People experiencing emotional distress and unusual psychological experiences, need protecting from the pathology-driven medical diagnostic approach, which has resulted in much untoward death and significant harm over the past half century.
Within this blog, I will outline a new campaign to achieve long-term improvement within mental health services, which challenges employers of those who practise this outmoded model.
During my 45-year career to date, I have worked within mental health and psychological services as both a practitioner and a manager. Throughout this time, I have been an avid supporter of MIND, having served on both local and regional committees.
Biomedical psychiatric practice, with its main vehicle of psychotropic drugs prescribing, causes harm: many lives lost and debilitating side effects from the consumption of these drugs. This is not about the profession of psychiatry as such – the same assumptions and practices are shared by most mental health professionals to some extent, and many psychiatrists themselves are concerned about these problems. It is about a whole paradigm that urgently needs to change.
This new campaign is set to address this growing problem, which is now of epidemic proportions, by encouraging legal action against mental health partnership NHS trusts protecting biomedical psychiatric practice. One case has been won and we hope other successes will follow. CAPDA (Campaign Against Psychiatric Drug Abuse) www.CAPDA.live is connecting with and supporting a growing body of aggrieved survivors of mental health services and grieving relatives and friends of those who did not survive. We call on others to get in touch via the contact details at the foot of this blog.
Since the late 1970s, I have been a part of; visited; or heard about many novel services for helping people in distress, which have been outside this diagnostically based paradigm; or, have received a light touch from it.
On many occasions, I have felt great optimism that these novel approaches would bring about radical and lasting change across national mental health services; and, that the biomedical model would be in the descendent. However, these services, whether they have been client-centred crisis intervention teams; community mental health teams; or crisis houses, have for the most part, been short-lived.
Many of these services could have been described as centres of excellence or examples of best practice while they existed. One by one, as key personnel retired or moved on, or due to funding being withdrawn, invariably, they reverted to the fold of the medical diagnostic psychiatric approach. Hopes for real and lasting change were dashed and yet another false dawn returned to darkness. (To be fair, some contemporary NHS Trusts are providing some non-medicalised services in the form of crisis helplines, brief dynamic interpersonal therapy and EMDR [Eye movement desensitisation and reprocessing], etc.)
Ironically, many of the champions of the innovative services over the past fifty years were consultant psychiatrists, who saw the limitations and harms caused by their traditional biomedical paradigm.
Despite small changes here and there, whether short-lived or otherwise, the biggest frustration and disappointment of my career, to date, has been the continuing dominance of this paradigm for UK inpatient services within which the terms disorder, disease, syndrome, comorbidity and dual diagnosis are commonly used. The biomedical paradigm was emboldened, following the publication in 2013 of the now widely-discredited DSM-V (Diagnostic and Statistical Manual – 5th edition) (APA, 2013).
Harms caused by prescribing – and what is to be done?
Early in 2020, I thought long and hard about what should be done. I was appalled to learn of 500,000 psychotropic drug-resulting deaths across North America and Europe among the over 65s, as estimated by the Danish researcher Peter Gøtzsche. (Gøtzsche 2015). It did not take long for me to match that figure for the under 65s, within this same geographic area, totalling one million deaths, annually. A long-time colleague has suggested this is an underestimation.
Many are acknowledging that psychiatric drugs do more harm than good (Timimi, 2020) so why does prescribing seem to continue unchallenged? Something needed to happen to tackle this epidemic.
In July 2020, I produced a document proposing a class action lawsuit against employers, protecting biomedical psychiatrists who have a record of untoward death or serious harms, caused by chaotic or excessive prescribing of psychotropic medication (Henden, 2020a). In common with other class actions (nb asbestosis, the Hillsborough disaster and Post Office proprietors), I was prepared for a 5-7-year legal battle.
I was delighted when my proposed class action lawsuit received wide support from sympathetic mental health colleagues (both nationally and internationally); and, from survivor and user groups. What resulted from the subsequent publicity, was a good number of concerned people, nationwide, coming forward, who had lost close relatives or friends to biomedical psychiatric practice. Many others offered their personal stories of psychotropic drug-induced harms, several harms spanning decades.
I am not against all psychiatric drug use. In fact, during the 1980s, as a community mental health worker, there were several occasions when I recommended to both GP and psychiatrist colleagues that a small dose of one or other form of psychiatric drug might benefit a crisis referral. My rule of thumb was always the same: “the lowest possible dose, for the shortest time necessary.”
Psychiatric drugs are not treatment; this is simply ‘symptom-masking’ and should be seen as such. Real healing comes in the form of psychological therapy or specific techniques. Increasingly, “the fault in your brain” hoax is being exposed (Moncrieff, 2016). It is unhelpful for medical practitioners, aided and abetted by pharmaceutical companies, to continue perpetrating this falsehood both to prescribers and among people presenting with mental distress. In my psychotherapy practice, still, I have clients who parrot this hoax, after informing me about the particular psychotropic drug they are taking. Given that the international ‘antidepressant’ industry, alone, is worth in excess of $13.69bn annually (MedGadget, 2019), there is a good financial motivation to perpetuate this hoax.
