• Mental Illness and doctors 07 March 2016 | View comments

  • 07th March 2016 | By David Jolley

    The Guardian newspaper has run a series of articles about health and health services, including mental health and mental health services over the past two weeks.

    By Thursday of this week niggling between medical practitioners and clinical psychologists had gripped the correspondence columns.

    David Enoch, a venerable and wonderful man, now in his nineties wrote: ‘I declare from 60 years as a physician in psychological medicine, that the medical approach has been extraordinarily successful. I experienced the old regime of the 1940s and then the golden era of psychiatry, with the discovery of successful antipsychotic, antidepressant and anti-anxiety drugs and the establishment of ‘talking cures’.

    He was taking exception to the claim by Richard Bentall, a psychologist, that a narrow medical approach has been ‘extraordinarily unsuccessful’

    A narrow approach is likely to have weaknesses and limitations but the medicine and psychiatry which David Enoch describes, and is illustrated by his own impressive career, has been broad church and is robust – hence the good outcomes which we should not easily deny or dismiss.

    We have seen the closure of mental hospitals because fewer people are left damaged by untreated major illnesses. We have seen a reduction of suicide rates, especially in older people. We are in the midst of further efforts to counter stigma and ignorance of mental illness and to encourage a reasonable share of resources to be directed to the care of mentally ill people of all ages.

    Improvements have depended upon the charisma and energetic devotion of people like David Enoch, harnessed with the equally determined passions of other professionals and ordinary people who have been touched by mental illness.

    Andrew Spooner, a GP in a small town, writes a personal view in the BMJ March 5th

    ‘I am besieged by rules in the form of guidance from NICE, professional bodies, specialist colleagues, pharmacy advisers and many others’

    ‘I no longer feel as though I have the autonomy to offer guidance suited to individual requests’

    ‘Recently the system requires me to recommend care which I think is wrong’

    ‘Informing patients that a guideline or requirement is wrong would be professionally dangerous’

    ‘When I strive to follow system requirements, patients become unhappy and I am blamed for not delivering personalised care’

    ‘Other professionals can substitute for me only if they follow tight protocols, further reducing the patient’s autonomy'

    David Enoch retired from clinical practice only very recently. I doubt he ever let rules prevent him from providing what he considered to be the most appropriate care for an individual. Neither should we or anyone else. The danger of the plethora of guidelines and their adverse effects singly or in combination should be recognised and the virtues and value of independent clinical practice recognised and celebrated.

    This coming week will see the first ‘Conversation’ under the auspices of Dementia Pathfinders at Bowdon Vale for Rev Ros Watson and me. First steps into another world. Wish us well.

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