Norway’s health service is piloting treatments for psychosis that don’t involve medication.
New non-drug treatment facilities have developed amidst a growing movement in Norway to change its mental health system, following criticisms from the UN Committee Against Torture.
Norway is now the first country in the world to embed drug-free psychiatric facilities as an option in its state-run mental healthcare system.
Reading the interviews with Norwegian service users featured in a recent news article on these facilities, it would be easy to conclude that anti-psychotic drugs are inherently problematic, as though these drugs are a black-and-white alternative to genuinely caring treatment.
For me, the key statement in the piece is the quote from Malin, aged 21, who had several stays in psychiatric wards where “powerful anti-psychotic medication was the only treatment on offer”.
Any person who is seriously ill, whether with acute psychosis or acute cardiac failure, needs more than just medication.
People in the acute phase of psychosis are often having terrifying experiences that make it challenging for them to discern what is real.
People in acute heart failure are often terrified by sensations of being unable to breath or even of drowning. These are not experiences that will go away simply by talking them through with a sympathetic person.
Someone going through this kind of hell needs respect and compassion more than ever, but respect and compassion are not the treatments.
The dignity afforded to a sick person by being treated with respect and compassion is a basic human right that should underpin any treatment plan, whatever the illness. We would never imagine that respect and compassion alone could cure heart disease.
‘Any person who is seriously ill, whether with acute psychosis or acute cardiac failure, needs more than just medication.’Professor Helen Minnis
Non-drug treatments certainly have their place in the treatment of psychosis. For example, cognitive behavioural therapy (CBT) has been shown to be effective in reducing psychotic symptoms.
CBT for psychosis needs to be offered by well-trained, skilled practitioners and it might not always be possible for people who are very unwell with psychosis to engage in psychotherapy.
Just as for medication, non-drug treatments must be offered with respect and compassion. Once again, respect and compassion are not the treatments – it is the CBT that is the treatment.
‘The medication is not the problem. If any treatment – drug or non-drug – is offered without respect and compassion, then that is the problem.’Professor Helen Minnis
For centuries, people suffering from psychosis were locked away in asylums receiving drug-free treatments.
If memoires from that period (e.g. Silvia Plath, Frances Farmer) offer any insight, then those drug-free treatments were sometimes offered with a startling lack of respect for the dignity and unique qualities of the individual.
Anti-psychotic medication has allowed many people suffering from psychosis to have their lives back. It is usually a key element of treatment, especially in the acute phase.
Let’s not throw the baby out with the bathwater. Just as insulin has revolutionised the lives of people with diabetes, anti-psychotic medication can be a crucial part of the treatment of psychosis.
The medication is not the problem. If any treatment – drug or non-drug – is offered without respect and compassion, then that is the problem.
Professor Helen Minnis
Helen Minnis is professor of child and adolescent psychiatry at the University of Glasgow.
She has had a longstanding clinical and research focus on the psychiatric problems of abused and neglected children.
Currently her focus is on intervention research, including a randomised controlled trial of an infant mental health service for young children in foster care and a randomised controlled trial of dyadic developmental psychotherapy for primary school-aged children in adoptive or foster placements.
She is also conducting behavioural genetic research focused on the role of abuse and neglect and its overlap with neurodevelopment across the life-course.
She has collaborations with colleagues at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, the universities of Aalborg and Aarhus, Denmark, and with the Gillberg Neuropsychiatry Centre, Gothenburg, Sweden.
Follow Professor Minnis on Twitter.
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