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Response to: Are specialised affective disorder services useful?
- Muhanad Sawa, Fiona Craig, Consultant General Adult Psychiatriss, Mersy Care NHS Trust (10 June 2009)
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Muhanad Sawa, Specialty Registrar 5 in General Adult Psychiatry Member of the Royal College of Psychiatrists, Fiona Craig, Consultant General Adult Psychiatriss, Mersy Care NHS Trust
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m.sawa2{at}nhs.net Muhanad Sawa, et al.
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Corresponding author: Muhanad M Sawa MRCPsych, Specialty Registrar 5 in General Adult Psychiatry Mersey Care NHS Trust, Windsor House, 40 Upper Parliament Street, Liverpool, L8 7LF Tel: 01512505324, Fax: 0150 709 7608 Fiona Craig MRCPsych, Consultant General Adult Psychiatrist, Mersey Care NHS Trust, Windsor House, 40 Upper Parliament Street, Liverpool, L8 7LF Dear Editor, We would like to thank the authors of the Editorial article published in the Psychiatric Bulletin last February (Debra et al, 2009), which provided a welcome insight into specialist mood disorder services, with the possibility of bringing hope to those with chronic depression. We would like to make a specific reference to the mention of hope and how it is related to the prognosis of depression. Turner et al (2001) suggested that staff should be holders of hope and the significance of hope inspiring relationships between staff and workers was stressed in Pepper et al (2003). Hope is also gaining importance especially within the context of recovery. Schrank et al (2008) conducted a comprehensive review looking at different definitions of hope and current assessment tools. This increase in attention to the concept of hope serves to take us beyond comments that it is simply a common sense notion. The impression that was developed while reading the article is that the interventions of importance are mainly medical or even surgical. Apart from “instilling hope” due to the mere presence of such specialist services, there was little reference by the authors to the psychological or social interventions provided by these centres. For those less inspired by the medical model in terms of understanding their depression, this approach might run the risk of disillusionment as a result of misplaced hope. Depression’s aetiology is multi-factorial with psychological traumas in early childhood playing an important role in developing depression in later life. Psychological interventions for severe cases of depression are well established therapeutic options. National Institute for Health and Clinical Excellence (NICE) guidance on treatment of depression recommends CBT based therapies, Interpersonal Therapy, Couple-focused therapy and Psychodynamic psychotherapy. These options should be considered and provided if patient’s choice favours this (NICE, 2007). Some of our patients are not medically minded and would rather choose a psychotherapeutic intervention, or require social interventions or change to bring about any lasting improvement. Specialist services no doubt can and do bring hope and recovery to many; but significant investment in the medical models described might risk disempowerment and ultimate loss of hope. Declaration of interest: nil References Great Britain. National Institute for Health and Clinical Excellence (2007) Management of Depression in Primary and Secondary Care. London: National Institute for Health and Clinical Excellence. Repper, J. and Perkins, R. (2003) Social Inclusion and Recovery: A Model for Mental Health Practice. London: Bailliere Tindall. Shepherd, D. J., Insole, L. M., Mc-Allister-Williams, R. H. and Ferrier, I. N. (2009) Are specialised affective disorder services useful? Psychiatric Bulletin, 33, 41-43. Shrank, B., Stanghellini, G. and Slade, M. (2008) Hope in psychiatry: a review of the literature. Acta Psychiatrica Scandinavica, 118(6), 421 – 433. Turner, D. & Frak, D. (2001) Wild Geese: Recovery in National Schizophrenia Fellowship. Wales: Green Gauge Consultancy and N.S.F Wales, Powys. |
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