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W.H.O. and U.N. Join Calls to Transcend the Medical Model

On June 10 the W.H.O. called for a fundamental change in mental health services.

Key points

  • The United Nations Special Rapporteur called for a move away from drug-company supported biological explanations of human distress in 2019.
  • The World Health Organization recently echoed the U.N. in a report calling for fundamental changes in mental health services.
  • The report emphasized social determinants of mental health such as violence, discrimination, poverty, exclusion, isolation, and unemployment.

The thousands around the world who critique an overly biological approach to understanding and helping one another when we are very distressed are often dismissed as "radical" or "extremists" or "ideologues." Critics of the dominant "medical model" approach, promoted by biological psychiatry and the drug companies, are often labeled and denigrated as "anti-psychiatry". We, however, view ourselves as anti bad science and anti ineffective, unsafe treatments.

Yet even some prominent psychiatrists have spoken up against the corrupting role of drug companies and the simplistic model they have promoted in order to sell their products. In 2005, Dr. Steven Sharfstein, then President of the American Psychiatric Association, wrote:

“If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model.”

In the same year, his British counterpart, Professor Mike Shooter, President of the Royal College of Psychiatrists, scolded his colleagues in no uncertain terms:

“I cannot be the only person to be sickened by the sight of parties of psychiatrists standing at the airport desk with so many gifts with them that they might as well have the name of the drug company tattooed across their foreheads.”

More recently the message has been taken up by no less an organisation than the United Nations, in the person of its "Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health" (2014-2000), Dainius Pūras. In 2019, Dr. Pūras, a Lithuanian psychiatrist, wrote:

“Current mental health policies have been affected to a large extent by the asymmetry of power and biases because of the dominance of the biomedical model and biomedical interventions. This model has led not only to the overuse of coercion in case of psychosocial, intellectual and cognitive disabilities, but also to the medicalization of normal reactions to life’s many pressures, including moderate forms of social anxiety, sadness, shyness, truancy and antisocial behaviour.

"…This message may further the excessive use of diagnostic categories and expand the medical model to diagnose pathologies and provide individual treatment modalities that lead to excessive medicalization. The message diverts policies and practices from embracing two powerful modern approaches: a public health approach and a human rights based approach ... Overmedicalization is especially harmful to children, and global trends to medicalize complex psychosocial and public health issues in childhood should be addressed with a stronger political will.”

On June 10th, the World Health Organization joined in, with a 300-page document entitled “Guidance on Community Mental Health Services: Promoting Person-Centred and Rights-Based Approaches.” The document emerged from a UN group headed by Dr. Michelle Funk, a psychologist who is Director of the Policy, Law, and Human Rights unit at the WHO Department of Mental Health and Substance Abuse. It argues:

"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 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."

Here is a link to the video of the launch of the Guidance. The document offers 22 exciting international examples of the way forward, including Open Dialogue, Soteria Berne, Tupu Ake in New Zealand, and Hearing Voices Support Groups.

Esteemed journalist and campaigner Robert Whitaker has commented:

"The WHO report makes for a landmark event. A global rethinking of mental health is clearly underway, and the model programs highlighted in this WHO publication, most of which are of fairly recent origin, tell of real-world initiatives that are springing up everywhere."

Previously isolated pockets of activists — patients, family members, mental health staff and researchers — are increasingly joining together in global organisations, such as the International Institute for Psychiatric Drug Withdrawal and the International Society for Psychological and Social Approaches to Psychosis, to name just two.

It will be harder for die-hard defenders of the medical model to dismiss such organisations, or the UN and the WHO, as extremist, anti-psychiatry radicals. The time for a fundamental paradigm change in mental health may, finally, be drawing near.

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