|In the US, we’ve been so focused on psychopharmacology in the last three decades that one wonders what psychiatrists even thought about before Prozac came along in 1987. One of those things actually had roots in early psychopharmacology era – the Community Mental Health Movement. Prior to the 1950s and the coming of Lithium  and Thorazine , the treatment of mental illness had been largely custodial. Dramatic treatments may have helped some patients, but not enough to empty the large State Hospitals where many of the chronically ill lived. By the 1960s, the new medications were being widely used to treat psychotic patients. The combination of often deplorable condition and high costs in the State Hospitals, the arrival of effective treatments, the problem of "institutionalization," and dominant social forces resulted in legislation that funded "deinstitutionalization" and the movement of large numbers of chronic patients into the community to be cared for by Community Mental Health Centers. The watchword was treatment in the "least restrictive environment." The hospitals are empty, but problems of funding cuts and the refractory illnesses created new problems with a large sub-population of chronic patients living marginally, among the ranks of the homeless, or chronically incarcerated. Community programs now vary widely from place to place depending on State funding patterns. Word-wide the same variability of care prevails…|
MENTAL HEALTH CONSUMERS CALL FOR EVIDENCE-BASED REFORM
A large group of mental health consumers and professionals calling themselves the "Alliance for Better Access" have issued a formal response to an article that appeared in The Sunday Age newspaper (Drug trial scrapped amid outcry 21/8), calling on the federal government to base mental health reform on the best evidence available. They are asking the government not to cut psychological services in the Better Access program. Earlier this year, the federal budget boosted support for early intervention programs, which was partially funded by cutting mental health services in a program called "Better Access to Mental Health Care". As the Sunday Age highlights, international mental health experts have questioned the benefits of early intervention programs for those "at risk" of psychosis. Ben Mullings, a psychologist who has worked in the Better Access program since its inception says, “If these cuts to psychological services go ahead, the level of treatment available for people with depression and anxiety will fall below basic minimal standards. These guidelines are well-established right across the scientific research in our field”
The "Alliance for Better Access" have argued that mental health funding needs to go to programs that are backed by extensive research and independent evaluation. They point out that cutting the Better Access program to fund other services that are not well-established in the research, is not an informed way to make decisions. Given that the Better Access program is based on decades of psychological research, the group is calling on the federal government to leave the program intact. With depression predicted by the World Health Organization to be one of the world’s leading health concerns by 2020, treatment of depression needs to be affordable and easily accessible to the general population.
Darren Stones, a mental health consumer, says “Scaling back Better Access will make it next to impossible for the average Australian to reach out for help. How are we supposed to afford psychological services if Medicare wonâ€Ÿt provide enough support?” Like many people involved in the "Alliance for Better Access", he has criticised the cuts to services from 18 sessions down to just 10 sessions per year, on the basis that it will restrict access for those people who are most in need of psychological care.The response from the "Alliance for Better Access" is not opposed to programs that target young people or psychosis, but rather, it calls on any changes to the system to be based on the best evidence about programs accessible to the general public across all age groups. Spokesperson for the group, Ben Mullings, says “We want to see government funding aimed at improving and enhancing the current system, instead of dismantling our existing programs that have years of research showing they are effective.” In the coming week the Alliance for Better Access will publish an article on its website outlining the extensive scientific evidence that underpins the Better Access program. This website also contains stories of real people who will be affected by these cuts to services.