Support for individual litigants
It is interesting that the earlier class action lawsuit proposal has now morphed into supporting individual litigants against mental health partnership NHS Trusts, which are protecting biomedical psychiatric staff who are or who have harmed people in emotional distress. Drilling down to examine what is really going on here, it would seem partnership NHS Trusts are supporting some clinicians whose practice is in contravention of their Hippocratic oath, “First do no harm”. There is a related ethical issue here, too. Given that there are efficacious non-medication approaches (eg trauma-informed care and/or therapy) for helping people recover from emotional stress or unusual experiences, is it acceptable for NHS Trusts to continue to condone harmful so-called treatments?
Lucy Johnstone and colleagues, in their Power Threat Meaning Framework (PTMF) (Johnstone & Boyle, 2018), proposed a constructive and helpful alternative to the medical model’s diagnostic (and medication) approach, the latter which is neither scientific nor meaningful. If this approach has been demonstrated to be harmful to people in distress, and NHS Trusts continue to support it, could this be good grounds, too, for litigation?
A victory to encourage others!
Already, one case has been won under Section 2 of the Human Rights Act 1998 and is awaiting final settlement. There are many other strong cases which could be going to law over ensuing months. As cases gain media publicity, I am very optimistic ‘the Savile effect’ will see more and more coming forward. Also, as law firms gain experience in winning cases, they will be more willing to take on other similar cases.
The new campaign
Campaign Against Psychiatric Drugs Abuse (CAPDA) was launched officially on 13th January 2021.It will support individuals with their complaints and legal actions against NHS trusts and other providers of mental health services, that are falling short of their duty of care with people they serve; and, that are failing to protect them from the harmful actions of employees using the biomedical psychiatric paradigm. CAPDA does not seek to target individual practitioners nor the pharmaceutical companies, whose products they prescribe.
Quality Improvement for mental health services
This new approach to tackling harmful interventions within mental health services is more than simply highlighting and litigating against what is and has been causing death and serious harm; it is about Quality Improvement, a recent focus of NHS services (NHS, 2014).
The CQC (Care Quality Commission) has a strong interest in this area, too. Under Regulation 12 (Safe Care and Treatment), I quote: “The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm… CQC can prosecute for a breach of this regulation or a breach of part of the regulation, if a failure to meet the regulation results in avoidable harm to a person using the service or if a person using the service is exposed to significant risk of harm.” (CQC, 2020)
In almost all cases that have come to my and colleagues’ attention within the past year, mental health partnership NHS Trusts would appear to be in breach of this regulation. In addition to private prosecutions we are supporting, there could follow CQC prosecutions, too. A recent CQC report on mental health services found that mental health services are still struggling to provide people with the help they need (CQC, 2018)
My best hopes resulting from the outcome of many and varied legal cases, is that the accumulated pay-outs for damages will cause employers to abandon their protection of poor practice; take a closer look at the prescribing patterns of their practitioners; and begin discussing policy change and giving priority to reshaping their mental health service provision.
With further publicity raising the profile of what is happening, it is my greater hope this will encourage national government to take action, too, regarding safe and effective interventions.
Psychiatric drugs’ annual bill and reallocation
How much is spent by NHS Trusts, annually, on psychotropic drugs? Currently, through an FOI (Freedom of Information) request, I sought the annual psychiatric drugs bill for the UK, finding it to be well in excess of £1/2bn. This equates to over ten million counselling hours.
I am a believer in the NHS: its medical services, core values and beliefs. It was my employer for twenty-two years and I had the privilege of working within teams helping hundreds of people regain their mental health. To wish to cause it more than £10m in legal pay-outs, may seem a heartless act. However, this sum could be regarded as money well spent, if it results in countless lives saved in the future and others’ quality of life improved by reduced drug-induced harms (a simple search in Google Scholar will reveal, for more than 15 years the academic literature demonstrating these harms, has been growing); and by mental health services policy change.
Wouldn’t it be wonderful, and of great benefit to people in emotional distress or experiencing unusual phenomena, if the lion’s share of this annual drug spend could be directed towards training and employing staff in efficacious trauma-specific interventions? (Research shows that the majority of people contacting services have some sort of trauma background; Butler, et al, 2011). Also, for these services to be made widely available within a primary health care setting, such that instead of GPs reaching for the prescription pad, they make a referral to one of two or three counsellors for individual or couples’ therapy, working within the practice.
The current IAPT (Improved Access to Psychological Therapies) service has been applauded in many quarters. Others have criticised its limited effectiveness; its questionable measures of successful outcomes; its largely CBT approach; and the fact that suicide risk, commonly, is one of its exclusion criteria.
Strenuous efforts must be made to ensure that any savings on psychotropic drugs budgets are not made a grab for by HM Treasury, as happened with the sell-off of the old mental hospitals in the 1990s.
What about ‘Maintained on medication’ in the community?
