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イギリスの精神医療は危機状態:オブザーヴァ紙の意見

2017.07.02
The Observer view on a crisis in mental health
https://www.theguardian.com/commentisfree/2017/jul/01/observer-view-on-mental-health-crisis

Anxiety can be good for you. It is part of the “fight or flight” reflex triggered in the presence of danger. The amygdala, the brain’s alarm system, is responsible for generating negative emotions. To prevent them flooding the brain, this part of the iambic system must be quiet. Working hard on non-emotional mental tasks inhibits the amygdala which is why keeping busy is often said to be one source of happiness. Keeping busy is not what the anxious and depressed can do – and so a cycle of misery is locked into place.

In England, new figures released last week revealed that misery appears to be escalating at an alarming scale. Prescriptions for 64.7 million items of antidepressants – an all-time high – were dispensed in 2016, the most recent annual data from NHS Digital showed. This is a staggering 108.5% increase on the 31 million antidepressants dispensed 10 years earlier.

Is the scale of the rise a welcome sign of progress, more people coming forward for help? Or does it also flag up a rising tide of insecurity and distress, beginning in the very young, that requires a more profound change in society as a whole than individual GPs repeatedly reaching for the prescription pad?

Helen Stokes-Lampard, chair of the Royal College of GPs, said: “The rise could be indicative of better identification and diagnosis of mental health conditions across healthcare and reducing stigma … Nevertheless, no doctor wants their patient to be reliant on medication and where possible we will always explore alternative treatments, such as talking therapies.”

She also pointed out that talking therapies are in desperately short supply. She urged NHS England to meet its commitment to have 3,000 new mental health therapists based in GP surgeries. Kate Lovett, dean of the Royal College of Psychiatrists, said talking therapies have their place but “for people who have recurrent episodes of depression, longer use of antidepressants reduces incidence of relapse”. The theory that more people may be coming forward for help is positive news – but, for many, that is still not early enough. One study followed a large cohort of children through to adulthood and found that half of the adults who had a psychiatric disorder at 26 first had problems before the age of 15. While the young have never been better behaved, drinking and smoking less, their levels of anxiety and depression are rising and the chances of even the most chronic cases receiving adequate help are still shamefully slim.

In My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind, published three years ago, Scott Stossel explains how as a child he had separation anxiety then he developed phobias about flying, fainting, speaking in public, closed places, germs, vomiting and cheese. Antidepressants and therapy have not provided relief. “To grapple with understanding anxiety,” he writes, “is in some sense to grapple with and understand the human condition.”

The human condition today is ever more complex in an era of the internet, social media and the focus on status, appearance and material success. However, more is required as an antidote than early intervention, self-help and medication alone. As Richard Layard rightly argues in Happiness: Lessons from a New Science, a boost to serotonin and dopamine, both associated with mental wellbeing, is also provided by public policy that is judged on how it increases human happiness and reduces misery.

What might that mean in practice? A real living wage, a living rent related to local income levels, an end to the gig economy, affordable housing, investment in training and skills, an end to the freeze in benefits, proper pay for public sector workers and an increase in spending on the NHS. According to the Nuffield Trust last week, the NHS in England is currently receiving an annual increase of less than 1% compared with 4% over its history. Children born today, according to the Office for National Statistics, are likely to spend at least 20% of their lives in poorer health, a disgrace in a rich country such as this.

The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her own community”. It is also a definition of the common good that is the kind of medicine we all need.


Adult Improving Access to Psychological Therapies programme
https://www.england.nhs.uk/mental-health/adults/iapt/

 7年前に発表されたマーモット・レヴュー。全部読むのは骨が折れるが、ソーシャル・モビリティ等の課題に興味がある人には今でも有益だと思う。

Fair society; healthy lives
http://www.parliament.uk/documents/fair-society-healthy-lives-full-report.pdf

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