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 Frequently Asked Questions: Myth and Fact.

Myth: There are “serious” and “non-serious” mental disorders.
Fact: All mental disorders are distressing to those who suffer them. The distinction was first raised in the USA for political reasons and adopted in Australia to justify cost-cutting.

Myth: Psychiatrists only prescribe medication.
Fact: Psychiatrists are trained to recognise what will, and will not, respond to medication. Other options are available for various “talking” therapy approaches which can be offered depending on the patient’s circumstances, their condition and their wishes. Sometimes both medication and therapy might be combined for best results.

Myth: Those who seek therapy are not really ill, just bored.
Fact: Research into patient characteristics (for those accessing this mode of treatment) demonstrates their high level of previous trauma (sexual/physical abuse, bereavement etc) , and the frequency with which this group has failed prior attempts at briefer treatments. The term “worried well” is too often used in an uninformed way, often to justify cost-cutting measures rather than best outcomes for troubled people.

Myth: All non-medical therapies are the same.
Fact: Different approaches have differing aims, and require differing training. Cognitive therapy aims to challenge the negative thought patterns that are said to lead to painful feelings. Dynamic Psychotherapy aims to uncover the unconscious roots of distressing symptoms to facilitate a resolution.

Myth: Dynamic Psychotherapy is “just talking” and can be done by anyone.
Fact: Long term intensive therapy, in those patients for whom it is indicated, consists not only in uncovering one’s personal past/history, but more specifically aims to elaborate how the patient unwittingly does things in the present to seemingly recreate the past difficulties - thus perpetuating problems / symptoms. This gives a person more choice about how to deal with problems ie: they can choose to do things differently. It is clearly, a sophisticated and complex treatment that involves intensive training.

Myth: Psychotherapy takes too long and is therefore too expensive.
Fact: Although uncovering deep seated origins of conflict is time consuming, well established research has shown it to be cost-effective as it reduces other medical costs (say from unnecessary visits to other doctors) and increases productivity.

Myth: Psychotherapy is an outmoded form of treatment.
Fact: This form of treatment is widely used, with or without medications, to help people resolve emotional issues. It can be long-term or short-term but is often the decisive factor in promoting a sustained recovery, particularly when other treatments have failed.

Myth: Cognitive therapy cannot be as effective as dynamic therapy.
Fact: The two therapies have different aims and are used in different situations. Cognitive behaviour therapy can be very effective for the early relief of symptoms such as some forms of anxiety and depression; people who have problems where this hasn’t helped can then opt for dynamic psychotherapy if indicated. Other people’s condition may be such that they embark on dynamic psychotherapy from the outset. Different people need different approaches which can be assessed at the time of consultation.

Myth: Current Medicare arrangements preserve people’s access to intensive therapy
Fact: In 1996, Medicare rebates were reduced after an arbitrary limit set by Government in order to reduce expenditure. Although some people who satisfied various criteria could still access intensive therapy, nevertheless the access was not sufficiently intensive for a small group of patients. These people have had to struggle with less than they need, since that time. Access has been preserved up to a point, but at a reduced intensity which can adversely affect outcomes for some.

Myth: Deinstitutionalisation can’t work.
Fact: The idea of trying to integrate psychiatric patients into the community in order to reduce stigma and negative outcomes is worthwhile and valuable. However sufficient resources have arguably not been made available for a proper trial of this policy. In addition, other psychiatric facilities were downsized to cut costs thus compounding the negative consequences of too little funding with not enough backup. It still is true that a properly funded system will provide a range of options for the range of clinical issues encountered in everyday practice.

Myth: Psychiatric patients are always dangerous.
Fact: This is an understandable reaction to media coverage of distressing incidents. The truth seems to point to the problems lying in the area of inadequate follow-up and supervision of ill patients who may be prematurely discharged due to pressure on beds in hospitals. All this in turn is fed by a chronic underfunding and understaffing of the public psychiatric system which leads to the frustrating scenario of “revolving door” admissions. Enquiries have been held in several States to address this problem.

Myth: Long waiting lists for psychiatrists are due to inefficient work practices.
Fact: The problems of chronic underfunding and understaffing of the public psychiatric system, closures of hospitals resulting in bed shortages etc have resulted in an increasing number of people seeking help from private psychiatrists. The system as a whole is thus strained and unable to accommodate the demand, and this is exacerbated by the fact that psychiatric care may in many cases be a time consuming endeavour. Inefficiency is not part of the problem.

Myth: The tragedy of youth suicide is too complex to resolve.
Fact: Early detection of problems, awareness of difficulty, and the availability of help can be critical factors determining outcomes. However a 15 year study on successful intervention on youth suicide, from Western Australia, concluded that when a young person is admitted to accident and emergency departments following self harm behaviours, "…there were gross deficiencies in the kind of care being provided, not adequate assessments being made and the follow up tended to be woeful". The report showed that we can successfully intervene and dramatically reduce the suicide risk if " you actually take the trouble to spend enough time with the person to gain their confidence, take a good history and ensure that whatever treatment is provided is addressing some of their immediate needs. It was particularly important to improve the likelihood of decent follow up." The emphasis here is on being able to spend enough time and having enough expertise; both these factors are increasingly under threat in a strained, cost-cutting political environment.


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© - National Association of Practising Psychiatrists 2004