Psychologists are the ones with all the psychological knowledge, psychiatrists just have a diagnostic tool for medication.
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Sadrina
This a sweeping generalisation. Not something I agree with with my 50+ years experience
Tony
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But Psychiatrist donât lead mental health services anyway. What gives you that idea?
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Yes they do, they are the responsible clinicians, the buck stops with them even if some of them have never had contact with the patient in question.
I think the issue isnât so much about who leads what - but more along the lines with the application.
If this were a situation where a patient voluntarily seeks therapeutic psychological support then the application will be adhering towards patient rehabilitation - there would be a strong focus respecting their autonomy, decisions and importantly it would be a gradual line to support. And thatâs the key word âsupportâ.
However, the context here is different when the law is implemented. Would it matter if a psychologist or psychiatrist take the lead? In my view - no.
Why? Because the objective is different. The Mental Health Act 1983 objective is to prioritise risk prevention, and everything else becomes conditional on that priority. And, the only way it can facilitate that is by carrying out an intervention at the expense of the patientâs autonomy.
So, that in itself sets the marker. It is not a voluntarily circumstance where the patient on their own seeks support to be better than they were.
It is a forced position where the patient whether they like it or not is required to be in a ward and more often than not medicated for it - why? Because the law has a focus on preventing risk. It is to control the individual so they do not become a risk. The law is not designed to rehabilitate the individual - it is to contain them.
So in essence it makes no difference who leads who when the law leads everyone.
Seem to have touched a few sensitivities here, well done. Ref they are responsible clinicians and the buck stops with them, my actual, but limited experience, i.e 4 mental health doctors 3 didnât comply with regulations or show much sign of professional competence, is that the organisation they work for, in this case NHS and County Council circle the waggons and avoid them being held to account, again in this case, aided and abetted by CQC, GMC and Ombudsman. The case also resulted in contact with 2 Clinical psychologists that seemed to know what they were doing. I was struck by the OK very subjective impression given by this small sample that the doctors gave an air of being very important which perhaps feeds the awe many gift to them. The psychologists just got down to business in a professional way.
It would be interesting if this debate developed in a considered manner.
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In answer to your first point, it is about who leads because the answer for all patients at the moment is medication. Have you ever tried to seek psychological support on the NHS? A therapist had to volunteer to see me because she was getting fed up with the team of laypeople and psychiatrists doing nothing with my calls, she got a bit of history and suggested a trauma test, that was 2 years ago, still no trauma test. Not to mention I was misdiagnosed with bipolar 15 years ago and not once has any psychiatrist recommended therapy. And those that say itâs better used in conjunction with medication put you on medication then never arrange the therapy not to mention that psychologist jobs in the NHS is few and far between because they use the medical model taught to psychiatrists.
A, the law was made like this: we need to detain these people but it needs to be a medical decision so weâll put psychiatrists in charge.
Psychiatrist donât have a clue whatâs going on with the person theyâve detained and worse they detain them because of the diagnosis-medication schema they follow which is you have a diagnosis, youâre not taking medication so you must be unwell. Iâve sat through assessments there is no mention of risk to self or others.
Most people are detained in hospitals because theyâre seen as needing medication hence why, and this happens a lot, when my friend tried to kill herself the other week she wasnât taken to hospital. By the way, she feels the system has washed its hands of her.
All treatment should be voluntary. Psychologists understand the individual is the expert on themselves or seek to facilitate the person to understand themselves. Psychiatrists just go diagnosis medication and it doesnât help 98% of the people itâs used on. Antipsychotics have a 2% affectiveness rating.
P.s. you canât section someone so they donât âbecome a riskâ they have to be a risk to themselves or others, at least, thatâs the law.
But you hit on another point âif the patient were to voluntarily seek supportâŚweâd respect their autonomyâ autonomy, in law, should be respected up to the point they are a risk to themselves or others. This doesnât happen, in practice because patients autonomy is not respected unless theyâre on meds and doing everything the mental health team say, thatâs not autonomy. Thatâs a dictatorship. And itâs often used as a barometer for unwellness, either admit weâre right and you need help or you are unwell. So essentially admit youâre unwell and do what we say and weâll leave you alone thatâs not really leaving someone alone. They do it to patients all the time, come in informally (voluntarily) and we wonât section you, thatâs not voluntary, thatâs coercion.
Why oh why you would want to help someone that doesnât want your help is insanity.