Mental health needs to catch up
Mental health professionals should take a lesson from other medical disciplines, according to a visiting expert.
Vaughan Carr is professor in the School of Psychiatry at the University of New South Wales and heads the Schizophrenia Research Institute.
He said clinical practice and research go hand in hand in advancing the treatment of physical illness, resulting in steady improvements in treatments and results.
He cites breast cancer treatment as a example mental health practice could follow.
Illness is being detected and treated earlier and clinical trials compare the current gold standard of treatment with alternative treatments, he said.
‘‘ We have seen incremental improvement in breast cancer morbidity and mortality,’’ he said.
‘‘I think improvement in the quality of mental health services would be given an enormous boost if there were infrastructure established for the effectiveness of good clinical research.
‘‘ We need to integrate our research effort with the clinical services so that the two support each other, so the research effort improves the clinical work.
‘‘They should be in the same place, and certainly talking and working collaboratively together.
Mr Carr said the Schizophrenia Research Institute has carried out a large scale epidemiological survey of psychosis in Australia and found some disappointing results. Although patients are more satis- fied with their treatment overall outcomes remain about the same as they were 12 years ago.
Rates of drug and alcohol abuse among patients have risen and they are less physically healthy.
Fifty per cent are obese, 50 per cent exhibit metabolic symptoms, such as large waist, high blood pressure, high serum lipids or high blood glucose and 25 per cent are at risk of a serious cardiovascular event in the next five years.
The survey found increasing numbers of people with psychoses were accessing services.
‘‘What we don’t know is the extent to which those interventions are soundly-based,’’ Mr Carr said.
‘‘We know, for instance, that cognitive behavioural therapy is very effective but we don’t know the extent to which the so-called counselling work being provided is delivering those treatments we know are effective.
‘‘ That’s the challenge – that what is being delivered has good [evidence-based] support.
‘‘To be frank, I would expect that there are low levels.’’
Governance structures should insist that services delivered have built- in measurement of outcomes, he said.
Schizophrenia typically appears in adolescence or young adulthood, so parents should pay attention if their teenager becomes more socially withdrawn, depressed, unpredictable or impulsive.
‘‘These are all non-specific,’’ he said.
‘‘We can’t accurately predict on the basis of anything who is going to develop schizophrenia.’’
Three- quarters of mental diseases have their onset before age 25.
‘‘You have a signal that a young person emits that they are in some kind of trouble and deserves to be taken seriously, and deserves to be evaluated, and to receive treatment based on the evaluation.’’
Mr Carr visited Wellington as this year’s Chad Buckle Fellow.
He gave a public lecture and also conducted lectures and workshops for mental health professionals.
The fellowship was established after Chad Buckle killed himself in 2003 while a compulsory patient of the acute mental health unit in Wellington and each year brings an international expert in mental illness to Wellington.