Thursday, 15 November 2012

brain surgery for mental illness - psychiatric system failure

The Dundee Advanced Interventions Service (AIS) in Ninewells, Hospital, Scotland, is a "specialist service providing assessment and treatment for severe and chronic treatment-refractory depression (TRD) and obsessive-compulsive disorder (OCD)".  Treatment includes neurosurgery for mental disorder, NMD, or brain surgery.  A small hole is made in the skull using a special drill, a fine probe inserted, an electrical current generates heat which destroys a very small area of brain tissue.

The mental health charity Mind has information on 'Making sense of neurosurgery for mental disorder' and makes this point "However, in cases where a patient has not previously responded to medication or electroconvulsive therapy (ECT), it is possible that all physical treatments, including surgery, are inappropriate." and also "NMD is not a cure, and people who have the surgery are likely to need continued psychiatric support afterwards, even if the surgery is considered to be successful.  The procedure cannot be reversed.". 

Mind states that in 2009/10 only one person in England underwent NMD, authorised by the Care Quality Commission, with no other applications received.  In Scotland the AIS annual report for 2012 (p6/7) states that, for the year ending May 2012, there were 45 referrals (18 men, 27 women), 26 assessments (12 men, 14 women) and 3 Anterior Cingulotomy operations carried out, one of these patients from England.  The previous year 6 patients had received brain surgery.   No details on whether men or women.  In 2011 the population of England was around 53 million compared to Scotland's five millionTen times more people in England and yet less numbers getting NMD.

In the summary and conclusions (p8) of the AIS report is the phrase "we believe that there remain considerable numbers of patients with unmet needs and we are keen to ensure that they have the opportunity to be referred to the service.".  And here is where for me the alarm bells are ringing very loudly.  As if brain surgery for mental illness is a treatment of choice and to be promoted.  Rather than a demonstration of psychiatric system failure.

Note the larger percentage of women being referred for brain surgery, similar to the twice as many women as men receiving shock treatment (ECT).  And, according to the report, Fife where I live referred the most numbers of patients, percentage wise of population compared to other Scottish areas.  Psychiatric drugs didn't suit me, made me more depressed, caused me to have suicidal thoughts.  Would I have been a candidate for brain surgery if I hadn't managed to take charge of my own mental health and recover?  

Living in Fife, being a woman, there is no doubt the odds would have been stacked against me, if it hadn't been for my resilience and non-conformist attitude.  [Or "selfish and unreasonable" as I was described in an Email the other day by a senior Scottish Government person, in response to my challenging the conflicts of interest that arise when governments fund voluntary sector organisations.  For how many arms does a body need to have?]

Here are some suggestions.  Let's concentrate on developing alternative psychological treatments for mental distress and less of a reliance on psychiatric drugs.  Let's aim for treating the whole person and listening to their story, rather than seeing them as split into body, mind and brain.  Let's provide more opportunities for people to develop resilience and personal strength so they can know their own minds and be in charge of their own destinies.

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