Book Review
Implications for design in mental health
Dr Robert G MacDonald RIBA, who has a life-long Bipolar disorder, and Mary MacDonald, his carer, review A prescription for psychiatry, Why do we Need a Whole New Approach to Mental Health and Wellbeing? (2014), by Peter Kinderman (published by Pelgrave MacMillan, New York, ISBN 978-1-137-40870-9).
Reviewing this book from a Bipolar perspective, we find that Professor Peter Kinderman’s ‘Prescription for Psychiatry’ presents a refreshing challenge to the psychiatry profession. Peter suggests that traditional mental healthcare is flawed, and is in need of radical remedies. He argues for moving away from the ‘disease model’, and instead embracing psychosocial approaches to a wellbeing model of mental health that recognises all our essential and shared humanity. The author, the Professor of Clinical
Psychology at The University of Liverpool, argues for a complete paradigm change in our thinking. We think it is significant that Peter Kinderman is a sibling of someone with serious mental health problems, and has himself been a personal user of mental health services; he has received NHS psychotherapy from a medical psychiatric psychotherapist for two years. We need to listen to a psychiatrist speaking with such direct experience. This seems to be a rare and valuable combination of academic experience, professionalism, and special personal insight. It is of key relevance to the Design in Mental Health Network, and supports the organisation’s aims, because all the lessons suggest we need to listen to all service-users.
THE NIGHTMARE IN THE MENTAL HOSPITAL Peter relates a story of a nightmare set in a mental hospital. We have actually survived the nightmare. His fear of being detained in secure psychiatric ward is for us real. The first night in the single bedroom is a solitary experience.
‘His prescription questions the professional knowledge of psychiatry, but also has deep questions relevant to all design and environmental professions’
How to escape? Rage or fulminate, only to be overpowered, sedated, and restrained in the ‘clinical seclusion’ suite? Try running? We tried, and filled a hospital sack with possessions, only to be restrained and again placed in a windowless room. Try playing the game of jumping through the hoops of assessment after panel assessment ? Having been ‘sectioned’, and facing a tribunal panel of five professionals; it does help if you have an external ‘spiritual’ guide on your side. For some reason spiritual advice is actually listened to.
ECT The biggest real threat in the real nightmare is ECT (electro-convulsive therapy); it was only with the external intervention of a friendly medical practitioner, on our behalf, that ECT was resisted. Our question to Peter would be: ‘How many patients are still given ECT, without their choice, and what is its ‘success’ rate? It all reminds us of ‘The Madness of King George’, where nobody is listening to the voice of the ‘insane’ King ? At the end of the day, King George was not mad, but physically ill, and all the doctors had so many ‘treatments’ for the ‘test case King’.
ALTERNATIVE PRESCRIPTIONS On the basis of his academic experience and rich insights, what does Peter Kinderman suggest as an alternative prescription? Firstly, the message of mental health and wellbeing must be right. Secondly, we need to lose the language of psychiatric disorder and demystify all the talk of clinical ‘ligatures’. Thirdly, perhaps the most challenging issue is to be careful with medication. This is a real challenge to the pharmacological industry. We need to lose the indignity of queuing for medication, and can we redesign
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the way in which medication is dispensed? In our case, we have been prescribed extensive medication, but without any discussion of process or de-medication. Fourthly, to offer psychosocial services and therapies; how might these therapies be delivered to long-standing patients, and how to wean them off medication? Fifthly, offer
non-medical residential care. In an ideal humanist world care at home should be paramount, because familiar people and surroundings assist recovery; the opposite is the clinical shared ward (they still exist), and all efforts should be towards domestic design ambience and friendly atmosphere.
CLEAR MESSAGES FOR THE NETWORK These are clear messages for the Design in Mental Health Network. Sixthly, there is the need for democratic multidisciplinary design teams of professional colleagues; we would even go as far as to suggest the inclusion of patients’ panels and representatives. Seventh, the mental health and wellbeing services should work alongside other social services. What Peter Kinderman is prescribing is a very major revolution in mental health services and psychiatric practice. His prescription questions the professional knowledge of psychiatry, but
Cover image courtesy of Palgrave Macmillan.
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