(Apr. 12, 2016) The first step in helping individuals with mental illness is not to hurt them, says psychiatrist Allen J. Frances.
“Unfortunately, the US approach of exclusion and neglect often makes people get much sicker, rather than helping them get well,” he writes in a recent “Saving Normal” column he authors for Psychology Today. “The specific forms of mistreatment have changed dramatically during the past 50 years, but their cumulative dehumanizing impact has been a constant.”
On Antipsychotics
In “Setting the record straight on antipsychotics,” the professor emeritus and former chair of the department of psychiatry at Duke University School of Medicine discusses the role of medication in improving or worsening psychiatric outcomes. Frances says “dangerous misuses of antipsychotic medication,” including “reckless over-prescription,” can worsen outcomes. But he cites evidence that the majority of people with chronic severe mental illness “will have relapses that are always disruptive and often dangerous” without maintenance medication.
The former chair of the DSM-IV task force faults psychiatry critics who claim, in the face of substantial research to the contrary, that antipsychotics cause or worsen psychotic symptoms and should not be taken long-term as a result. “This generalizing, and the proselytizing that often comes with it, has dangers for others who go on to have a very different lived experience. Influenced by popular books and blogs, people who truly need antipsychotic medications discontinue them-sometimes with disastrous consequences.”
Writes Frances, “even factoring in all the side effects, going off antipsychotic medication is usually a bad bet for the severe and chronically ill. The consequences of relapse can be unpredictable and sometimes horrible…. Patients, families and prescribers need to understand both the real benefits and the very real risks of antipsychotic medications. The mistaken idea that antipsychotics cause psychosis is an unnecessary and dangerous distraction from what is already a tough enough risk/benefit calculation.”*
Frances catalogues the mental health system failures in the United States in a column entitled, “World’s best and worst places to be mentally ill.” The US is arguably “the worst place in the developed world to have a severe mental illness,” he says because of failures including a focus on scientific research to the exclusion of clinical research, underfunding of mental health programs and overarching American attitudes toward mental illness.
* Allen details the evidence for and against antipsychotic therapy for chronic psychotic disorders in a Huffington Post blog, “Do antipsychotics help or harm psychotic symptoms?”
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Frances, Allen J. (16 February 2016). “Setting the record straight on antipsychotics.” Psychology Today.
- Frances, Allen J. (1 February 2016). “Do antipsychotics help or harm psychotic symptoms?” Huffington Post.
- Frances, Allen J. (28 Dec 2015). “World’s best and worst places to be mentally ill.” Psychology Today.
Next week: How many psychiatric beds does America need?
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