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Psychopharmacology
Less Medication, More Talk Therapy
The US is lagging way behind other nations in its treatment of the mentally ill.
Posted November 4, 2015
The health care system in the U.S. is broken for all but those with the best health insurance. Like an ostrich with its head in the sand, Americans are delusional to profess we have the best health care system in the world. We do not. It might be true when considering some of our top medical centers, but our nation as a whole lags far behind others in providing timely, effective medical care for the masses.
In the latest release of The Commonwealth Fund's “Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally” the US, despite having the most expensive health care in the world, came in last when compared to 11 other first world countries. Whether you love or hate Obamacare, the biggest negative when comparing our system with these countries is the absence of universal health coverage. We are less likely to seek medical attention, more likely to skip needed tests, less likely to fill prescriptions and more likely to skip doses, all because of the cost.
Not convinced? Consider some basic metrics that determine the health of a nation. According to the Centers for Disease Control, the United States has a higher infant mortality rate than 27 other wealthy countries. During the first year of life, a baby born in the U.S. is two times more likely to die than a Korean baby, and three times more likely than a Japanese baby. Ranked from state to state, we do not look like one of the wealthiest countries in the world, with Mississippi's infant mortality rate ranking below Botswana, a third world country with a GDP per capita that is one third that of the US.
As for life expectancy, the Organization for Economic Cooperation and Development (OECD) ranks the U.S. twenty six out of thirty six wealthy countries with a life expectancy of 78.7. Denmark is 79.9; the U.K. with its widely decried ‘socialized medicine’ is 81, while Switzerland ranked first at 82.8 years.
With all of these problems for health care in general how does behavioral health stack up? The World Health Organization (WHO) rated the incidence of mental health disorders in 27 countries. The US topped the list, followed closely by Ukraine and Colombia. Countries with the lowest rates of mental illness are Japan, China and Israel. In a prior book, Better Than Normal: How What Makes You Different Can Make You Exceptional, I reference an NIMH study that found 26% of Americans had a diagnosable psychiatric illness — one in four! This begs the question: Is this real, or are there other factors in play?
If it’s real then we need to redefine the parameters of what constitutes a mental illness. However, the more likely explanation is that this is a case of over diagnosis run amuck. There are five reasons for this: pharmaceutical profits, pop-a-pill psychiatry, our microwave culture, patients who have no time to “waste” on talk therapy and insurance companies that pay little for therapy. Unfortunately, these factors make the U.S. a nation of the quick fix, where meds are handed out like Halloween candy to anyone with a little anxiety, depression or insomnia.
While the stigma for mental illness as a whole is slowly decreasing, schizophrenia is a disorder that continues to be feared and misunderstood. It's arguably the most stigmatized of any medical disorder. The U.S. has over two million individuals being treated for schizophrenia and the mainstay of treatment are high dose antipsychotic meds to curtail delusions and hallucinations, which means patients are left to suffer with severe, debilitating side effects such as weight gain, drowsiness, emotional numbing and tremors. Make no mistake, these meds work well and quickly, which has contributed to a decrease in psychotherapy when treating schizophrenia while ever newer anti-psychotics are developed and released. But is this the best way to treat the condition?
Finally some good news: A new government-funded study compared much lower doses of antipsychotic medication coupled with one-on-one talk therapy for patients, accompanied with family-focused therapy versus medication alone. Patients who received the combination treatment had fewer suicide attempts and hospitalizations. This study has been ongoing for two years, but the gains in recovery are very promising, especially when you take into consideration that, in general, three-fourths of schizophrenic patients stop taking their meds in less than two years because of the cost.
While this sort of treatment has been routinely used in many other countries, it's fairly new to the U.S. With this new standard of care implemented after the first occurrence of psychosis, researchers are seeing a more robust and a longer lasting response. Schizophrenic patients who had given up on their meds due to severe negative side effects are now finding relief with this new treatment approach, and many are returning to live relatively normal lives.
Dr. Kenneth Duckworth, the director of the National Alliance on Mental Illness, called the findings, "a game-changer for the field." Imagine that, a study which proves the benefits of psychotherapy. Sounds like common sense, so why are we the last country in the world to realize this?
