nets, and health services, are often overlooked or excluded from mental health concepts and practice. This leads to an over-diagnosis of human distress and over-reliance on psychotropic drugs to the detriment of psychosocial interventions – a phenomenon which has been well documented, particularly in high-income countries. It also creates a situation where a person’s mental health is predominantly addressed within health systems, without sufficient interface with the necessary social services and structures to address the above mentioned determinants.

The biomedical model of mental health is an “illness” model, and thus the notion of recovery is associated with a reduction of symptoms. The individual is in recovery from a disease, and psychiatric drugs are understood to be a first-line treatment to help people recover in this way.

The WHO guidance doesn’t spend much energy criticizing the biomedical model of care, but there is an implicit message in all of its pages: that model of care has failed, and what is needed now is a fundamental rethinking of what is possible. The authors write:

A fundamental shift within the mental health field is required, in order to end this current situation. This means rethinking policies, laws, systems, services and practices across the different sectors which negatively affect people with mental health conditions and psychosocial disabilities, ensuring that human rights underpin all actions in the field of mental health. In the mental health service context specifically, this means a move towards more balanced, person-centered, holistic, and recovery-oriented practices that consider people in the context of their whole lives, respecting their will and preferences in treatment, implementing alternatives to coercion, and promoting people’s right to participation and community inclusion.

Am I the only one who finds the history/politics/science of mental health fascinating?!  Apparently not, as this article was one of the most emailed yesterday.

"The American Psychiatric Association has been trying [meet the scientific demands of the present day], mostly by leaving behind ideas about the meaning of our suffering in favor of observation and treatment of its symptoms."