The future (and shocking past) of mental health treatment

In a few decades, society will look back at the current mental health crisis and analyse why so many people suffered from mental illness in the latter part of the 20th (and early part of the 21st) century…

Why, they’ll ask, could we not fix the world’s leading cause of disability (depression, impacting about 300-million people) yet we could solve incredibly complex physical issues – even editing our own genome – seemingly at will?

Some of the reasons behind the failure to address worldwide mental health issues are complex and multifaceted but there will be one glaring failure that explains many cases of depression – the failure to offer effective treatment.

This failure to propagate health care solutions for mental illness that really work in the long-term has plunged countless millions into a cycle that’s become all too familiar to those working in mental health care.

Millions are stuck in a destructive cycle of long-term mental illness

So, how have we ended up with a situation where many people are being offered treatments that have a poor track record in helping long-term? Any why do people blindly accept these treatments again and again?

First, the spread of antidepressant medication – particularly SSRIs, now the most widely prescribed antidepressant  – since the 80s has a lot to answer for.

Blindly accepting what the medical profession tell us about treating depression isn’t helpful sometimes…

Time and time again, studies show little benefit from taking SSRIs (Selective Serotonin Reuptake Inhibitors) such as Citalopram and Fluoxetine for most people suffering from mild to moderate depression and anxiety. They just don’t work most of the time – the evidence is clear.

However, for most busy doctors, they have become the first line of defence when someone seeks treatment for depression and anxiety.

The reasons for this are debatable but probably derive from now-discredited studies in the early 90s which purported to show miraculous results after taking SSRIs, based on the idea that a chemical imbalance in our brains cause issues such as depression.

If this medication is so ineffective, why do people keep on taking it and accepting the advice of a medical profession that has failed them time and time again?

The answer is simple: we want to trust people in authoritative positions. We want the doctor to be right when he says this tablet will help cure our depression – we want the quick fix. We want to trust that they know what they’re doing when it comes to mental health because society has conditioned us to believe the person in the white coat has the answers. But many don’t.

Like the patients, they too have been misled, but by rogue studies and promises by big drug companies. The latest consensus is that SSRI medication is not an effective way to help someone with mild to moderate mental health issues (i.e. a majority of those seeking help) – but the people on the front line of mental health care don’t seem to have read this memo.

Exacerbating the problem is the fact that, to many doctors and people seeking treatment, mental health is a magical, mysterious thing: “We don’t know how this works…but we’re learning…it’s trial and error…if this doesn’t work, we’ll try something else…” are common refrains.

So the window into the magical chemical world of our brain’s provided by the claims of chemical imbalances causing mental health issues is, on initial inspection, hugely significant and helpful when addressing an increasing number of patients seeking help.

Trouble is, it isn’t true in most cases, but you can understand how a busy health professional might be happy to subscribe to this theory given its apparent widespread acceptance.

At the time, it was most people’s best guess as to the cause of most mental illness, and bias towards acceptance of the theory led to studies being published that maybe shouldn’t have seen daylight, and others suppressed for similar reasons. It gained huge traction and has stuck ever since.

If conventional front-line treatments for mental health issues don’t work most of the time, what does?

Key to finding treatment that does work is moving away from the discredited chemical imbalance / medication model and looking at the root cause of issues such as depression and anxiety.     

We know what mental health is made up of several key building blocks – combinations of self-esteem, social anxiety, levels of resilience, coping skills, thinking styles and perspective – and it is these we should be looking at when treating issues such as mild to moderate depression.

Encouragingly, a new generation of treatment programmes have already demonstrated high levels of effectiveness in helping people overcome depression and anxiety-related disorders for good on an emotional/psychological level, rather than a chemical level.

These education-led programmes have shown great promise so far in deconstructing the patterns of negative thinking that are indicative of many mental health problems. 

Many of those who have made dramatic recoveries have been stuck in the treatment cycle shown in the graphic above for years and it’s only when they break out of this holding pattern and learn how their mental health works, that they’re able to live free of mental illness.

In the near future, it will surely become as normal to prescribe treatment on an emotional and psychological level as it is now to try and address issues on a chemical level. 

It might take a few years for the research to drip into the consciousness of mental health professionals, but it will surely happen as we seek ways to address the ongoing crisis.

To learn more about world class, education-led mental health programmes, click here.