BMJ Press Releases, Saturday 20 July 1996
Volume 313 No 7050
EMBARGOED 00.01 HRS 19 JULY 1996
POLARISED PSYCHIATRIC SERVICES ARE FAILING THE MENTALLY ILL
[The rise of counselling and the return of alienism]People with disabling mental illness are increasingly being abandoned by psychiatry and referred to unproven counselling services, according to a report in this week's BMJ
In recent years there has been a strong drive from both government and leaders in mental health to concentrate resources on the most severely mentally ill. But it seems that only those with psychotic illnesses such as schizophrenia and manic depression are counted as priority patients. As a result many people with other long term and disabling mental disorders such as agoraphobia, post traumatic stress disorder or depression, are not getting the services they need. Instead many are turning to counsellors.
Whilst some psychotherapies are of proven effectiveness, non-directive counselling is not one of them. Non-directive counselling is also unlikely to be as effective as the better defined pyschotherapies such as behaviour therapy or cognitive therapy, for the treatment of phobias, panic attacks, or obsessive-compulsive disorders and phobias, the author argues.
Unless non-directive counselling can be shown to be effective, proven psychiatric treatments should not be withdrawn from these patients. Currently, some GPs refer their patients to counsellors inappropriately because the lack of local psychiatric services leaves them with no other choice.
The author warns of a return to the world of Victorian psychiatry where only the psychotic get treatment and the stigma of "insanity" deters people from seeking psychiatric help.
Contact:
Simon Wessely
Reader
Dept of Psychological Medicine
King's College School of Medicine & Institute of Psychiatry
London SE5 8AF
Tel: 0171 740 5078
Fax: 0171 740 5129
ETHNIC MINORITY CHILDREN MISSING ASTHMA TREATMENT
[Influence of ethnic group on asthma treatment in children in 1990-91: national cross sectional study]The risk of underdiagnosis and undertreatment of asthma is higher in children from ethnic minorities. Children from inner city areas, particularly those from ethnic minorities, are less likely to be correctly diagnosed as asthmatic than other children, according to a study in the BMJ
And even if children living in inner city areas are correctly labelled as asthmatic, they are nearly twice as likely not to be prescribed any drug for asthma compared to children in the general population. Approximately 17,500 children in England and Scotland participated in the first national study to report inequalities in the management of asthma among ethnic groups in the UK.
The authors from the department of public health medicine at St Thomas' Hospital say the inappropriate management of asthma may increase the child's risk of school absenteeism, the number of emergency visits and hospital admissions.
Contact:
Enric Duran-Tauleria
lecturer
Dept of public health medicine
St Thomas' Hospital London SE1 7EH
Tel: 0171 928 9292 extn 1497
Fax: 0171 922 8254
MEMORY DAMAGE IN HEART ATTACK SURVIVORS
[Chronic memory impairment after cardiac arrest outside hospital]Cardiac arrest can cause marked loss of memory and the longer the attack lasts the worse the damage appears to be, according to a paper in this week's BMJ.
A study of survivors of cardiac arrests experienced outside hospital compared their memory impairment with a control group of patients who had suffered only myocardial infarction. Nearly 40 per cent of the survivors of arrest had important chronic deficits in long term memory whereas none of the controls had severe deficits.
The authors suggest that more rapid response from emergency services could improve the outcome for those suffering arrests outside hospital, as the deficits were directly-related to duration of attack before defibrillation. Also with increasing numbers of people surviving heart attacks outside hospital, they recommend the setting up of targeted rehabilitation programmes to help survivors make the best use of their remaining memory.
Contact: Dr N R Grubb
Dept of Cardiology
Royal Infirmary of Edinburgh
Edinburgh EH3 9YW
Tel: 0131 536 1000
Fax: 0131 536 2021
HIGH COST OF CARE AT HOME FOR A TERMINALLY ILL CHILD IS WORTH THE EXPENSE
[Home ventilation of a child with motor and sensory neuropathy]The case of a young terminally ill child who was cared for at home by means of a ventilator and a team of specially-recruited community nurses despite the high costs involved is reported in this week's BMJ
The child was diagnosed as having a severe and progressively debilitating neurological disease and was being cared for in an adult intensive care unit. It was not thought that this was a suitable long-term option. At a meeting of all those involved in the child's care including parents, nurses, physicians and the business manager of the acute unit (not a trust at the time), it was decided that the child would not benefit from further treatment. She would have a far better quality of life if allowed to spend her last months enjoying as normal a family life as possible, even though she might not live as long. She died 16 months after going home.
The cost of her treatment was approximately �160,000 compared to the projected costs of �75,000 for Child B's transplant.
All commentators on the case - whether directly involved or not - praised the decision as being by far the most humane in the circumstances. It is not clear whether treatment at home would have been substantially more expensive. One comments: "Public health physicians daily face dilemmas in essence no less difficult than those described in this case - with the key difference that they must choose between groups of individuals, rather than individuals themselves."
Contact:
Dr Robin Davies
consultant paediatrician
Gwynedd Community Health Trust,
Women & Children's Business Unit Headquarters
Caernarfon
Wales LL55 1BH
Tel: 01286 675863
Fax: 01286 678552
PLEASE STATE THE BMJ AS THE SOURCE OF ALL ARTICLES USED
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