Wake-up call for British psychiatry

Abstract

The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty's future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty's core values and renew efforts to use psychiatric skills for the maximum benefit of patients.

Teaching medical students and recruitment to psychiatry: attitudes of psychiatric clinicians, academics and trainees

“…11 Negative attitudes resulting in prejudice are based on the perceptions that psychiatry is not medical or scientific and that prognosis is hopeless 12 -but who else can change this view among our colleagues if not psychiatrists educating the next generation of doctors? There are some obvious problems facing British psychiatry, such as the downgrading of medicine in our treatment practice 13 and psychiatrists' own beliefs that the prognosis of patients is poor, 12 which need to be addressed before we can begin to inspire our medical students to enter the profession.…”

A survey of psychiatrists’ attitudes towards the physical examination

“…practical obstacles such as shortage of time and equipment, concerns about the re-traumatising effect of the examination on patients who have been abused, a degree of examination 'skill atrophy' which may occur as trainees progress through psychiatric training and the general attitude that competency in this area is beyond the repertoire of skills that a psychiatrist should possess (Craddock et al, 2008;Gabbard & Nadelson, 1995;McIntyre & Romano, 1977;Mitchell et al, 1998;Read & Bentall, 2012). Other factors could include the lack of clear gold standards for PE, a misplaced faith in the value of routine investigations, an aversion to performing the examination because it can appear at odds with the other therapeutic aspects of the relationship between the patient and the psychiatrist and, in some cases, a fear of exacerbating the patient's level of agitation and aggression (Murray & Baillon, 2013).…”

Diagnosis and Treatment of Mental Disorders in the Context of “Nature – Nurture” Dichotomy

“…Британський Журнал Психіатрії [3] наголо-шує, що сьогодні гострою є проблема спро-щення методів лікування. Ця ситуація спро-вокована як державою, так і самими психіат-рами, і не йде на користь пацієнтам.…”

“…Сучасний лікар пови-нен сприймати особливості світогляду паціє-нта не як хворобу, а як одну з багатьох точок зору. За словами Н. Креддока та його колег [3], до практичної медицини мають бути до-пущені лише найуспішніші та найзацікавле-ніші у позитивних результатах.…”