By Gary Screaton Page
The headline reads, “Big plans for mental health care.” That news would be good news if it wasn’t so bad.
Niagara Health System hires renown pyschiatrist Dr. Edgardo Perez
For more than fifty years what were once “normal” human issues–childbirth, excessive drinking, obesity, difficult children, criminal behaviour, among others–have become medical conditions. Men and women who drink excessively are “ill”. Fat people are “obese” and have “hormone imbalances.” Criminals who molest children, serially murder, and the like are “misunderstood,” “victims of abuse,” “mentally ill”, or with some exceptions—some but not all—anything but responsible for their behaviour. Medicine is redefining the problems of society. Thus the “bad news” I mentioned earlier.
Seems the Niagara Health System in its wisdom has finally found the psychiatrist—a medical person who takes a medical approach to mental health problems—it was looking for: Dr. Edgardo Perez. That the NHS found such a competent psychiatrist with the wealth of training and experience Dr. Perez has, both in private and public sectors, is good news. That the good doctor wants to “be in the community, reaching out to those people (with mental health problems) so we can help them,” is also good news.
So, what’s the downside? Not surprisingly, being a psychiatrist and a physician—i.e., a medical doctor—Dr. Perez, if The Tribune (July 19, 2012) is correct “wants to recruit more psychiatrists, build teams of psychiatrists, doctors, nurses, and effectively create a mental health system that while it takes advantage of the hospital . . . reaches out to those in need.”
What’s wrong with that approach? It ignores the fact that most mental health issues are arguably not “medical problems” at all. Yet, for many of the above practitioners (psychiatrists, doctors, nurses) if not all of them, mental health issues are just that, medical problems to be solved with a medical approach: mechanistic, passive, biological, external to patient, interventionist (pharmaceuticals, surgery, electroconvulsive therapy, among other medical approaches), to cure disease, solution-focused (assuming the doctor knows best) and crisis-oriented.
Most mental health issues I suggest, again arguably—although the research is overwhelmingly supportive of the proposition—require a mix of mechanistic and subjective approaches (oh, how the scientists hate that word “subjective”), active, cognitive, emotional, behavioural, social, process-oriented, internal to patient who actively participates in the process, heal disease if actually present (there will be clearly measureable signs if it is), and promote the growth and learning of the client (I won’t use “patient” as that, too, presupposes a medical problem.)
Consider as just one simple example the treatment of depression by the medical community. While, for the purposes of space and the fomenting of discussion, I have simplified the case to some degree, is increasingly driven by the writing of prescriptions for anti-depressants. These meds are among the most prescribed in the medical community. Yet major studies clearly show that as much as 75% of them should not be given and that depression is more often than not (and there are definite medial exceptions the presence of which I suggest can be shown clearly with real data from real diagnostic tests, and not just the e.g. neuroimaging and the DSM-IV, V, or whatever number comes up next!) treated with medications when talk therapies are at least as effective and do not have the medical side effects that come with some of the most promoted medications on television: liver disease, high blood pressure, suicidal thoughts, even death!
I would consider Dr. Perez’s “Big plans” more favourably if he had included a goodly number of psychologists, psychotherapists, social workers, psychometricians, naturopaths, and other mental health practitioners not so prone to jump to the conclusion that meds are the best way to help someone with mental illness.
Perhaps then we would see tons—yes, tons—fewer Ritalin® or like medications given to children who may well have manageable behaviour problems if only you could get their parents to parent better. Yes, there are exceptions but in 43 years of teaching the majority of “problem children” I saw proved to be not only not so problematic, but quite responsible people when their parents were taught how to cope more effectively and without meds!
Dr. Perez, has his professional acumen and his heart in the right place. Surely, though, there is ample room for some alternative approaches to the mental health issues facing our community than simply a medical approach. Surely, there is ample room for some non-medically-oriented practitioners on board. But, then, perhaps I misunderstood what the article said about the good doctor’s intentions.
Dr. Gary Screaton Page is the author of ‘Being the Parent YOU Want to Be: 12 Communication Skills for Effective Parenting’. He is a Chaplain with the Niagara Regional Police Service and registered general practice pyschotherapist who he has provided counselling and other assistance to many newcomers to this region of Canada. Gassilde’s story is adapted from the book Gassilde written by her son, Jean d’Or Nkezabhizi. Contact Gary at drgary@cogeco.ca.
(Niagara At Large invites you to share your views below, remembering that NAL only posts comments by individuals who are also willing to share their first and last names.)
Niagara At Large 
Worrisome too is the Diagnostic Statistical Manual (DSM) used by thousands of prescribing professionals. Apparently, unless you get a diagnosis, you can’t be insured, and in the past all sorts of ‘diseases’ were named, such as homosexuality, hysteria, etc… Even as we become more sophisticated as a people, we abandon these old prejudices, but add more — think of the many ‘diagnoses’ of syndromes…. shyness was once categorized as something to be avoided, and now is name some new-aging syndrome.
Overmedicated we are, for certain.
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Let’s hope that this new Niagara ‘shrink,’ like Dr Gary Page said, is less concerned about what his team members call themselves than what each can do in helping a full range of mentally ill and hurting people.
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Let’s hope that this new Niagara ‘shrink,’ like my friend Dr Gary Page, is less concerned about what his team members call themselves than what each can do in helping a full range of mentally ill and hurting people.
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Bill, you are so right. Who does the helping (medical or non-medical) ultimately is not as important as being sure those in need get the right help. I have seen laypeople work amazingly well with depressed and otherwise stressed persons and certainly acknowledge the need for medication at times. To take a medical approach to the exclusion of others is a mistake that will surely hurt some people. Our understanding of mental health is still evolving. Otherwise why so many versions of the DSM? Medicine has its problems and limitations as have other approaches. A multi-disciplined team may go a long way toward minimizing errors and increasing effectiveness. Many eyes — read “many disciplines” — see more clearly, more often than not, than too few.
Dr. Hogg, as he said, is my friend. He was a practicing psychiatrist and surgeon. He was an excellent teacher of medicine and author of papers on mental health issues. He understands well that many disciplines can play a role in helping hurting people.
Too often we get more concerned about what people are called than about what they can do and what they know. Of course people need to be trained, but many lay people have gifts that can make a difference in the mental health field, too. Not just those of us who have “credentials” of one kind or another.
The key is to help the many people with mental health issues who are not getting help now. Restricting the helpers to only medical personnel is short-sighted.
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I meant, of course, ‘new-agey’, not aging, as I am. Gail
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All I see in the way of mental health services is the over-drugging of people using some medications with questionable effects. While I am not anti-medication and feel there is a role for medication for some people in some cases, I do feel there is a role for more holistic practices in both treatment settings, as well as so called social policy. This means that psychotherapy, trauma counseling, employment supports, anti-poverty programs, and so forth are just as important in many, if not all, cases. On a broader social scale, anti stigma campaigns and changes to legislation and media practices, can also make a big difference in aiding people to seek help in the first place. Stigma I feel is still as much of a barrier as it always was.
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