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- Johann Hari: Lost Connections - 8 Settembre 2018
This week on MIA Radio, we interview Professor Jim van Os. Professor van Os is Chairman of the Division of Neuroscience at Utrecht University Medical Centre, Utrecht, The Netherlands, and Visiting Professor of Psychiatric Epidemiology at King’s College, Institute of Psychiatry in London. He trained in psychiatry in Casablanca, Bordeaux and the Institute of Psychiatry at the Maudsley Royal Hospital in London.
We last spoke with Jim for the podcast in August 2017 and this time we focus on a recent paper written by Jim and co-authors that was published in the journal World Psychiatry in January 2019. The paper is entitled ‘The diagnosis evidence-based group-level symptom-reduction model as organizing principle for mental health care. Time for change?‘ Jim says that, arguably, ‘love is the most powerful evidence-based treatment in mental health’ and his paper envisions a future for mental health that moves away from symptoms and diagnoses and towards peer support and lived experience.
In this episode we discuss:
- What the diagnosis evidence-based group-level symptom-reduction model is and how it currently informs mainstream mental healthcare.
- How mental health funding and mental health professional partners work together to monitor and assess the effects of current evidence-based interventions.
- How this curative medical model is attractive, but often fails to work for patients.
- That the focus on biological, brain-based diseases and symptoms conflicts with the experience of people who are attempting to develop a narrative view of their difficulties and suffering.
- That the paper is an attempt to start a discussion about building a synthesis between the diagnosis, symptom-based medical world and the lived experience of individual people.
- How the creation of specific and discrete diagnoses has reinforced the symptom-led approach to mental health and has also necessitated the stratification of doctors into silos of expertise.
- How Jim favors a spectrum-based approach over a fixed diagnosis and that an example is autism spectrum disorder as described in DSM V.
- The limitations of using ‘target symptom reduction’ as an outcome measure for mental health.
- That symptom reduction can be beneficial in the short-term but is not a good long-term measure of recovery.
- That the paper attempts to make clear how important individual experiences are and the need to be sensitive to the existential domain, saying “restoration of health is not the goal, it is the means to enable a person to find and pursue meaningful goals, accordingly, the person’s existential values become central”.
- That the evidence suggests that any treatment effect or improvement is often down to meaningful interaction rather than the specific expertise of the treating professional.
- That, in many countries, we still see a huge gulf between mental healthcare and social care which remain separate and remote from each other and that this separation is not how the person experiences their world.
- The importance of including lived experience in the evidence base, particularly because randomized controlled trials, considered the gold standard of evidence, are often not conclusive in the field of mental health.
- That, in mental health, evidence shows that 30% to 40% of the response is down to placebo and the expectation of being helped.
- That the desire is to make the existential domain the primary lens through which to view human experience and to respond to mental or emotional suffering.
- That, arguably, ‘love is the most powerful evidence-based treatment in mental health’.