A first step might be to examine more closely what is meant by this. In many cases, it simply means, following an outpatient appointment or in-patient stay, during which time they are offered inadequate or no psychological therapy, diagnosed with a DSM-V label and then given psychiatric drugs. They are then sent home with more drugs to take for an indefinite period. It is highly questionable whether people experiencing unusual psychological phenomena ought to be prescribed long term psychotropic drugs. Seikkula et al’s ‘Open-Dialogue’ approach provides a powerful alternative (Seikkula et al, 2006). Psychotropic drug manufacturers give minimal advice on withdrawal, so GPs and psychiatrists have to make it up as they go along, acting like amateur chemists. Invariably as people withdraw too quickly, they end up reverting to the original dose, often at the suggestion of their clinician.
In many cases prescribers interpret their clients’ unpleasant withdrawal experiences, as a “return of their illness”, so advise reversion to the original dose. Prescribers tend, generally, to discourage discontinuation. Borrowing a medical hat for a moment, I have diagnosed this as “the AFAQL (Anything for a quiet life) syndrome” in both GPs and psychiatrists. The language used to persuade those in receipt of the drugs to continue is: “I don’t think you are ready yet.”; “Remember the last time you tried to come off?”; and, “Let’s give it a few more months and have another chat then.”
Psychiatric drugs should very rarely be stopped abruptly. They should be tailed off over an extended period, with the assistance of an experienced person and with appropriate psychological support running alongside.
The campaign’s broadening base
I am heartened by the growing support from a wide range of individuals and groups for the campaign. Within CAPDA, we welcome stories from all who have experienced harms and/or have known people who have died while on the receiving end of biomedical model psychiatry. Strong cases can be referred to law firms we are in touch with, to be taken forward on a no win-no fee basis.
Already, a picture is emerging of a growing catalogue of untoward death and drug-induced harms which have lasted for several decades, in some cases.
For your stories, please email CAPDA personnel as follows:
Lucinda Lidstone: [email protected]; or,
John Henden: [email protected]
(Please specify if you would prefer complete confidentiality to be maintained; or, if there are some aspects of your story, we could refer to anonymously for the campaign.)
It is very helpful for us to build a bigger picture of the scale of the problem; give another voice to the voiceless; and, to support and encourage, as and when appropriate.
Reasons to be optimistic
Biomedical psychiatric practice supported by NHS trusts, has been under closer scrutiny for over a decade now. Despite the model’s non-engagement and perceived deafness to its critics and its lack of response to research papers exposing the lack of an evidence base, the level of disquiet has been growing with each untoward death and severely harmed life. The lived experience and service user lobbies have been finding a stronger voice and been growing in confidence. Along with the increasing concern expressed by mental health service reformers, we could soon be reaching tipping point.
I can foresee a time when a few high-profile prosecutions of NHS trusts, that protect and defend this harmful approach to emotional distress, will not only stretch the patience of mental health service providers’ finance directors but will also both inform and swing public opinion away from the current harmful approach and towards more helpful, constructive and life-enhancing interventions (treatments) for those in distress. We all know of someone who has been affected.
— John Henden, 14th January, 2021.
Butler, L. D., Critelli, F. M., & Rinfrette, E. S. (2011). Trauma-informed care and mental health. Directions in Psychiatry, 31, 197-210.
CQC (2018) The State of Care in Mental Health Services 2014-17. Findings from CQC’s programme of comprehensive inspection of specialist mental health services. CQC 2018. https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-12-safe-care-treatment
APA (2013) American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Gøtzsche, P. (2015) Deadly Psychiatry and Organised Denial. People’s Press
Griffin, J. & Terrell, I. (2004) Human Givens: a new approach to emotional health and clear thinking. HG Publishing
Henden, J. (2020a) UK nationwide appeal for a class action lawsuit against partnership NHS Trusts employing medical model psychiatrists. 5th Draft. Unpub.
Johnstone, L. & Boyle. M. with Cromby, J., Dillon, J., Harper, D. et al. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society. Available from: www.bps.or.uk/PTM-Main
MedGadget (2019) Antidepressant Drugs Market Size, Share, Current trends, opportunities, Competitive Analysis and Forecast to 2019 – 2025 https://www.medgadget.com/2019/08/antidepressant-drugs-market-size-share-current-trends-opportunities-competitive-analysis-and-forecast-to-2019-2025.html
Molodinski, A., Pontis, S., McAllister, E. M., Wheeler, H., and Cooper, K. (2020) Supporting People in Mental Health Crisis in 21st Century Britain. BJ Psych Bulletin. 44.231-232
Moncrieff, J. (2016) The Myth of the Chemical Cure: a critique of psychiatric drug treatment. N.Y. Springer
NHS (2014) First steps towards quality improvement: A simple guide to improving services https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2011/06/service_improvement_guide_2014.pdf
Seikkula. J., Aaltonen,J., Alakare, B., Haarakangas, K., Keränen, J. Lehtinen, K. (2006) Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research Volume 16, 2006 – Issue 2
Timimi, S. (2020) Personal communication
Thanks, Enric. We have been delighted by the response from so many senior campaigners in the field. Also, we have been contacted by many survivors of the psychiatric system, who have either suffered themselves or lost loved ones to it. As of 8 days ago, our new website went live: http://www.CAPDA.live I recommend you take a look at the ‘Your Stories’ section. Best, John Henden, co-founder of CAPDA
Excellent initiative, John!